Deficiencies of the lower rim of the eye socket and cheek create a hollowed-out appearance. Some call this a tear-trough deformity although this is not really accurate. A tear trough deformity is a depression between the eye and nose, technically known as the nasojugal fold best cheek implants in Seattle.

Underdevelopment or underprojection of the lower orbital rim and cheek is part of a more global midface issue, with a flatter bone profile across this area. This can be evidenced in a profile photo by dropping a vertical line from the lens of the eyeball downward. If the cheek and orbital rim is behind this line, the bone is deficient.

Correction of combined orbital rim and cheek deficiencies is most predictably done with implants.

There are several types of implants for the orbital rim. Some extend from the orbital rim towards the nose and down into the tear trough, some extend out from the rim to the cheeks, and others connect the orbital rim to the outer corner of the eye. Pre-formed orbital rim implants are currently available in solid silicone as well as polyethylene. (Medpor) Implants can also be hand carved out of a block or sheet of Gore-tex. (PTFE) I do not believe that the material used makes any difference. It is more important to have the right shape implant in good position than anything else.

Orbital rim implants are best placed through a lower eyelid incision directly onto the bone. This is an obvious way to go if the patient needs skin removed from the lower eyelid as well. It is possible to place them through the inside of the eyelid (transconjunctival approach) but this is more difficult. Lifting up the periosteum of the bone is important so that a cuff of tissue can be used to cover a part or all of the implant. Bringing tissue back up over the implant is important to prevent the edges of the implant from being visible. This is particularly important in those people with thin lower eyelid skin, which seems to be most people who have bone deficiencies in this area. I always secure the implant to the bone with small tiny screws so that it will never move. You will always be able to feel where the implant is as there is little tissue between the implant and the skin in the eyelid area. Most importantly, you just don’t want to be able to feel them.