Alloplastic Facial Implants

Abstract

As the face ages, there is thinning of the epidermis, volume loss and rearrangement of the soft tissues, and malabsorption of the skeletal framework. It is essential to have a thorough understanding of the aging process for successful facial augmentation and rejuvenation. Alloplastic implants can be used to provide a long-lasting solution for augmentation of skeletal deficiencies, restoration of facial irregularities, and rejuvenation of the face. In this study, we describe the ideal implant characteristics along with the advantages and disadvantages of various implant materials. We also present techniques in nasal and premaxillary augmentation, midface augmentation, mandibular augmentation, and lip augmentation. Additionally, computer-aided design and manufacturing as well as bioprinting are emerging technologies with growing applications in facial plastic and reconstructive surgery. We discuss their role in the creation of patient-specific custom implants. The overall goal of facial rejuvenation is to address multiple aspects of the facial aging process including deficiencies in the skin, soft tissues, and skeletal framework. The use of alloplastic implants alone or synergistically with additional surgical procedures can restore a wide range of anatomical deficits that occur with age.

Alloplastic malar implants in aesthetic facial surgery

“…Deformities of the midface can be classified into three types [4 ▪ ]. Type I exhibits bony hypoplasia with adequate soft tissue; in type II deformity, commonly seen with aging, the bony anatomy is normal but there is soft tissue loss; type III deformities exhibit deficient bone and soft tissue.…”

Polymeric materials and processes to produce facial reconstruction implants: A review

“…Synthetic implant devices, normally referred to as medical implants, have shown promising clinical outcomes when considered as suitable alternatives to bone grafts [4,11]. These implant devices can be used where the function of bone grafts needs to be enhanced, extended, or totally replaced [2,17]. Synthetic implant devices ideally need to be capable of encouraging cell proliferation and distribution, providing scaffolding during cell attachment and tissue ingrowth, and providing mechanical support necessary for withstanding the effect of the possible formation of hard and soft tissue stresses [2,12,17,18].…”

“…These implant devices can be used where the function of bone grafts needs to be enhanced, extended, or totally replaced [2,17]. Synthetic implant devices ideally need to be capable of encouraging cell proliferation and distribution, providing scaffolding during cell attachment and tissue ingrowth, and providing mechanical support necessary for withstanding the effect of the possible formation of hard and soft tissue stresses [2,12,17,18]. For successful facial augmentation, synthetic implant devices need to remain integrated and fixed at the implantation site, retain their original form, and not degrade [2].…”

“…Polymeric materials such as polymethylmethacrylate, polyether etherketone, silicone rubber, expanded polytetrafluoroethylene, and high-density polyethylene have been used extensively as non-degradable facial implants in cranio-maxillofacial surgery [2,4,11,17,20]. Degradable polymeric materials such as polycaprolactone, polylactic acid, poly-L-lactic acid and polyglycolic acid are commonly used to produce scaffolds for bone growth where bone augmentation is required but this falls outside the scope of this paper.…”

“…Polymethylmethacrylate (PMMA) is a non-degradable, high strength and rigid polymeric material which is normally produced through polymerization of methylmethcrylate monomers, and it is mostly used in craniofacial reconstruction [2,17]. PMMA is compatible to the human biological environment and has low toxicity rates when used as an implant material.…”