Can tear trough/infraorbital rim implants be placed through incisions in the hairline?

The placement of tear trough or infraorbital rim implants is a delicate procedure that requires precise access to the area beneath the eyes. The two most common surgical approaches—the transconjunctival (through the lower eyelid) and intraoral (through the upper gum line)—are favored because they provide direct and unobstructed access to the infraorbital rim with minimal disruption to surrounding tissues.
**Why Not Use Incisions in the Hairline by the Temples?**
Using incisions in the hairline near the temples to place infraorbital implants is not practiced for several reasons:
1. **Anatomical Distance and Complexity**: The infraorbital rim is located beneath the eye, while the hairline by the temples is situated laterally and superiorly. Accessing the infraorbital area from the temporal hairline would require navigating through a complex network of facial structures, including muscles, nerves, and blood vessels. This increases the risk of damaging important anatomical features like the facial nerve branches, which control facial expressions.
2. **Limited Direct Access**: The pathways from the temporal region to the infraorbital rim are indirect. Surgeons would have to create extensive tunnels beneath the skin and soft tissues, which can lead to increased swelling, bruising, and a higher risk of postoperative complications such as hematoma or seroma formation.
3. **Visibility and Precision**: The standard approaches allow surgeons to have a clear and magnified view of the surgical field. This visibility is crucial for precise implant placement and for minimizing the risk of asymmetry or malposition. An approach from the hairline would offer limited visibility and control.
4. **Scarring and Healing**: While incisions in the hairline can be hidden, they are not without their own risks. Scalp incisions can lead to noticeable scarring, hair loss around the incision site (alopecia), and prolonged healing times.
5. **Lack of Established Techniques**: Surgical procedures are developed and refined over years of practice and research. The transconjunctival and intraoral approaches have well-established protocols, known complications, and predictable outcomes. There is a lack of clinical evidence supporting the efficacy and safety of placing infraorbital implants through temporal hairline incisions.
**Advantages of Standard Approaches**
- **Transconjunctival Approach**: This method involves making an incision inside the lower eyelid, leaving no visible external scars. It provides direct access to the infraorbital rim and reduces the risk of injuring the lower eyelid support structures, minimizing the chance of eyelid deformities when performed correctly.
- **Intraoral Approach**: An incision inside the upper lip avoids external scarring and provides a direct path to the midface region. While there is a risk of introducing oral bacteria, proper surgical technique and postoperative care significantly mitigate infection risks.
**Minimizing Risks**
Surgeons take several precautions to minimize the risks associated with these incisions:
- **Sterile Technique**: Strict adherence to sterile procedures reduces infection risk, even in the bacteria-rich environment of the mouth.
- **Experienced Surgeons**: Choosing a board-certified surgeon with specialized training in facial procedures decreases the likelihood of complications like eyelid deformities.
- **Postoperative Care**: Following the surgeon's aftercare instructions helps promote healing and reduces the risk of infection and other complications.
While the idea of using incisions hidden in the hairline by the temples might seem advantageous for hiding scars, the anatomical and practical challenges make it an unsuitable approach for infraorbital rim implant placement. The standard surgical techniques are preferred because they offer direct access, better visibility, and have a proven track record of safety and effectiveness. If you're considering this procedure, it's important to consult with a qualified facial plastic or oculoplastic surgeon to discuss the best approach for your specific needs.

The success of implant placement is always best when the surgeon can have good control over the pocket where the implant is placed.
I can’t think of a way plastic surgeon could place an orbital implant through a hairline incision and still maintain control over the dissection.
if there was a better way to do the procedure, we would all be doing it. plastic surgeons think of ways to improve surgery on a daily basis and there are still some pretty big voids that could use improving.By the way, would you be willing to be the first patient to have a hairline approach for placing a midface implant? I know I would not. Problematic outcomes are not simply based on the incision, but also many other aspects of surgery, including patient candidacy.
Best,
Mats Hagstrom MD