Am I A Good Candidate for a Custom Midface Mask Implant?

Q: Dr. Eppley,  I discovered Dr Eppley after I was diagnosed with midface hypoplasia due to receiving cranial radiotherapy by mistake when I had Leukaemia aged 5. I did have a malocclusion Class III but that was corrected with upper jaw surgery. Under our health system in the UK the plan was to treat the remainder of my midface hypoplasia with implants, as well as a mid facelift, but the care I have received here has been very poor in achieving that so I am not looking elsewhere. I should also add I am not entirely sure how honest the government health system has been about the degree of my facial deformity so even to know that in Dr Eppley’s professional opinion would be most valuable.

A: Thank you for sending your pictures and 3D CT scan. Having had a LeFort I osteotomy you have maximized the forward lower midface advancement with conventional osteotomies. By your external appearance you would certainly be a good candidate for a custom midface mask implant. The only cautionary caveat is the prior history of radiation which increases the risk of complications with an implant. Whether that risk is minimal or of some significance is not known and having had radiation decade ago does not lower that risk. The adverse effects of radiation do not change with time.

With an implant in a field of prior radiation there are two approaches. One approach is to just place the implant and see what happens. This would be a reasonable approach if the risk of complications was known to be minimal. The other approach is to pretreat the midface tissues with fat injections to improve the vascular quality of the soft tissues. This would be the approach of the risk of complications was known to be moderate or even high.

The dilemma is, of course, that no one knows what your risks are from prior radiation. And there is no test to make that determination. The only preoperative ‘suggestion’ is that youm healed satisfactorily from a LeFort osteotomy…although this is an autologoous proceduer and not an implant-based one.

Dr. Barry Eppley

World-Renowned Plastic Surgeon