How Should I Revise My Existing Medpor Face Implants Placed A Long Time Ago?

Q: Dr. Eppley,I’ve spent countless hours reading your blog, and reviewing your incredible work. 

I had orbital rim, malar and paranasal implants (medpor porex) with accompanying midface lift ten years ago.  Although I was pleased at the time, and in the immediate short term, as years passed the extremely subtle intervention has been disappointing.  I would like to consider a “refresh” procedure (as opposed to “revision,”) as again, I was pleased at the time, and thankfully the surgery was safe, successful, and recovery was extremely smooth. Fourteen years later, I am still without any ill effects (other than the lack of result). 

As such, I started consulting with a number of surgeons, with advice ranging from “never touch porex, especially after that many years,” to those recommending I stack new implants on top of the old ones, to those suggesting removal of old implants and placement of new ones with new material such as PEEK.  As  I have read your blog, I observed that you do remove porex implants regularly, and suggest never to stack (although the one blog post I read about this subject was regarding silicone, so perhaps I shouldn’t assume that is the case for porex as well?). 

So, my question is essentially after so many years, is it possible to remove medpor porex orbital rim, malar and paransals without considerable risk? Or at this point, should I explore other alternatives?

Thank you for any guidance.

A: Thank you for your inquiry. When it comes to indwelling Medpor facial implants and any subsequent surgery all options are on the table that you have mentioned including stacking new implants on top of the existing ones or removing and replacing them for new implants. These are simply surgical techniques and, in and of themselves, should not guide what one does.  Nor should what surgeons prefer to do or are capable of doing should be what one does. What matters is what exactly are you trying to accomplish and how much change is needed to the implants you already have. It is easy to see that if you needed some minor or modest amount of additional augmentation then removing and replacing may be more surgery than is warranted. Conversely if you need a significant change in the footprint of the implants and/or projection or a change in the implant concept, then you can see that remove and replace would be the more appropriate strategy. In otherr words first determine your goals (the problem) before deciding what the solution should be.

There are some caveats to the prior statements which include the following. One problem with revising or replacing Medpor implants is that they rarely can be seen in a 3-D CT scan. This can make an  understanding of what their current effects are difficult and making new implants that offer more improvement over what they are is less predictable since you cannot see them. But the first step is to always get a 3-D face CT scan and see what can be seen.

Lastly, it does not matter whether Medpor implants are in for 14 years or 14 weeks once the tissue in growth has occurred it remains static. Thus longer indwelling  Medpor implants are no more difficult to remove than those of a shorter implantation time.

Dr. Barry Eppley

World-Renowned Plastic Surgeon