Will I Get Cheek Sagging After Removal of Infraorbital-Malar Implants?

Q: Dr. Eppley, Two months ago I had infraorbital rim implants that extended into the mid face/cheek. The augmentation was only about 1.5-2mm for most of the cheek and about 3mm for the under eye area. I’m not happy with them and intend to get them removed. 

Beside for not liking how they look, there are two other issues I have: 

1) my smile looks distorted. The upper lateral areas near my eyes seem pretty expressionless, and my lower cheeks look off from a 45 degree angle (almost like a little ball sticking out) 

2) my midface just feels stiff. Especially the upper area, it just feels like my facial muscles aren’t as soft/versatile as before. 

So my questions are: 

1) are my above concerns valid? Essentially, have you ever seen them? 

2) after getting the implants removed, will my smile return to the way it was before? 

3) is it possible for there to be cheek sagging even with the implants in place? The logic in thinking is because the soft tissue is separated from the bone, perhaps it doesn’t always reattach properly even when the implants are there? Especially because silicone implants are slippery and maybe the soft tissue won’t adhere to them the same way it adheres to bone? 

4) considering I’m in my mid twenties and only had around 2 mm of augmentation of the implants will only be in place a few months before removal, would you anticipate I will avoid complications associated with implant removal? 

A: In answer to your infraorbital-malar implant postoperative questions:

1) Cheek implants are well known to cause the temporary midface stiffness and smile distortions that you have described when put in through the mouth. Infraorbital-malar implants placed through lower eyelid incisions, however, do not in my extensive experience.

2) If the implants are the cause of the smile distortion then removing them, presumably, would be the solution.

3) The elevated cheek soft tissues never reattach as they can’t to a smooth surfaced implant. They are merely held there by the implant’s volumetric displacement. This is the concept of ‘soft tissue float’ in implants.

4) Regardless of the thickness of augmentation the detachment of the soft tissues and the implant’s footprint are the same. You are hoping that a thinner implant has a lower risk of cheek sagging after removal than a thicker one….which is a hope that does not have a sound biologic basis.

Dr. Barry Eppley

Indianapolis, Indiana