Custom Facial Implants

Q: Dr. Eppley, I am writing to you with a question about custom facial implants. Though I am a big fan of your work and admire what you have done for so many people, I am scared to travel out of the country for surgical work.

I have found a reputable craniomaxillofacial surgeon in my home country who also specialises in plastic surgery. He offers custom implants made out of PEEK, titanium or medpor for all areas of facial augmentation. (It is my understanding that PEEK implants for facial augmentation are not yet approved by the US FDA.)

I queried as to why he does not offer silicone implants but he simply stated that the other three materials were his preferences. I did worry about the large incisions that would be required for jaw implants made of solid materials, but with his experience, I feel less worried.

From your medical knowledge, which of these three materials would be the most ideal for my jaw/side of chin augmentation? 

My biggest worry with such a procedure is getting the implants infected. I understand that medpor has a rugged surface that bacteria like to hold onto and is more prone to late infections than a material such as silicone. I am not so sure about PEEK or titanium. 

The initial cost of the surgery and implant is not a worry for me but my worries stem from potentially getting a custom implant infected, having to unzip and zip up my incisions again, and having to fork out the cost for a new implant. 

Which of the three materials should I go for? Which has the smallest likelihood of getting a late infection? It is something that worries me as I don’t want to keep having to go through surgery. I really just want it to be my last.

A: The question of what facial material is superior is a common one and much thought is given to their biologic tissue interactions. But having done many hundreds of custom facial implants the most important issues are not the material’s biologic properties as the body tolerates all of them equally well and the relevance of tissue adhesion is far overstated. The two factors that matter the most are 1) can the implant material permit it to be placed with minimal scarring and, of greatest importance and often completely overlooked is 2) how easy is the material able to be removed should a revision be necessary. Given that revisions in custom facial implants approximate 20% to 30% (that always surprises patients but it is true nonetheless) that issue takes on extreme precedence. For that reason I don’t prefer any of the materials you have mentioned as they are all more difficult to place and hard to remove and I haver removed a lot of all of them. But the best choice of these less than ideal materials would be Medpor.

Dr. Barry Eppley

Indianapolis, Indiana