Facial Implants

Excerpt

Facial implants enhance the aesthetics of the aging or underdeveloped face and can correct asymmetry secondary to trauma or congenital malformations. The areas where facial implants are commonly used for enhancement include the chin, zygomas, and mandibular angles. The 2020 American Society of Plastic Surgeons member survey revealed that malar implant surgery was the most commonly performed facial implant surgery and the 3rd most frequently performed cosmetic surgical procedure. The treatment's popularity has increased by 938% since 2000. Chin implants also increased by 63% in the same time frame. Facial implants may be used on other bony surfaces, like the nose, glabella, and temple, though less commonly.

The ideal implant is chemically inert, biocompatible, and easy to manipulate. However, implants are foreign bodies that come with a host of risks. Facial implants can be organic or synthetic. Synthetic facial implant materials used within the United States are numerous, but the most commonly used presently are polyethylene, silicone, and titanium. Autogenic grafts, once common, have fallen out of favor due to long-term unpredictability.

One of the most common facial implant complications is poor cosmesis, often due to asymmetry. Rare but severe complications include infection and bone erosion. Fortunately, providers can remove implants if these conditions arise. The implants that allow soft tissue ingrowth are more challenging to remove than solid implants that form a fibrous capsule.

Software-aided comprehensive analysis helps determine the proper surgical treatment for a patient's facial defect. Facial analysis is still evolving with technological advancements, including three-dimensional (3D) treatment planning. Bony relations are easily compared in two-dimensional (2D) images and are used to help determine their soft tissue counterpart. For instance, the lateral cephalogram is the foundation for genioplasty evaluation. Midface deficiency evaluation is challenging with 2D radiographs and may improve with further studies.

Multiple criteria have been developed to help providers make objective-based decisions. Additionally, the ebb and flow of society's fads must be considered. Clinical success depends upon diagnostic accuracy, appropriate facial analysis, correct implant selection, and good surgical technique.