I have tear trough deformity and negative vector orbit genetically. I want a permanent solution to this problem (Photo)

Question

Have had filler before but because of how deep the tear troughs are it made it even worse. I am looking for a person that specialises in sub-malar, malar, infra-orbital rim implants and not just a Doctor that has cheek implants in their repertoire. I feel tired a lot of the time and my eyes do feel heavier because of the hollows. I constantly look tired irrespective of diet, sleep, etc and want a change. I want something that is completely natural looking.

Bryan Mendelson, MD, FRACS, FACS (retired) · Answer

This is an entirely reasonable and logical request, to want a permanent correction of the 'negative vector' mid cheek configuration, but achieving this is not so simple.  I will explain this term 'negative vector' which is a term used by plastic surgeons to explain the difficulty to their patients. People who are not so affected will most likely not have heard this referred to, yet this 'vector' is most significant in facial appearance.
  
 The vector is 'shorthand' to describe the position of the cheek relative to the front of their eye. Most people have a positive vector, meaning their cheek projects further forward than the front of their eyeball, which is the usual attractive configuration. It results from having a strong bony skeleton at the top of the cheek. The skeleton not only provides support for the lower lid above, but also being strong bone, it is the framework for the attachment for the muscles and ligaments of the cheek structures below the orbit. The orbit is the cavity in the bone that contains the eyeball (called the globe) and its related structures. People with a positive vector (indicating that the cheek is forward of the globe) inherently appear healthier and also more attractive, especially those with a strong positive vector. This is why the size of the cheekbones is so important. People who have the opposite configuration of their lid- cheek, a negative vector inherently lack good bone support of the lower lid and cheek.
  The reason fillers, and fat injections also for that matter, don't work in this situation is because by their nature they are soft tissue fillers, a soft gel and not bone which the missing tissue, and which is solid and capable of providing support, Fillers are for the  short term  also and need to be redone For a minimal negative vector soft tissue fillers may benefit, but adding soft tissue where bone is missing is not a solution.A bone substitute material is required and these are called implants. Implants, in contrast to soft tissue fillers have a defined shape and are permanent. 
The usual implants are laid over the outer cheekbone called the zygoma to add attractiveness and they have a marvellous effect, but they are intended for a different purpose, which is to enhance the oblique projection, not specifically the front,. Different implants are required to correct the deficient orbital rim and below, When implants are placed, all the overlying soft tissues are elevated off the bone surface to the desired position, as one block of soft tissue, containing all the muscles, ligaments, fatty tissue and their related vessels and nerves Then the implant is placed between the soft tissue and the bone as an onlay over the bone to maintain the position of the soft tissues in the new, forward location. As the soft tissues are elevate off the bone they also rotate up to a degree, taking the drag off the upper cheek and the lower lid.
What are these implants made of? Traditionally solid silicone, but in recent years porous polyethylene, called Medpor implants have become more widely used beause they  allow integration with the tissues, overcoming a limitation of silicone, which does not integrate. Then there is my preferred implant material, hydroxyapatite. This is the name of the mineral of bone. It can be made synthetically, but is best in its natural form, derived from coral as the coral used has the same crystalline structure as facial bone.. The body accepts this pure mineral and over time the persons own bone grows in to form their own bone implant replacement for the deficiency. There are no long term risks from the biology of the material.
The surface of the deficient bone being augmented is not smooth and it varies in shape from person to person and in the same person over time. Preformed solid implants, silicone and Medpor, cannot fit the bone surface contour precisely, as does the coral hydroxyapatite. The coral comes as granules that are mixed with the patient's blood to provides the medium to carry the granules onto the bone surface. Then as the blood clots, which it does outside the vessels, the granules are kept in position in the clot, interlocked with each other. The surgeon builds the size and shape of the implant on the bone by adding as much of the mixture as required. The clot immediately fixes the new implant in position, following which the patients own fibrous tissue and vessels grow into the clot. By 2 years the patient's bone is replacing the fibrous tissue.
  People who have a real negative vector suffer premature sag of the cheeks due to the lack of support, and so at the time of correction they require a mid cheek lift to correct the premature aging and to now look youthful and refreshed.
I recommend you have a subperiosteal mid cheek lift with hydroxyapatite augmentation of the mid cheek skeleton to permanently correct this situation. Then with the soft tissues reattached to the improved skeleton, you will have the benefit of agendas if you were born with these cheek bones.Unfortunately for you there are very few surgeons who have the expertise in using the hydroxyapatite coral.

I have tear trough deformity and negative vector orbit genetically. I want a permanent solution to this problem (Photo)

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I have tear trough deformity and negative vector orbit genetically. I want a permanent solution to this problem (Photo)

Answers (1)

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Recommended reading

Everything you need to know about Eyelid Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.