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2015v1.0
SECOND EDITION
Atlas of
FACIAL IMPLANTS
LEAD EDITOR
Michael J. Yaremchuk, MD
Clinical Professor of Surgery
Harvard Medical School
Chief of Craniofacial Surgery
Massachusetts General Hospital
Boston, MA, USA
ASSOCIATE EDITORS
Catherine S. Chang, MD
Beverley Hills, CA
Former Fellow, Adult Reconstructive & Aesthetic
Craniomaxillofacial Surgery
Division of Plastic & Reconstructive Surgery
Massachusetts General Hospital
Boston, MA, USA
Erez Dayan, MD
Reno, Nevada
Former Chief Resident
Harvard Plastic Surgery
Boston, MA, USA
Mohamed Amir Mrad, MD, FRCSC, MBA,
FACS
King Faisal Specialist Hospital and Research Centre
Department of Surgery
Plastic Surgery Section
Riyadh, Saudi Arabia
Alan Yan, MD
Fellow, Chang Gung Memorial Hospital, Taiwan
Former Fellow, Adult Reconstructive & Aesthetic
Craniomaxillofacial Surgery
Division of Plastic & Reconstructive Surgery
Massachusetts General Hospital
Boston, MA, USA
For additional online content visit ExpertConsult.com
© 2020, Elsevier Inc. All rights reserved.
First edition 2007
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(other than as may be noted herein).
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ISBN: 978-0-323-62476-3
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Last digit is the print number: 9 8 7 6 5 4 3 2 1
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Preface
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This atlas presents the use of alloplastic implants utilized for aesthetic and reconstructive applications of the
craniofacial skeleton. In the decade since I wrote the first
edition of the Atlas of Facial Implants much has transpired
in related technology, clinical applications and implant
design. For example, Computer Aided Design (CAD)/
Computer Aided Manufacture (CAM) of implants is
rapidly evolving not only for cranial reconstruction, but
also for aesthetic applications. Cranial implants are now
designed not only for protective or aesthetic indications,
but also with functional components (implantable neurotechnology - e.g. pressure monitoring, drug delivery…).
Recent studies have shown that critical areas of the
facial skeleton resorb with aging and hence, facial implants
have shown to be an important adjunct in rejuvenative
aesthetic surgery. Implants now have an accepted role in
refining orthognathic surgical procedures and surgically
treating Graves’ ophthalmopathy. These innovations are
included in this second edition.
In addition, the 10-year clinical experience has afforded
many new insights into this surgery providing improved
results and avoiding as well as treating complications.
This edition includes chapters arranged in five sections.
As before, the first section, Background, includes chapters
addressing implant fundamentals. It is followed by sections addressing implant applications for each anatomic
facial third - Upper, Middle and Lower Face. A fifth section, Developing Applications, now includes chapters
addressing implant use in facial rejuvenation, CAD/CAM
aesthetic surgery and postorthognathic surgery refinement. Videos of the implant procedure appropriate to each
anatomic area are now included.
vii
to
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MARILYNN
and KAIT
as well as
CHARLES and DEUCE (CHARLES II)
Chapter 1
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Indications for facial implants
The shape of the human face is composed of a skeletal bony framework that is covered
by a soft tissue envelope. Overall, skeletal proportions are probably the most important
component of facial attractiveness.
Fritz E. Barton Jr., 2009
Since the skeletal infrastructure of the human face is
fundamental to its appearance, its surgical change can
be powerful. Conceptually, autogenous bone would be
the best material to restore or augment the craniofacial
skeleton because it has the potential to be vascularized
and, then, incorporated into the facial skeleton. In time,
it can be biologically indistinguishable from the adjacent
native skeleton. Practically, the use of autogenous bone
to augment facial skeletal contours is limited. Donor
site morbidity as well as the time and operative costs
associated with autogenous bone graft harvest can be
significant. Furthermore, the inevitable resorption and
the poor handling characteristics of autogenous bone
grafts limit the quality and predictability of the aesthetic
result. With the exception of interposition grafts used to
reconstruct segmental load-bearing defects of the maxilla and mandible, the majority of craniofacial skeleton
replacements and, particularly, facial skeleton augmentation is done with alloplastic implants. A diagrammatic
survey of the alloplastic implants used for facial skeletal
reconstruction and enhancement is presented in Fig. 1.1.
Subsequent chapters will address each anatomic area.
Patients with normal, deficient, and surgically altered
or traumatically deformed anatomy may all benefit from
implant augmentation of their craniofacial skeleton.
1
Fig. 1.1 A diagrammatic survey of the alloplastic implants used for
facial skeletal reconstruction and enhancement.
3
Chapter 1 Indications for facial implants
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FACIAL BALANCE AND DEFINITION
Most often, facial skeletal augmentation is done to enhance facial appearance in
patients whose skeletal relationships are considered within the normal range.
They want more definition and angularity to their appearance. Other patients
desire to “balance” their facial dimensions. The woman in Fig. 1.2 underwent
chin and mandible angle augmentation at the time of rhytidectomy to provide
angularity and balance between her upper and narrower lower face.
Fig. 1.2 A 52-year-old woman underwent
mandible augmentation, chin augmentation,
and rhytidectomy. (A) Preoperative frontal
and (B) preoperative lateral view. (C)
Diagrammatic representation of implant
augmentation. (D) Postoperative frontal and
(E) postoperative lateral view.
A
C
B
4
D
E
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