Facial Implants in Cosmetic

Surgery
Outline
• Introduction
• Preoperative evaluation
Introduction
• Facial implants offer a novel minimally invasive treatment option that can
address certain complaints.
• The surgeon must be fully competent with not only the surgical technique
but also with the properties, risks, and benefits of the material being used.
• Management of patient expectations is perhaps the single most important
factor in predicting outcomes in cosmetic surgery.
• SIMON (single immature male over-expectant narcissistic), described by
Gorney to identify potential problem patients.
Red flags
• 13 red flags by Gunter to identify a (8) older neurotic man overly
potential problematic patient with worried about aging
possible psychological issues. (9) paranoid thoughts
(1) minimal disfigurement (10) history of dissatisfaction from
(2) identity problem of sexual multiple physicians
ambivalence
(11) sudden dislike for one’s
(3) delusional view of body image anatomy
(4) unrealistic life change as a result of
surgery (12) hostile attitude toward
(5) confused motives for wanting surgery
authority figures
(6) history of poor relationships (13) present misfortunes blamed on
(7) unresolved grief or current crisis appearance
Preoperative Evaluation
• Thorough physical examination is of paramount importance.
• Aesthetic concerns and expectations should then be discussed.
• Reviewing photos of the patient’s front, oblique, and profile is useful for
both the surgeon and patient.
• Anthropometric measurements of balanced faces can provide the surgeon
with some objective basis that can be used in deciding what areas need to
be augmented or reduced and to what extent.
• Recent advances in preoperative evaluation including 3D CT scanning,
stereolithographic modeling, 3D printing, and a variety of other software
programs are available.
Alloplastic Materials
Ideal implant material
Biocompatible and has minimal interaction with the surrounding tissues, such that its
morphology is maintained after placement in contrast, skeletal augmentation with
autogenous bone can remodel, in time affecting its size and shape.
The host tissue response includes some level of capsule formation around the implant being
placed.
Porous implants typically result in less robust capsule formation compared to smooth
implants.
Implant migration and adjacent bone erosion also tend to be lower in porous implants.
Solid silicone implants offer several advantages over other materials—they can be effortlessly
carved to achieve a desired shape and size, as well as be easily fixated with screws or sutures.
Incidence of infection, although low regardless of the implant type, has been reported to be
lower when silicone implants are used.
Positioning and Immobilization
• Implant placement is described in both supraperiosteal and subperiosteal
planes.
• The subperiosteal pocket dissection is preferred as it involves a plane of
dissection that is bloodless and safe relative to surrounding neurovascular
structures.
• Regardless of the area being augmented and the type of implant used,
proper immobilization of the device can provide a more accurate,
reproducible result.
• A major advantage of screw fixation over the other methods (e.g., sutures)
relates to more accurate final contour because gaps between host bone and
the implant are