Q: Dr. Eppley, I visited a craniofacial surgeon for advice because my right zygoma is lower, depressed and flat while the left one is just perfect (high, round, nice projection, and I want to leave it like that without surgical approach) He than diagnosed me with hemifacial microsomia. I asked him about the option of a custom implant on the right zygoma to make it just as high, round and projected as the left one. He than said it is a bad idea to use implants for several reasons that sound convincing but proposed to use Beta-tricalcium phosphate granules trough a surgical approach to achieve the symmetry. He said it will act like an implant and also be permanent. He is a very well known surgeon and I do trust him, but I can’t find alot about this approach and that kind of worries me a bit. Are those granules really able to bring the zygoma (not the arch) forward?
A: The use of hydroxyapatite granules (or beta-TCP) in craniomaxillofacial surgery is an older approach for bony augmentation. It has a long history that dates back to the 1980s when hydroxyapatite blocks and granules became commercially available. I used it fairly frequently back then myself as there were no other non-bone material available. While it is a more ‘natural’ material, injecting/placing granules is an imprecise and relatively uncontrolled method of augmentation. For small amounts of augmentation that do not require a precise shape, it may still have a role in some select circumstances. But a ball of granules placed on the bone is easily compressible and displaced and defies being able to be accurately shaped. I have no doubt HA granules will provide you some augmentative benefit but it will not be effective in getting the most accurate and symmetric result to your normal side. It is simply a matter of the limitations of the material’s properties. The use of HA granules today is usually limited to older craniofacial surgeon’s who still have the historic belief that any synthetic material is ‘bad’. As for achieving perfect bone symmetry in the face to an opposite normal side, it is impossible to rival a custom computer-generated implant approach that creates the perfectly-shaped implant down to fractions of a millimeter. Such an implant on the zygoma/zygomatic arch is really conceptually the same as any other synthetic implant used in cosmetic cheek augmentation. I fail to see what makes that approach ‘bad’.
Dr. Barry Eppley