Is there any doctors that specialize tear trough implants in the orbital rim? (photos)

Question

Eye bags and inverted cheekbones surgery question. I'm a 31yo caucasian male with a severe case of ugly face. The profile photo should sun it up. I want to get tear trough (infraorbital or orbital rim) implants. Want to find out which doctors specialise in this surgery, also the different types of implants, custom sculpted etc and how much each cost roughly. Also, should I get a lower bleph? Would prefer an Australian face specialist but can travel o/s if necessary.

Mitesh Kapadia, MD, PhD · Answer

I would consider getting filler injections into your lower eyelids and upper cheeks instead of a tear trough implant. Filler injections are less invasive and more customizable - the injections can be optimized to your unique anatomy. Surgery is a great option in many situations, but I would opt against surgery if there is a non-surgical approach to achieve the same result.

Edmund Fisher, MD · Answer

I agree you would benefit from cheek implants. Although tear trough implants are available, I would not recommend them unless you have already had a previous lower lid blepharoplasty with fat removal. Excellent and often permanent results can be obtained by moving the extra fat causing the bags in your eyes into the tear trough area. This is done by leaving the fat attached to it's blood supply and creating a pocket underneath the lining of the bone in that area. You do need the foundation of good cheekbones to achieve the aesthetic enhancement that you desire.

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

You are right in looking for a
specialist who corrects deficiencies of the orbital rim, but there is more to your situation
regarding the deficiency, as seen in your profile photo.
The deficiency is more than just the orbital rim itself, the entire mid cheek skeleton
is underdeveloped.  The skeleton of the mid cheek is formed by 2 bones. The strong outer cheek bone is the zygoma and the inner cheek bone is the maxilla. Both these bones contribute to the orbital rim, in their respective parts.
Usually the zygoma remains stable over time, but the maxilla begins to shrink in
the ealy twenties and if the bone was not strong originally, this can have a significant effect which can be disconcerting.

If either of your parents or a near relative
has this bone structure it would be an indication that this is hereditary. I
presume your facial appearance was like this in your teen years and hasn’t
changed much between then and now.

For someone who has this type
of bone structure you are most fortunate that your lower eyelids are still
sitting up where they belong. The bone beneath, being deficient, is not
supporting the lower lid and most people with this bone deficiency have sagged
lower lids with the white of the eye visible below the iris. This will happen
over time and is a further reason to correct this situation sooner rather than
later.

You asked a question that
invited some poor responses from some doctors, when asking abut the cost of
different implants.

This is your face and your
identity, so you should be asking what is the best implant to correct this
situation for your lifetime. The least expensive options are not real options for you.
Injection of fillers or fat cannot replace the bone deficiency. These injections just add
to the soft tissue to camouflage the look for a time. So being the least
expensive initially will cost you in the long run.

There is only one permanent
solution and that is bone like implants. This is real surgery as it is a real
problem. Porex implants as developed by Dr Yaremchuk in Boston are the standard
correction; they are synthetic also, but much better over a lifetime than silicone implants. However, I much
prefer to build up the bone using coral implants, which is a natural material made of hydroxyapatite. This is the same mineral  our bone is made of, hydroxyapatite. Like Porex, it is permanent but the reason is that it causes  your own bone to grow into the coral implant. So you end up with
your own bone being of the size and shape determined by the surgeon based on
your wishes. Because the facial muscles and ligaments are positioned as part of
this procedure it looks as if you were born with this appearance. So nobody
can tell you have had surgery and the benefit of good bone structure is that you
look fresh and yet,  importantly, age at a slower rate. Injections cannot achieve
this. Incidentally, the implants are placed through the lower lid, so a lower lid correction is part of the procedure.

Darryl J. Hodgkinson, MD, FACS, FRCSC (retired) · Answer

Your lateral view photograph shows the major problem in cheek bone development accentuating the tear trough.
Injectables give tempoary benefit but consider a permanent solution with a cheek implant which corrects the discrepitancy between the eye and cheek projection.

Is there any doctors that specialize tear trough implants in the orbital rim? (photos)

Answers (4)

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