The Custom Facial Implants I Designed for Her...Then Refused to Build!

When this patient came to see me about her under-eye bags, the fix was simple: a lower eyelid fat transposition. But when I went back to review her CBCT scan afterward, I found something she never asked about, a subtle flatness in her infraorbital rim and paranasal region, and a mild deficiency in chin projection. In this video I walk through exactly what I saw on her facial skeleton, the custom midface implant design I call a "boomerang" that would rebuild that shelf, the conservative chin implant that would balance her profile, and why I designed both, and then deleted the plan. This is a case study in reading the bone underneath the face, and in knowing the difference between a finding on a scan and a real complaint from a patient. If you've ever wondered whether your under-eye bags are really a fat problem or a skeletal one, or how to tell whether a surgeon is restoring you or selling you, this one's for you. Dr. Jonathan Zelken is a board-certified plastic surgeon in Newport Beach, California, specializing in custom facial implants, facelift, and blepharoplasty. Learn more at zelkenmd.com. Timestamps: 00:00 Introduction: the implants she didn't need 00:32 Meet Dr. Zelken: reading the bone under the face 01:01 The patient's complaint: under-eye bags 01:15 The procedure: lower eyelid fat transposition 01:39 Reviewing the CBCT scan afterward 02:16 The real cause: a skeletal deficiency, not the fat 02:44 What a skeletal fix would look like 03:19 Why a standard cheek implant would be wrong here 03:43 The "boomerang" custom midface implant design 04:23 The second finding: a mild chin deficiency 05:07 Two designs, and the decision not to build either 05:38 Findings vs. complaints: why I won't operate on this 06:09 The real judgment call in plastic surgery 06:55 How to tell if a surgeon is restoring you or selling you 07:19 Closing thoughts I can’t believe a plastic surgeon can do this! 📍 Dr. Jonathan Zelken MD 📍 1617 Westcliff Drive, Newport Beach, CA 92660 📞 (949) 432-4730 🌍 https://www.zelkeninstitute.com/