Hydroxyapatite for bony midface/infraorbital rim augmentation? Infection likelihood less than implants? (photos)

Radiesse is not the filler of choice for lower lids.  It is a biostimulating injectable, and new collagen will be formed around it.  However, nodules can sometimes form and with very thin eyelid skin may be visible.  They would then have to be surgically removed.  A better option is to try an HA filler as these can be dissolved.  Implants are another option. 

If you are looking to add projection to just the under eye area, I would not recommend using hydroxyapatite.  The under eye area has very thin skin, and in my opinion, softer fillers such as Restylane work better there.  If you are looking to add volume to the mid face (cheek), then hydroxyapatite could be used in that area.  Implants do provide a potentially permanent change and infection is a possibility but is not common.  I would say the chance of infection would be even less with injectable fillers than with implants.  

To provide clarifications about hydroxyapatite, whether it is in the form of granules or cements, it does not turn into bone. Bone may bond directly to its surface but it is still a synthetic material which can not become bone. As a synthetic material it is also not free of the risk of infection albeit very low. But the major problem with these materials is that they have to be intraoperatively shaped with a high risk of irregularities of which the thin eyelid and infraorbital tissues are going to allow any such irregularities to be felt for sure and may even be seen. Thus while hydroxyapatite has understandable biologic appeal it is a poor contouring material in the face due to difficulties in applying it in a smooth and even fashion through limited access incisions. Revision rates and dissatisfaction with this material for facial augmentation is not low and revisions of it can be difficult. The reality is that custom designed infraorbital implants give one the best chance for a smooth result that provides the best augmentation results with low rates of complications. Designing the implants to be placed before surgery using the patient's 3D CT scan provides the best fit as well as a thoughtful approach to what may best suit the patient's aesthetic needs.