Is It Possible to Get Both Infraorbital Rim Implants And Malar Implants?

Question

Surgeons have told me that I have a deficiency under my eyes. One surgeon recommended infraorbital rim implants. Another suggested malar/submalar combined implants (instead of the infraorbitals) to enhance the infraorbital plus my cheeks, which he said were flat. Can I get the malar implants and then, if still necessary, the infraorbital implants? (or the infraorbitals first and then malars) Is this a good idea? Can the infraorbital implants be added without altering the existing malar implants?

Kenneth D. Steinsapir, MD · Answer

In my opinion, malar and submalar implants can exaggerate under eye hollows.  On their own, submalars are less prone to this because the put volume very low on the cheek.  I think there are very few situations where this type of implant is helpful.  It can make the face look older in my opinion because lower center of gravity for the cheek is associated with an aging face.  The rim implant is also only helpful in very limited situations and it's placement can be associated with a lot of collateral eyelid damage.  

Can an orbital rim implant be placed after the fact.  I find that because the cheek implants have incorrect volumized the face, patient who have had this surgery come to me to have the cheek implant removed and have the midface more anatomically reconstructed.

Mehryar (Ray) Taban, MD, FACS · Answer

Infraorbital rim implants can help with all the issues you describe, either directly or indirectly, with possible adjunctive procedures. There are limitations to its effect. It is designed for patients with under eye bony deficiency, not just soft tissue hollowness. The technique of placement of implant and type of implant are critical too. It is best placed using transconjunctival (inside eyelid) approach. Solid silicone implant is safest. Depending on the size and position of the implant, it can also add volume to the cheeks if desired.

Aaron Stone, MD · Answer

I personally do not see the need for an infraorbital rim implant in cosmetic surgery. The malar implants suffice in the treatment of a negative vector (see the referenced webpage). Injectable fillers and fat grafts in my experience do so well for the tear trough and rim that I cannot see why anyone would subject themselves to an implant there.

	I prefer plain malar implants to malar implants with a submalar component. I find the submalar components do not look natural although some patients like that look. In my opinion deep fat grafts (deep to the SMAS layer) and deep sculptra injections look much more natural. Part of that may be the way they move with facial expression as opposed to submalar implants which do not move. If you do it that way it does not matter which you do first (malar implant vs. fat or injection) as one does not preclude the other.

	I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

	My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Is It Possible to Get Both Infraorbital Rim Implants And Malar Implants?

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Is It Possible to Get Both Infraorbital Rim Implants And Malar Implants?

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