Q: Dr. Eppley, two weeks ago I got silicone malar cheek implants done. At first the healing process seemed to be going fine but then I started to feel pain and discomfort in the area where my implant was at on the left side. My dissolvable stitches also broke so I was bleeding a lot and went back to the Dr. .He said the cut was half healed half open and from what he could see it looked raw and red looking, I was also having some fluid coming out. Obviously he said it was infected but said it wasn’t enough to concern him and put me on Amox/K Clav 875 for 2 weeks. It’s been 4 days & it doesn’t seem like it’s getting worse or better what do you recommend is the next step. It still hurts when I smile or chew and is more swollen then the other side. Could there be a pus pocket like an abscess in the location of the implant? How can I find out? I’m thinking maybe an x-ray or MRI can show if there is something forming around the implant causing the discomfort? If so can it be drained? I just don’t want to have my implant taken out if there is some other way to go. Thanks in advance.
A: The most typical postoperative time period for an infection to occur from facial implants is 10 to 21 days after surgery…so you are right in that time period. But whether you have an actual infection or not is not clear. It is either an infection or a wound dehiscence (incision separation), both of which can give you pain on mouth movement. There is no value in getting an x-ray or other radiographic assessment as that is not going to change the clinical management of your cheek implant problem. You have two approaches to do. One is to stay on the antibiotics, see how the intraoral wound heals, and let time dictate what will happen. If improvement is going to occur it will be slow and will not occur in just 4 days. If it is an infection, it will eventually get worse and be obvious. (antibiotics alone will rarely cure an implant infection) This is the most convenient approach (not surgery)O even though it is not the most efficient. The other approach is to go back to surgery, wash out the implant site and thoroughly clean the implant, re-insert it and get a good wound closure. This is not convenient (as it is surgery) but it is the most efficient approach and the most assured one to retain the cheek implant long-term.
Dr. Barry Eppley