Q: Dr. Eppley, from my research and various consultations, I believe Medpor facial implants is the way to go. I have heard that with silicone it will eat away the bone’s density as it has shown on my latest CT scan. (which was sent to you also) Over years will the bone keep deteriorating from the silicone? What is your opinion on both types? pros/cons?
A: Whatever you have heard about silicone facial implants is both inaccurate and untrue. It does not cause any deterioration of the bone. That is an occasional passive phenomenon in the chin where the implant may settle into the bone from the pressure of the overlying muscles if the implants are placed too high on the chin bone. It is a simple passive phenomenon and not an active inflammatory process, It is never seen beyond the chin area in my experience.
I have used plenty of both silicone and Medpor facial implants in both primary and revision work. I could detail all of the advantages and disadvantages of each but, in short, if I never could place another Medpor implant I wouldn’t. (I still do when patients want but I have yet to see any advantages with its use and there are plenty of disadvantages) It costs more, has a higher rate of infection (as any textured surface implant does anywhere), is difficult to place, requires longer incisions to insert, is harder to modify, and poses a real problem when it comes to revisional surgery. (and remember even with custom implants the revision rate is not insignificant in the young male face patient) Whatever benefits they may be to some tissue ingrowth are overwhelmed by all of these disadvantages and screw fixation easily eliminates its only one advantage. (tissue ingrowth = implant stability) Over the years I have come to one conclusion about Medpor… it is an implant material that is really a poor choice for facial implants but it has been around so long and is an alternative to silicone that doctors keep trying to make it work.
But some patients are very emotional in their decision for Medpor although the logic of its use does not meet the scientific test for being any better than silicone. (and is a much worse handling material) But if that is what the patient wants, I will use it most of the time unless I feel it really compromises the ability to get the desired result.
Dr. Barry Eppley