Custom Facial Implants after Orthognathic Surgery and Fat Injection Cheek Augmentation
Q: Dr. Eppley, I consulted with you last year regarding custom cheek-infraorbital and jawline implants. I had double jaw surgery one year ago and fat transfer to the cheeks six months later. Since my consultation with you, I’ve had filler (Voluma with around five syringes to cheek/jaw/chin) and rhinoplasty.
I had a couple questions:
1) If you recall, a local surgeon recommended contouring of the maxilla (and plate removal) in addition to implants. You said that it could be done, but that the exposure of the maxillary sinus — while fine on its own — would greatly increase the risk of infection if cheek implants were placed concurrently. I was wondering if perhaps mild/moderate burring could be performed such that the risk level would be acceptable. If it makes a difference, I think the osteotomy was performed slightly higher than the traditional LF1 cut. I attached VSP prediction and post-operative photos.
2) Would it be possible to design cheek/orbital/jaw/chin implants before the filler is dissolved? I have both clinical photos and a CBCT scan from last year
3) Would it be possible / make sense to excise the transferred fat during implant placement? I also have both clinical photos and a CBCT scan from February, which was before the fat transfer. This may be bad reasoning, but it seems intuitive to me that given likely uneven fat resorption, augmenting the cheeks/rims based on the bony contour may produce a soft tissue result that doesn’t “evenly” match the implant. In other words, if the implant doesn’t “account” for the fat transfer varying thickness (and it seems like this would be difficult to do), that varying thickness would be present in the result.
Thanks so much for your help/advice,
A: In answer to your custom facial implants questions:
1) As long as the burring does to expose the maxillary sinus the concurrent implant placement can be done. But it always turns out poorly if there is a sinus exposure when any type of midface implant is placed.
2) Having injectable filler in the face does not interfere with implant designing which is based on the bone anatomy and not that of the overlying soft tissues.
3) It would be very difficult and ill-advised to try and remove injected cheek fat from a prior procedure. Such fat is up in the soft tissues where the terminal branches of the buccal facial nerves reside. The area may be able to be treated by small cannula liposuction but not by an excisions method.
Dr. Barry Eppley