Supplementary Material for: Delayed Extrusion of Hydroxyapatite Cement Orbital Floor Implant: A Rare Case Report of Augmentation Failure

Hydroxyapatite implants are widely used in orbital reconstruction due to their biocompatibility and capacity for osseointegration. Complications such as implant exposure or extrusion typically occur in the early postoperative period, with late-onset cases being exceedingly rare. This report presents a 78-year-old female who developed hydroxyapatite implant extrusion seven years after orbital volume augmentation for an anophthalmic socket. She presented with lower eyelid retraction, ectropion, redness, and a fistula in the inferior fornix. Surgical management included implant removal, placement of a dermis fat graft from the abdomen to restore orbital volume, and correction of eyelid deformities using a tarsal strip and full-thickness skin graft. Postoperatively, the patient achieved successful resolution of symptoms, restoration of orbital volume, and correction of eyelid position. This case emphasizes the need for long-term surveillance following orbital reconstruction and highlights effective management strategies for rare delayed implant extrusion.