Should I Use Standard or Custom Midface Implants?

Q: Dr. Eppley, I had cheek implants that I initially liked and then replaced them with new cheek implants that I thought would be better…but they weren’t. I now realize that I like my original cheek implants much better. I would also like some paranasal augmentation as well. My question is whether I should go back to my original I should go back to my original standard cheek implants or, because of the desire for paranasal augmentation, go with a completely custom midface implants approach.

A:I think the debate is whether to replace your current implants with the standard ones that you had previously of which you have good aesthetic satisfaction, along with new standard paranasal implants, or to take a completely customized approach to the midface area. That decision, quite frankly, is an economic one. One could make arguments for either approach. For standard implants, which will be the most economic approach, you were happy with a standard style previously and the paranasal area generally works well with a standard paranasal implant. Conversely a custom implant approach can be done where implant designs are made specifically for your bony anatomy to cover these areas. When one is in a position to have a viable debate between standard and custom implants the ultimate question is how much better will the aesthetic result be with a custom approach versus a standard one. For example if you could accomplish 90% of your desired asthetic results with standard implants why would you pay more for custom? However if you could only achieve 50% or less of your desired results with standard implants then the more economic approach would not be prudent in the long run.

That being said the other argument for a custom implant approach, which I have seen many times in patients where standard implants will produce an acceptable result, is that the patient feels better with implant designs in which they can see what they are beforehand and have confidence about what they look like and where they are going to be placed.  This is almost always true in the patient who has had one or two prior standard implant surgeries.

The other decision that may sway a patient towards the custom implant approach is if they are having another facial area where a custom design is absolutely needed. This may be applicable to you since for your chin, in which a prior bony genioplasty has been done, a custom implant approach would be the most assured method to achieve very specific augmentative changes.

This is a long answer to a short question, I’ll be at an important one, which implant approach do to take?