Infraorbital implants - What are the choices of incision placement and their associated risks? (Photo)

Hello and thank you for sharing your questions and photo. There is an intra-oral technique that in my experience hides scarring and results in a natural cheek augmentation. Cheek implants are relatively safe treatment and unlike many procedures they are completely reversible and implants can be removed. They are challenging for some patients with asymmetry as considerable care is required to avoid increasing asymmetry. As with all procedures there are some potential risks including increased swelling and longer recovery, infection or allergy. I recommend consulting with a facial cosmetic surgeon specializing in cheek implants for a professional assessment and opinion.

In the one photo provided, it appears that you have excess or herniated orbital fat (bags beneath the eyes) which are treated with a transconjunctival approach to remove this fat. The best approach to address the malar area or cheek is through an intraoral incision. There are many sizes and variations to provide well defined cheekbones. These solid silicone implants can also be customized using a CT scan. They will provide definition as well as lift to the cheek area. The results are permanent yet reversible.

Not sure if you need such implants but if you do, it is best placed using inside eyelid approach. When done correctly, it is scarless and will cause dry eyes. Best to have personal consultation. Based on your photo, lower blepharoplasty with repositioning of the eye fat bags to the hollow area may be another option.

There are many procedures you can do to treat under eye hollows and dark circles. A surgical option to remove skin and/or fat with implant or reposition will be the best long term.  There are many things you can do to treat under eye hollows and dark circles. A surgical option to remove skin and/or fat will be the best long term.  However, non invasive less downtime options such as fillers, lasers, microneedling/PRP, cosmelan peels and stem cells can all help give some improvement. I suggest. You get a formal consultation to see what is best for you and your goals.  Best, Dr. Emer

 Cheek implants are manufactured in a large array of thicknesses, sizes, and shapes which is best determined at the time of the consultation and examination. The cheeks, the maxilla, and the implants are three-dimensional structures, and the augmentation occurs in three dimensions. In our practice, we place solid silicone  Cheek implants through an intraoral approach under a brief general anesthesia. From the one with very limited photograph, it shows that you also have significant bags in the lower lids which should be addressed from  by a lower lid blepharoplasty performed through trans-conjunctival approach. 

The placement of custom infraorbital-malar implants can be placed through either a lower eyelid incision or intramurally. There are advantages and disadvantages with either approach. The incisional choice is really driven by the design and whether the implant needs to saddle the infraorbital rim to any significant degree.