What makes implants (orbital rim/malar) better than fillers for correcting hollows/orbital rim deficiency? (photo)

Rim implants have very specific indications.  They are irreplaceable when skin must be recruited from the cheek to reconstruct the lower eyelid after lower eyelid blepharoplasty complications, post trauma reconstruction, and certain post cancer reconstruction situations.  While the rim implant can be used to increase cheek bone projection, that is not its essential function in these cases.  It's essential function is to create a place to sew the lifted cheek to at the orbital rim which is necessary as a way of bringing cheek skin into the lower eyelid.I do not agree with Dr. Mackenzie that rim implants are needed when there is poor bone projection at the orbital rim.  The hyaluronic acid fillers have proven to be a fantastic alternative to surgery even in these situations.  So unless you really need skin recruited into the lower eyelid, fillers have proven to be a far better alternative to rim implant surgery.

Both implants and fillers are useful to treat the lower eyelid hollows (aka tear troughs).  I usually recommend using fillers first to any interested patient, simply because it is quick, without recovery time, and temporary if patients don't like the end result.  If they like it, and want more, that's when I recommend the implants.  I personally prefer implants simply because the results are much more predictable, long-lasting, and are more "robust" than the fillers.  Plus, the implants still can be removed if there is a problem or a patient changes his/her mind.  Not all surgeons are comfortable with fillers, and the most common mistake is to overfill, so ask your surgeon if they have experience injecting that area- it can be tricky and unforgiving, and requires a cautious approach.

Fat grafting is the best solution because:It is permanent when properly done- unlike temporary fillers The stem cells resident in the fat rejuvenate the overlying skinThe surgeon has more flexibility in distributing the volume where it is needed- unlike implants Check out the web link below for the proper way to process fat so it is permanent and the video below to see how fat grafting improves facial contour. 

Facial rejuvenation through volume changes is one of the most common means around the eyes and cheeks. It used to be that implants were always used. Today I almost never use implants anymore. They are foreign material and have many problems. You can try fillers, but I utilize advanced fat transfer techniques that lasts forever. Facial fat grafting is the key to facial rejuvenation. I would look into this more specifically with an advanced cosmetic surgeon to  see I you are a candidate. Best wishes.

In the past, when fillers weren't available, rim implants were used more often. However, they are much more invasive with various possible side effects. In the age fillers, they have become almost obsolete, except in rare circumstances. That is not you. Fillers are safer and more predictable and reversible. They also tend to last a long time around the eyes.