If My Infraorbital-Malar Implants Are Removed Will I Have Cheek Sagging?

Q: Dr. Eppley, About two months ago I had infraorbital-malar implants. It seems most of the swelling is gone (80% or so), but I’m not happy with the results. My doctor tells me recovery takes a full year, but quite frankly I just don’t believe that, and I’ve lost faith that it’ll get better with time and I want to have them removed as soon as possible. Regardless, gambling with a year of my life is harder done than said. I saw a post of yours on Realself where you write that if patients aren’t happy after 6 weeks it’s unlikely their concerns will be resolved with time, and I agree with that. 

My main questions are as follows: 

1) can the implants be removed after 2 months? The implants were silicone 

2) From your experience does the face normally return at least closely to its original state? 

3) does removing them early (2-4 months post op) make it more likely for the face to return to its previous state? Because I feel waiting one year as the doctor wants me to may end up distorting my face for good. 

4) is there a legitimate concern for facial sagging? I’m concerned that the implant pocket will cause sagging (I’m 26 if it’s relevant). What about scar tissue? Is that likely to change the face? 

5) about how long does recovery take for implant removal? 

6) how long after removal can I get facial fillers in that area? 

7) if my doctor refuses to remove them before a year, can I go to a different doctor? 

8) is the cost for removal cheaper than the cost for placing them? 

Thanks in advance for the help,

A: In answer to your questions:

1) I think it is a fair statement to say that if patients are unhappy with the outcomes of their facial implants by 6 weeks after surgery, their concerns are rarely resolved by time along and some form of surgery is needed. This is a general statement based one my extensive experience but each case must be assessed individually.

2) Whether the face returns to its original anatomic state, I think that does not occur at the 100% level. The real question is not whether it returns to normal but how come to that can it occur. That is affected by many factors most prominently the size of the implant, how long it has been in and its material composition is.

3) As a general rule removing implants sooner rather than later (as long as one is 100% certain that want them removed), in theory is better for returning the tissues back to normal. But most of the issues that relate to the tissues returning to normal (disruption of osteocutaneous ligaments for their placement and tissue stretch) has already been done by the initial surgery.

4) Sagging is always a concern from any midface implant removal. The best way to prevent such sagging is to performed a cheek lift/fresuspension at the same time as their removal.

5) Implant removal would have a faster recovery than their initial placement.

6) Six months

7) A patient can choose to go to any doctor at any time.

8) Not knowing what your original surgical fee were, I can not say. But since the implant fabrication cost is not needed for their removal that may be less.

Dr. Barry Eppley

Indianapolis, Indiana