What are facial implants made from?

Facial implants are most commonly made from silicone of ePTFE.  ePTFE stands for polytetrafluoroethylene.  It is a soft, porous material that allows the body’s tissue to grow into the device. The silicone used in facial implants is generally very soft and malleable.  However when they are placed on the bone they feel very firm.  The malleable nature of silicone implants allows the surgeon to place them through small incisions.

Are facial implants safe?

Yes.  Every surgery has its own unique set of risks and complications.  However, the surgery involved in facial implants is considered a very safe surgery because there are no major nerves or vessels in the path of the dissection.  Of course, there are risks of infection, bleeding, extrusion, malposition, and asymmetry.  But for the most part, these are not life threatening problems and leave no permanent sequela.  Infections may be treated with antibiotics.  In some case the implant may need to be removed.  Infected implants can be replaced generally after three months.  Any asymmetry can be improved by re-positioning the implant, trimming the implant, or placing custom implants.

Where do the implants sit?

Some facial implants sit on the bone, such as chin implants, cheek implants, submalar implants, jaw implants, and certain nasal implants.  Temporal implants sit on the muscle. Lip implants sit within the lip substance.

What do facial implants feel like?

For the most part, the implants feel very much like the tissue they are augmenting.  Silicone and ePTFE are soft materials.  But when they sit on bone they fell firm.  And when they sit in the soft tissues of the lips they feel soft.  This is one of the wonderful products of silicone and ePTFE.

Will people be able to tell if I have a facial implant?

If the implant is chosen and placed properly, the results should look and feel very natural.  Most facial implants require no external incision.  The exception to this are temporal implants, but even these incisions can be hidden well.  Lip implants are placed through the corner of the mouth leaving no discernible scar.  Chin implants are placed are placed either through the mouth or under the chin.  The external approach to chin augmentation is more common than the intra-oral approach and leaves a small scar that heals very well.

Are facial implants screwed in?

Some facial implants are secured with a screw, others with stitches.  Some however, like lip, temporal and chin implants do not require any type of fixation since the implant sits snug in a precisely developed pocket.

What are the different areas plastic surgeons place facial implants?

Virtually every area on the face can be augmented with facial implants, but the most common areas include the temples, the forehead, the mid-face, the nose, the chin, the cheeks, the lips, and the jawline.

Why do some people with cheek implants look fake?

Only the unnatural results are discernible.  And many of the older generation implants are inferior in shape and placement to the new styles and surgeries.  Lastly, implants may become visible decades after placement in the background of poor placement and facial fat atrophy.  However, this has become less common with the newer and more natural looking facial implants and advanced techniques.

What are the risks of facial implants?

The main risks of facial implants differ from area to area. In general the main disadvantages to facial implants include prolonged swelling in the mid-face as occurs from cheek implants, asymmetry, infection, and extrusion.  Studies indicate that the risk of a facial implant infection is about 4%.  In some cases infections of facial implants can be treated with antibiotics.  In other cases the implant must be removed.  If the implant is removed, filler can be placed to temporarily reduce asymmetry (assuming one—not both implants, are infected and removed), and an implant can be replaced in about three months.  

How long do facial implants last?

Silicone and ePTFE do not dissolve.  Thus, they may potentially last a lifetime in the body.  They do not require removal and replacement after an arbitrary number of years, nor do they  wear-and-tear like tires.  However, the tissues of the face DO undergo wear-and-tear thanks to the likes of gravity and aging.  Soft tissues may need to be modified to enhance the implants after decades of aging.  Everyone is different.

What if I don’t like my facial implant? Is it easy to remove?

Yes.  Unlike Gore-Tex or injected silicone (both of which are generally avoided in the face nowadays), silicone and ePTFE implants are easy to remove.  There is a saying in plastic surgery that the ideal implant should be easy-in, easy-out, and easy-in.  Meaning, the reality of implant infection must be considered necessitating the removal—and later replacement of the implant.   Silicone and ePTFE meet this criteria. They are both easy to place and remove.    However, the removal of the implant at times does require the use of a screwdriver if a screw was placed to secure the implant.  And, the surgeon must be adept at the dissection.  Thus, for well trained surgeons with the proper tools, facial implants are easily removable and can almost always be removed and replaced through the same incisions they were originally placed.

What happens if a facial implant gets infected?

We all hope the day never comes, but the reality is that about 4 percent of facial implants will become infected at some point.  Sometimes an infection may develop shortly after surgery.  Other times an infection may brew slowly over months to years before it becomes clinically visible.  In low grade infections caught early, the implants can be salvaged with antibiotics.  In situations where an infection overwhelms the implant and soft tissues, the implant will have the be removed to allow the body to heal. It may be replaced, in most cases, at about three months.

How much do facial implants cost?

The cost of facial implants varies depending on the area of the face, to experience of surgeon, to the number of implants, to the geographic location of the doctor.  Other factors include whether or not the surgery will take place under general anesthesia or local anesthesia, and whether or not the implants will be off-the-shelf or custom.  As a general rule, expect to pay the same amount for a pair of facial implants if not more, than for a pair of breast implants.  If the facial implants are custom, expect to pay at least $5,000 to $6,000 more to account for the imaging studies necessary to make the custom implants.

