Orbital Rim Implants
Orbital rim implants placement is usually undertaken as a day case procedure under a general
anaesthetic. A subciliary (below the eyelashes) or transconjunctival (inside the lower eyelid)
incision is made to access the bones of the orbital rim. The decision on which implant to use is
discussed with you at your consultations.
The implants are placed directly onto the bone of the orbital rim and secured with 1-2 small
titanium screws to prevent any movement of the implants following placement. The wound is
closed with very small stitches.
Following surgery you can expect some soreness and some swelling. The initial swelling and
bruising will settle over 10-14 days; however it will take a number of weeks for the swelling to
finally settle and the new appearance to take shape.
Orbital rim implants can be placed for a number of reasons:
- For people who have had underdevelopment of the mid part of the face and an overall flatter appearance to the face.
- For facial rejuvenation; commonly as we get older the tissues of the mid face tend to descend which looses the youthful appearance that we had. A small cheek implant can help restore the fullness of the cheekbones that we had when we were younger.
- For patients who have sustained previous fractures of the eye socket. In these cases if the eye socket bone has not been corrected or even occasionally due to soft tissue changes that can occur following trauma, the orbital rim can appear flat and implants can help to correct the residual facial asymmetry and flattening.
- For patients with congenital asymmetry of the infra-orbital region.
What are orbital rim implants?
Orbital rim implants are usually made from either medical grade silicone , from medpor or from PEEK, all materials have been commonly and successfully used in surgery form many years The implants are designed to fit directly onto orbital rim and are usually preshaped. Custom made implants can be obtained, if wished or considered necessary, although a CT scan of the bony structures is required before these can be constructed.
What are the alternatives to orbital rim implants?
Non-surgical alternatives include the use of facial fillers, which are usually temporary.
Surgical alternatives to cheekbone implants are either:
– On lay bone graft, this requires bone to be harvested from another site (commonly the hip or the skull).
- Fat transfer, where some fat is harvested from another part of the body (usually abdominal wall or thigh) and transferred to the area needing augmentation.
- Lower blepharoplasty with fat repositioning- a technique known as a septal reset, this can improve the appearance of the tear trough but will not be able to provide as much volume as an implant.
How is the procedure performed?
Orbital rim implant placement is usually undertaken as a day case procedure under a general anaesthetic. Access to the orbital rim is either made through an incision under the eyelashes ( a subciliary incision) or via an incision inside the lower eyelid, which isa known as a transconjuctival incision. In both cases the incision has to extend slightly out at the side of the eyelid which will leave a small but well hidden scar. The implants are placed directly onto the bone of the orbital rim and secured with 1-2 small titanium screws to prevent any movement of the implants following placement. The wound is closed with very small stitches.
Following surgery you can expect some soreness and some swelling. The initial swelling and bruising will settle over 10-14 days; however it will take a number of weeks for the swelling to finally settle and the new appearance to take shape.
What the risks and sequlae of surgery?
Initially following the surgery you can expect soreness, bruising, swelling and tightness. This will settle with time.
There will be a small scar beneath the lower eyelashes, this usually heals quickly. There can occasionally be some slight pulling down (ectropian) of the lower eyelid during the initial healing period.
Other complications are unlikely but include, bleeding, infection, facial asymmetry, numbness of the skin of the cheek and upper lip, which is usually temporary but can take a few weeks to fully settle.
Any surgery around the eyelid area carries a very small risk to vision.
Implant infection may mean the implant needs removal. If this occurs then you will need to wait until the tissues have healed before having another one placed.
It may be possible to palpate the edge of the implant under the skin if you have thin skin; however the edges are not likely to be visible.
Post-operative instructions following surgery:
You will be given a short course of oral antibiotics to be taken following the surgery and the course should be completed.
Bruising and swelling is normal and to be expected, the swelling will reach its worst at 3-4 days following the surgery and then gradually settle over the next week. Ice packs can help reduce this.
Sleep on 3-4 pillows at night as this will help reduce the swelling.
I would advise 2 weeks off work following this surgery and you should avoid any strenuous sports for 4-6 weeks. Gentle exercising can be resumed 3-4 weeks after surgery.
You will be seen in clinic for follow up, one week, 8 weeks and 6 months following the surgery.
