Which Would Be Better in my Under-eye Hollow Situation: Orbital Rim Implants or a Fat Transfer? (photo)

Thank you for your photo but they do not provide enough info to help direct your decision. The transition of the eyelid to the whole cheek is important.  I would usually consider an orbital implant for someone who has has a negative vector (eye is more prominent than cheek/lid junction). Seek an opinion from a surgeon with experience in periorbital aesthetics.

Dr. ES

From your photos (an exam would also be required) you would be a good candidate for either fat transfer or an implant. A full discussion re: pros and cons of each would take place at your exam with your plastic surgeon.

Yes, well done orbital rim-suborbital cheek implants will resolve this issue forever, and in my opinion will be a good investment because of how much this feature bothers you and because you like the result with Radiesse, which is a good trial.  The only question is timing:  It may be worth allowing the Radiesse to dissipate before implant placement, OR perhaps the surgeon can irrigate it out or remove it at the time of implant placement to avoid an additive volumetric augmentation of the area if you have the surgery sooner than Radiesse resorbs.  My preference is for the Flowers suborbital silicone devices (Implantech) but porous polyethylene also works very well.

You are very attractive even with the under eye hollows.  So this raises the natural question of if you are suffering from body dysmorphic disorder (BDD).  This is a thought disorder where individuals focus on slight physical flaws.  There are social consequences of this persistent attention focus including spending many hours a day focused on the issue, avoiding social circumstances due to feels that others are staring at the feature or talking about the problem.  BDD is not treated with surgery or fillers even though you have an issue.  Psychotherapy is needed to provide insight into the thought disorder.  If you are not sure if you might have BDD tendencies, an assessment by a mental health professional is appropriate.  If you have BDD, what we have learned is that there is often a miscommunicaiton between the individual with BDD and the cosmetic surgeon which is often the cause of even more problems after a treatment or surgery.

Thank you for the question and is encouraging to hear that you've had positive results with the Radiesse injections in this area. While autologous fat transfer injections is a good option, I would encourage you to look into Artefill injections in this area. This is an advanced injection technique and you would need it advanced injector to perform this for you.

My favorite procedure to correct the lid-cheek junction is the midface lift which is performed through the lower eyelid blepharoplasty incision. None of the complications or risks of implants or fat grafts. You can see some results on my website BeautifulEyes.com as well as here on Real Self.

Both will work for you so you will be dealing with the preferences of your surgeon.  I personally prefer fat over any implant since its natural and risks are minimal and everyone has plenty of fat to provide for grafting.  Yes, it may need to be repeated and it could leave lumpiness but I prefer natural over artificial whenever possible.

The debate you are having is a classic one for undereye hollows. Fat injections are certainly easier with less risk but no one knows how much would really stay. Often a second round of fat injections may be needed. It is very positive that you have had a positive result from filler injections and you can see it is just a volume issue. Orbital rim implants are permanent, cost more and they can be placed either through a lower eyelid incision or an intraoral approach. Either method has distinct advantages and disadvantages. It is simply a matter of whether you want to risk needing two fat injection treatments or a bigger surgery to put in implants.

Fat grafting a better option than the siliastic implants in my opinion. But seek a few more IN PERSON consults. 

I would expect that you are in your 30's.

Based on a photo and not an examination, I would suggest leaning towards fat transfer. I have used implants since 1984 and Fat Transfer since 1986, I have found fat transfer performed properly with periumbilical fat to have exceptional long range results in the tear troughs. Implants work well when there is not much asymmetry but remember implants will look different as you age especially in the mid-face and periorbital area. Fat will also lighten the dark area. I generally do not use Radiesse™ in this area.

R W Maloney MD