How do I go about choosing a doctor for facial implants?

Like anything else when it comes to finding a suitable doctor to meet your needs, it is advisable to do research.  Some of the things to look for when researching a cosmetic surgeon are credentials, years of experience, and reviews.  It is easy to check to see if your plastic surgeon is board certified by visiting the following website:

https://www.abplasticsurgery.org/public/verify-certification/VerifyCert?section=SurgeonSearch

In addition to board certification, one can look at reviews online, read their blogs to see if they are being asked to speak at meetings on a particular topic, or see how involved they are in organizations (which may function as an indirect marker for desire to keep up with trends in the literature).

What are custom facial implants?

Custom facial implants refer to the creation of silicone or ePTFE facial implants based off of imaging studies of the face to precisely match the contour of the underlying facial skeleton and fit precisely into soft tissue dimensions.  A large array of off-the-shelf silicone and ePTFE facial implants exist, but in certain cases of large asymmetries or for cosmetic goals that cannot be achieved with off-the-shelf devices custom implants may be preferred.

How are custom facial implants made?

The creation of custom facial implants relies on imaging studies of the face.  A CT of the face with 1 mm cuts is performed and sent to an implant engineer.  The engineer along with the plastic surgeon discuss the underlying bone configuration as well as soft tissue parameters to develop implants that fit better than off-the-shelf implants.  The process takes longer and costs more money, but the ability to improve symmetry to achieve the desired outcome is much easier with custom implants.  The custom facial implants will be made of silicone or ePTFE and can be placed in the same manner as off-the-shelf implants.

Why would I want a custom facial implant over an off-the-shelf implant?

Off-the-shelf implants are by far the most popular implants chosen by surgeons and patients.  They exist in various shapes and sizes and can accommodate most patients to achieve a desired outcome.  The advantage of customizing facial implants is the ability to see that the implant sits more precisely in the pocket, to correct asymmetry better, and to provide different looking results that off-the-shelf implants may not be able to provide.  A more precise fit may theoretically reduce the risk of implant problems, such as malposition, infection, and erosion.  When revision surgery is taken into consideration, custom implants may prove to be the more cost effective method of facial augmentation.

What is better, fat transfer or implants?

This is a ferociously debated topic among plastic surgeons.  In short, in some instances fat transfer is clearly advantageous.  In other cases, facial implants are the better choice.  It really depends on what the plan is, and what potential risks  (and costs) the patient and doctor is willing to take on.  It is important to note that fat transfer and facial implants, while similar in what they can achieve, do have significant differences and its own set of unique limitations.  For patients seeking facial implants, upon further education with the physician he or she may find that fat transfer is more suitable to fit their needs.  And vice vera.  Generally speaking, facial implants can provide more drastic physical changes to the face with far more predictability.  However, the risk of infection, movement of the implant post-operative, and extrusion of the implant make it sometimes less desirable to patients who are not looking for significant changes.  It is difficult if not impossible to create very drastic results with fat.  This is because not all of the fat injected will survive.  An often overlooked advantage of fat transfer is that fat transfer has the added benefit of providing stem cells to help rejuvenate the skin and improve skin quality.

What is the biggest problem with facial implants?

The major disadvantages to facial implants include  potential infection, malposition, asymmetry, implant visibility, and extrusion.  Thankfully, most of the time none of these complications surface.  And, the management of any of these complications is often straight forward.  But these problems do not exist to the same degree with its competing procedure, fat transfer.  Thus, benefits and risks must always be weighed before choosing facial implants over fat transfer or fillers.

What if a facial implant gets infected?

The good news is that in the large majority of cases, facial implants will not get infected. The downside of course is that if they do get infected they made need to be removed.  They almost always can be replaced 3 months later.  But in the interim, large facial asymmetries may exist (unless of course the removed implant was a chin implant).  The surgery to remove facial implants is often easy, safe, and quick.  They are designed to be inserted easily, removed easily, and replaced easily.  But there of course are costs associated with these procedures.

Can facial implants be performed under local anesthesia?

Yes.  Lip, temporal, and chin implants are easily performed under local anesthesia.  While cheek and mandibular implants may be placed under local anesthesia, it is far more uncomfortable for the patient than some of the other facial implants.  Nasal implants can be placed under local anesthesia too, but they are often combined with rhinoplasty which almost always requires general anesthesia.

Do facial implants hurt?

Surprisingly, face surgery generally does not hurt as much as body surgery.  The more extensive the dissection, the more post-operative pain one can expect.  Dissection for mandibular implants requires partial detachment of the masseter muscle, and may likely prove to be the most painful of the facial implants.  However, all facial implant surgeries is generally well tolerated with oral pain medications and should not preclude one for doing activities of daily living after surgery.

Will I be able to feel my facial implant?

Yes and no.  The implant will be palpable, but the real question is, “Will it feel like an implant or my body?”  Most people feeling the face of someone who has facial implants will not be able to discern whether or not the implant is tissue, silicone, or ePTFE.

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