Facial Implant Questions

Q: Dr. Eppley, I have some facial implant questions regarding silicone implants. It seems as if some “experts” on different forums believe that jaw iimplants and cheek implants with silicone are inferior to harder materials such as Medpor or PEEK due to the fact that silicone is softer and thus when subjected to pressures from soft tissues they may not retain the inteended sharp and angular look at, for instance, the edge along the mandible or along the lateral part of the cheekbones. (including zygomatic arch) Instead they claim that they may give a more rounded appearance that simply adds volume without retaining the sharp edges of identically designed implants made from hard materials.

1. Would you please comment on the above?

2. Are there any limitations on how you can customize silicone implants? For instance, can you customize them so they gradually taper off to 0 mm thickness, so they gradually blend into the existing bone structure around the eye area? Can you customize them to have a sharp, defined edge?

3. Some doctors claim that putting a screw through a silicone implant in the chin or jaw angles will eventually lead to the screw migrating through the implant because of the softness of solid silicone. Thus silicone implants may dislocate in the future when the screws no longer keeps the implant in place. Would you please comment on this?

A: In answer to your facial implant questions:

1) I consider the argument/opinion about the effects of available material compositions on the outer facial contours as lacking any scientific support. That is a discussion that has never made any sense from a biomaterial/biomechanical standpoint. One simply has to feel a silicone implant and wonder how it could ever be deformed from the overlying soft tissues. What effects the outer contours of the face is the shape and size of the implant not its material composition.

2) You can custom facial implants any way you want, there are not limits to their design. Whether the overlying soft tissues will allow the design to be fully seen and what the design should be to create the desired effects is a different matter with its own limits. 

3) What keeps an implant in the placed position on the bone long-term has nothing to do with any screw fixation. It is the scar tissue/encapsulation that is eventually responsible for its positional stability. Screws are used in the short-term to maintain position long enough for this encapsulation process to occur.

Dr. Barry Eppley

Indianapolis, Indiana