Genetic sunken eyes - Would I be a good candidate for infraorbital rim implants? (photos)

Question

I am a 30 year old Caucasian female who is approx. 5'2" and 115 lbs. I unfortunately have genetic sunken eyes, that are deep set, with very little fat under my eyes and thin skin, reveling my under eye veins as dark blue circles. I have misgivings about using filler and fat grafts seem to also be questionable. Would I be a good candidate for standard infraorbital rim implants or should I consider custom implants?

Kenneth D. Steinsapir, MD · Answer

I see 3-4 new consultations each week for individuals who were talked into grafted fat for the lower eyelid. It does not matter if you had nano, micro, or plain-old fat grafting, these grafts causing scaring, lumps, and disfigurement. If you gain weight, the grafted fat gains weight and these is no simply means of removing the grafted fat when it causes an issue.  Sadly, the orbital rim implant is also not a great option. The surgery required to place the rim implant causes harm to the lower eyelid. Yes, this can fill the orbital rim hollow. However, these are placed through skin incisions and damage the lower eyelid contour. I use orbital rim implants when I reconstruct these damaged lower eyelids, but after harm has been done to them. Do not put yourself in this situation. Orbital rim implants is not an established cosmetic surgery and are seldom performed  because of the complications they cause. There are surgeons who favor this implant as a primary surgical option-it is not a great option and I don't recommend this. On the other hand, under eye filler with Restylane is a very popular and successful option. The downside is that it lasts about a year before the service needs to be topped off. The service is very fussy so that you need to find a very skilled injector and we are rare.

John Michael Thomassen, MD · Answer

Part of the issue is herniated fat pads that add to the appearance of a trough.  I would recommend a lower lid blepharoplasty to remove that fat pad and fat grafting along the trough to correct this.

Mehryar (Ray) Taban, MD, FACS · Answer

Based on your photos, I believe you are better candidate for scarless lower blepharoplasty with repositioning (not removal) of the eye fat bags to the surrounding hollow area. But there are different options. Best to have more detailed evaluation and discussion to determine.

Robert T. Buchanan, MD (retired) · Answer

You have a space below the orbital rim above the muscle attachment to the bone. An implant would need to be custom made, preferably using a template off an MRI or CT. I believe a better alternative is use of a filler by an expert in the area. A heavy filler like Juvederm Voluma needs to be placed under the orbital ligament on the bone above the attachment of the muscle. Unfortunately too many injectors use a thinner filler more superficially. Research your injector carefully.

Genetic sunken eyes - Would I be a good candidate for infraorbital rim implants? (photos)

Answers (4)

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