Why Don’t My Custom Midface Implants Look Right?

Q: Dr. Eppley, Hello, i had double jaw surgery and custom mid face implants. Unfortunately im dealing with an issue that despite a sizeable infra-orbital implant – 5mm , i have significant depression and hollowness under the implant. My theory is that the ligaments were cut and the soft tissue/periosteum and fat pad sags below the implant, causing two issues 1) the shadows and sagging appearance and 2) lack of projection from the implant. When i pull my skin and fat up and back, the ogee curve is restored and the implant looks quite nice What do you think? Is this implant sagging from the surgeries? Or is my implant not big enough. I feel the lateral size of the implant is plenty large. Also one side is significantly worse than the other.

A: When you have an adverse aesthetic effect from an implant-related surgery it is always due to the same three potential issues….implant design, implant size and  implant placement. Sometimes it is just one, two or all three. It is never due to anything else. The release of the osteocutaneous ligaments occurs in every facial implant surgery and a necessary component of bone or implant surgery so that is never the culprit.

I would know immediately the cause looking at your implant design and pictures of your face. The orbital area is an unforgiving area for implants due to the thin overlying soft tissues so it is easy to have design flaws, over/under sizing and/or incorrect or asymmetric placement that will be very visible.

Dr. Barry Eppley

World-Renowned Plastic Surgeon