Can Custom Infraorbital-Cheek Implants Be Secured With Screws?

Q: Dr. Eppley, I have a few more questions before I make the decision on the custom infraorbital-cheek implants.

1. From my research on silicone implants, I’ve read from one surgeon that they cannot be screwed in because the silicone is too soft and would risk rupture over time. But from my understanding you plan to screw in the implant, so how would it not rupture? is this because we are using “hard” silicone?

2. The same doctor told me that the “pocket” that encapsulates the silicone must be exact, or the implant risks micromoving and eroding the bone due to the friction. Is this because off the shelf implants do not fit exactly? 

3. I’ve also read about capsular contracture with breast implants due to scar tissue forming over time around the foreign silicone. What confuses me the most about this is the prevalence of silicone implants in Asia, especially for rhinoplasty. Seems like a bad idea if it is used so often. Is this an issue?

It’s very confusing getting different answers from every doctor…the medical papers provide me a better understanding but unfortunately they mostly talk about chin implants, but I guess the general concepts apply to all facial implants.

A: In answer to your custom infraorbital-cheek implants questions:

1) There has never been a problem with screwing in silicone implants, I have done so in thousand of silicone implants. Solid silicone facial implants are solid enough that they can be securely fixed with screws. The surgeon making that statement is inaccurate.

2) That is another inaccurate statement that has no biologic basis.

3) Capsular contracture is a unique phenomenon that has relevance to a soft tissue implant that is intended to feel soft and move around. That is obviously the opposite of what facial implants are indented to do….remain firm and not move.

4) In reality the basic concepts and biology of facial implants is not confusing. But most surgeons will little clinical experience except maybe with one type of implant or one specific implantation site make it very confusing by promoting statements that have no sound biologic basis. (as in # 1 and 2 above)

Dr. Barry Eppley

Indianapolis, Indiana