Will Cheek Implants Pull Down On My Lower Eyelids?
Q: I would like to ask you some questions concerning cheek implants. I am a 23 years old male, my eyes have an outer tilt to them, there is no scleral show between the iris and the margin of the lower eyelid, my eyes are rather slightly deep set and i have already high lateral cheek bones. Although my cheek bones are already high, they are not very well defined and for this reason I want to get them bigger and to get a more dramatic and contoured look. I managed to get me samples of all cheek implant designs from Porex Surgical. I think the implant, that would provide the look, that i am desiring, could be the Extended Malar Shapes with a 5 mm augmentation that is shown in the picture. Recently I heard that such an implant that is placed near the infraorbital rim could pull down the lower eyelids. I like the shape of my eyes and if there is any risk of lower eyelid distortion downwards, I would rather go without these cheek implants. What is your opinion on this? Do you think there is any risk of lower eyelid distortion downwards with these kind of implants? Have you noticed such changes on the lower eyelid with this high and lateral cheek implants, yet? Thank you in advance for your reply.
A: The simple answer is no. The longer detailed answer is that there is no chance of any lower lid effects when placed through the mouth as the implant actually pushes up on the lid. There is a chance of lower eyelid ectropion if a cheek implant is placed through a lower eyelid approach however. This is a function of the incisional approach and how it is closed, not because of the position of the cheek implant.
In addition, the size of the cheek implant you have shown is way too big and positioned too far back on the zygomatic arch. One can do anything on a skull model as there is no soft tissue to go through and there is no appreciation of how it will look from outside later. I find that many of Porex’s midface implants are designed too big. There is a big difference between designing them on a skull model and actually putting them in and using them in real patients. The other issue is that small augmentations in the midface and cheek area can look more dramatic than you would think by just looking at the skull model. A little goes a long way in the cheek area. Oversized cheek implants is a common complication that I see from this type of facial implant and is due to this effect.
Dr. Barry Eppley