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

 How do the results compare?

Doctor Answers 13

Malar Implants

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Although fillers are alternative to implants, they are temporary and repeated injections are needed. They are obviously promoted by those who do not perform implants and are not facial plastic surgeons. Malar implants are the most obvious choice in patients who have hypoplasia of facial bones and are looking for a more permanent solution. 


Orange County Facial Plastic Surgeon

Fillers versus implants for orbital rim and malar volume

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In general, if you have a significant deficiency of bone in your cheeks or orbital rim, it's best to treat it with implants.  This replaces bone with material that better mimics the bone (it's relatively hard, and placed onto the bone).  Fillers are (obviously) soft, and add to the soft tissue volume.  This better mimics a situation where the soft tissue is the culprit, not the bone.  Does this make sense?

Cheek implants vs fillers for tear troughs (hollows)

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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.

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Eye hollow

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huijonglee, Try fillers before implants to make sure you like what you see. Implants are permanent (although silicone implants are easy to remove), not a bad idea to try a temporary fix before signing up for a permanent one. For hollow eyes I use a "SOOF lift blepharoplasty" which works extremely well. See my web site for further information. Good luck!!!

M. Sean Freeman, MD
Charlotte Facial Plastic Surgeon
4.7 out of 5 stars 52 reviews

Malar Hypoplasia

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Implants are a permanent correction of an anatomical problem. Fillers are a temporary camouflaging of the finding.  Fat transfer is a more long lasting camouflage technique.  All are acceptable treatments. Best wishes.

Orbital rim implants vs fillers

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Off the shelf fillers (e.g. Juvederm), fat transplants and permanent implants are all accepted treatment.
Orbital rim implants give an excellent and permanent result - but surgery costs more at one time compared to fillers and there can be complications.
Fat injections have predictable results in some surgeon's hands, but can resorb in 3 months - and need to be redone.
Filler injections give about 1 year of improvement and are done in the office. In time they cost much more than surgery. They can cause blue discoloration in the skin and permanent lumps (granulomas) that need surgical excision.

All are reasonable choices. 

Fat grafting best for correcting hollows/orbital rim deficiency.

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Fat grafting is the best solution because:
  1. It is permanent when properly done- unlike temporary fillers 
  2. The stem cells resident in the fat rejuvenate the overlying skin
  3. The 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. 

Fat transfer

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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.

Filler vs orbital rim implant

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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.

Rim implants are not better than fillers!

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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.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.