Thank you for your question.
You state in your question that ever since you had malar implants removed that the overall
shape of your eyes are different.
You just describe in detail the difference between the two and you provide a photo to
support this.
So certainly I can give you some guidance as to what your concerns are and this is of
course in the absence of a physical examination.
I’m a board certified cosmetic surgeon and fellowship trained oculofacial plastic and
reconstructive surgeon.
I’ve been in practice in Manhattan and Long Island for over 20 years.
Facial implants and cosmetic eyelid surgery is a very significant part of what I do.
I do a lot of work in volume augmentation these days thanks to new fillers and actually
a lot of options but to give you an idea of what I suspect you experience pre and post
the malar placement.
First of all, malar implants or sub-malar implants, depending on the type or combined
implants are basically placed through the mouth inside on top of the bone, the zygoma,
the zygomatic arch or the malar eminence that fills the space.
Now a lot of times, when I see patients who come for consultations and concerns about
their outcomes, they will have implants that may have caused the eyelid to pull a little
bit and sometimes they ask me to remove those implants.
When I do these procedures on my own patients, I tend to be more conservative.
I tend to put smaller to medium sized implants.
Now that being said, there is some potential shifting of tissue that may change of course
after the procedure of explantation removal is performed.
I noticed in the photo that there appears to be a slight bruise under your left eye
so I think probably, it is reasonable for me to conclude that you had this procedure
done relatively recently.
If it is unrelated well that’s fine.
That’s also potentially relevant later on.
However, if your procedure was done with the implants placed through the lower eyelids,
well then that has a different implication in terms of the disruption of the tissue around
the eye.
When the procedure placed where the implant is placed transconjunctivaly, well then that
means more eyelid tissue was disrupted which means scar tissue can be behaving in a slightly
different way.
Now understanding all of this, it is generally recommended not do anything if the procedure
of removal has been done relatively recently.
To understand the wound healing process, then you understand that there is swelling and
bruising as well as continuous remodeling that’s going on that can affect the position
of the lower eyelids.
That being said, seeing your doctor and having them examine your eyelids and look at the
relative position and if it is the same the doctor putting the implants, you can look
at your pre-operative photos.
A lot of times and it has been an observation and it is just normal human nature, you may
not realize that the eyes were somewhat asymmetric before the procedure.
And now that you had a procedure or 2 procedures, you are now looking at your eyes much more
critically.
Now of course there is a certain allowable natural asymmetry in the face but certainly
once everything is settled, you can probably explore options to surgically balance the
eyes more favorably but I would caution you from additional surgery until things have
settled down.
It is very important not to operate early and also look at the context how obvious something
is.
When I look at your photos, certainly I understand what you are describing but at the same time
it is not significantly glaring type of asymmetry.
Now that of course, you probably disagree because these are your eyes and you know your
face.
I think go back to the original doctor who performed the removal of the implants and
ask what can be done to help with this asymmetry.
Sometimes it’s just massaging and stretching the eyelids or doing things to help to the
affect the remodeling process during the wound healing phases when the body is undergoing
tissue remodeling.
So I think that you have options.
I think that you should discuss this with your doctor to understand.
No one understands the anatomy more than the doctor who performed the procedure.
If there is a concern about your confidence then of course meet with another doctor.
From my perspective, a specialist such as an oculofacial plastic and reconstructive
surgeon will probably be relevant because this is a very specific specialized area of
eyelid position.
So I hope that was helpful, I wish you the best of luck and thank you for your question!