The use of synthetic implants for augmenting skeletal deficiencies of the chin, cheeks, and jaw angles are common plastic surgery procedures. While these are common locations for implants, there are many more implant styles that can be used for facial enhancement of the midfacial area.
The bones of the midface have complex convexities and concavities from the prominences of the cheek to the concave surface of the maxilla. As a result, there is no one implant that can be used for all of them. Today’s midfacial implants have nine (9) different styles to meet these complex anatomical needs.
Cheek implants are the most frequently used facial implant next to that of the chin.. There are four different styles to choose. The standard cheek implant, also known as a malar implant, fits on top of the cheek bone and has a broad surface area that covers most of the external bony prominence. The two styles of this standard cheek implant differ in that the more extended version has a portion that goes up higher to make a smooth transition into the lateral orbital bone. The choice between one style vs. the other is based on how much flattening the cheek has and whether it extends up into the orbital area.
The submalar cheek implant is not the same as the malar implant. It is indicated when the cheek soft tissues are a little saggy with age and the area under the cheek prominence is a little sunken in. This implant fits on the underside of the cheek bone which helps lift up sagging tissues and fills out the sunken area under the cheek. The submalar cheek implant comes in two styles which differ in how much fullness is added to the submalar space.
The tear trough implant is a specialized lower orbital rim implant. It fills out the depressed suborbital groove that some people have naturally or develops from aging and tissue atrophy. This groove runs like a gutter from the inside of the eye downward. Instead of fat injections for augmentation of this area, a carefully placed tear trough implant provides a permanent solution.
The pyriform aperture implant fits along the bone which forms the side rim of the nasal cavity. It is designed to build out the base of the nose underneath the nostril. I have most commonly used this implant in secondary cleft surgery to build out the deficient maxillary bone where the cleft went through. But it is also helpful as part of rhinoplasty surgery when one has a flatter face.
The premaxillary or peri-pyriform implant builds out the entire base of the nose from one side of the pyriform aperture to the other. This includes anterior nasal spine area as well. For very flat midfaces, this implant can really help provide augmentation to the nose and upper lip.
The nasolabial or melo-labial groove implant fits onto the bone to the side of the nose and helps soften or build-out the very deep nasolabial fold or groove. Rather than using temporary injectable fillers placed beneath the skin, this implant placed on the underlying bone serves to provide the same push.
The Lefort or maxillary implant, the least common of all midfacial implants, is designed to be used during or after a LeFort I osteotomy. This implant would fit above the osteotomy line so that the midface would not look more deficient as the maxillary teeth come forward.
All midfacial implants, while being very different in shape and indication, share two common features. First, they are all placed from an incision inside the mouth so no skin incision is ever needed. Secondly, they are all best secured into position with a screw as their position is critical in getting the desired esthetic result.