Why Do I Have Peristent Fullness Of My Midface After Cheek Implant Removals?

Q: Dr. Eppley, I have read many of your online responses and would greatly appreciate your opinion on my situation. Four months ago, I underwent placement of malar/infraorbital implants via an intraoral approach. The implants were removed two months later, also through the intraoral route, meaning they were in place for approximately two months. Since their removal, I have noticed persistent fullness in the midface, along with a change in my upper lip appearance. Specifically, my upper lip now appears narrower, and the corners seem less everted (more tucked in) compared to my pre-operative state.

I am trying to understand the most likely cause of this change. From my perspective, possible explanations may include:

– Residual swelling or soft tissue edema in the midface

– Lack of soft tissue re-adherence to the underlying bone

– Scar tissue formation from the intraoral dissection

– Possible descent or altered positioning of the midface soft tissue

Do these types of upper lip changes typically resolve over time as the tissues settle and reattach, or can they become permanent?

If this does not improve, what treatment options would be available to restore the original upper lip appearance?

Thank you very much for your time and insight.

A:You have already provided the explanation for the residual effect that you have and could be precisely predicted when using the intraoral approach for the placement of such mid face implants.

One of your explanations, possible descent or altered positioning of the midface soft tissue, is exactly the reason why. When you enter the mouth to reach the undereye cheek  areas you have to detach all of the soft tissues including muscle attachments along the way. Then when the implants are removed all of these soft tissue attachments do not return from whence they were and by gravity end up more inferiorly positioned (fallen). This is exactly what happens with any type of midface degloving. This speaks to why I don’t use the intraoral approach for such midface implants as this is going to be a sequelae, even if you didn’t remove the implants, from that surgical approach. This does not occur when you use a more direct lower eyelid approach.

This is not a solvable or an improvable midface soft tissue problem.

Dr. Barry Eppley