Will Custom Infraornbital-Malar Implants Decrease Scleral Show?

Q: Dr. Eppley, Growing up I’ve always had dark circles and deep hollows under my eyes due to hereditary reasons. So around two years ago I tried filler for the first time and unfortunately it created a darker tint. Looking forward, I was hoping to find a more accurate and permanent solution to the issue. I then learned about the orbital rim implants from your page and was fascinated by your work! Reading about the orbital rim implants from your page I appreciate how the implant covers the tear trough deformity and rings simultaneously, which were my main concerns. Also reading, I saw that the results could also be adjustable if any inconvenience which really got me on board. I was initially concerned regarding scleral show, but then read that typically it must be done with a well done canthopexy to maintain and avoid the problem worsening. I attached some photos below and would love to hear back from you soon! I greatly appreciate your time Dr. Eppley. Thank you. 

A: Thank you for your inquiry and sending all of your pictures. You are correct in that custom infraorbital-malar implants are the preferred correction for your undereye concerns. You are also correct in that lower eyelid management is important during the closure. While you did not show a side view picture, it is likely you have a negative orbital vector.

Dr. Barry Eppley

Indianapolis, Indiana