Facial Implants

Benjamin A. Bassichis

19.1 Introduction

Over the past few decades, there has been a paradigm shift in the approach to the treatment of facial aging. This philosophical shift has consisted of a departure from older “subtractive” facial surgery techniques to newer “restorative” techniques and procedures to evoke more beautiful natural-looking results.

Older methods of facial rejuvenation consisted primarily of removing (subtracting) skin and fat and pulling tissues tight. In many instances, this led to a skeletonized and more aged, and operated-upon appearance. We now recognize that it is not only the skin that needs to be addressed to correct the signs of facial aging, but facial soft tissues, including subcutaneous tissue, fat, and facial bones that lose volume and projection over time.

The major architectural promontories of the facial skeleton, including the malar-midface region, nose, and chin, provide the structural foundation for aesthetic facial beauty. The overall harmony of the face is largely determined by the balance, size, shape, and position of these structural fundamentals. A cosmetic surgeon may be able to add facial implants to the facial skeleton to accentuate the areas of the cheekbone or chin. These skeletal augmentations re-drape and tighten the skin of the face as well as reorchestrate the elements of facial balance and proportion for an

B.A. Bassichis

Department of Otolaryngology – Head and Neck Surgery, University of Texas – Southwestern Medical Center,

5323 Harry Hines Boulevard, Dallas, TX 75235, USA and Advanced Facial Plastic Surgery Center,

14755 Preston Road, Suite 110, Dallas, TX 75254, USA e-mail: drbassichis@advancedfacialplastic.com

improved cosmetic result. Depending on an individual’s specific aesthetic requirements, implant procedures can be performed solo or in combination with other facial plastic procedures to provide a more healthy and youthful appearance. Implant placement surgeries are performed with hidden or invisible incisions so there are no visible scars and the results are immediately evident [1].

Proper selection of implants requires a working knowledge of general size, thickness, and material composition of available implant types. Alloplastic facial implants offer the surgeon many advantages over autogenous tissue, including easy availability of material and simplicity of the operative procedure. Care must be taken to select the proper implant characteristics for the desired aesthetic result, as each synthetic material has unique properties. With all implant types and materials, careful surgical technique is essential to minimize the risks of complications [1].

In the past, a variety of substances have been used for soft tissue and bony augmentation, including autogenous elements such as iliac and rib bone grafts and nasal cartilage. Varied alloplastic materials including ivory, acrylic, and precious metals remain solely of historical interest. Advancements in biomaterial science have promoted the use of novel, alloplastic implant materials for facial skeletal augmentation [2]. There are several general features that contribute to the biocompatibility of an implant. An ideal implant is comprised of materials that do not elicit a chronic inflammatory response or foreign body reaction, are non-immunogenic, inert in body fluids, and noncarcinogenic. Implant materials must also be nondegradable, yet malleable, such that the shape and position are sustained over time.

Reprinted with Permission of Springer, Berlin