Will Implants Or A Facelift Achieve My Facial Reshaping Goals?

Q: Dr. Eppley, I am scheduled (this upcoming week) to have a mid-facelift with a fat transfer and buccal fat removal. During the initialconsultation, the surgeon mentioned that based on the look and projection I’m looking to achieve, facial implants might be needed.  He also advised to have the implant procedure done a few months after the mid-facelift and fat transfer, so we can better determine more accurately the implant specifications once the swelling and fat transfer have subsided. The implant and placement that I’m interested in is a thin, elongated implant to be placed right under the temple and extend on the high point of the cheeks.

Here are my questions:

  • Is there a benefit to having 2 separate procedures, one for the facelift and the other for the implants? (I prefer to have one procedure to prevent another anesthesia)
  • Is there a possibility to not need a fat transfer at all if implants are used?
  • Where will the incision be for the implant? Through the hairline, mouth, or inner lower eyelid? 
  • Is there an option to use Porous polyethylene instead of silicone? 

A:Thank you for your inquiry and sending your pictures. The first and most important question is what exactly are you trying to achieve. I could probably guess based on the procedures that are being considered as well as your young age and your pictures. However I really don’t want to guess and I need for you to tell me specifically what that is.

But some of the answers to your questions without knowing your goals I can say the following:

1) it is likely what is meant by that you may need facial implants is that if the first procedures aren’t effective for your goals then implants will need to be done later. That’s the question is not whether these procedures should be combined or separated but based upon your goals what is going to be the most effective approach. Until I know your exact goals it is impossible to say whether such procedures should be done together, separate, or whether only one of them should ever be done.

2) One of the basic reasons for implants as to avoid the use of fat or filler injections later… Provided the area of augmentation needed is in the zone where the implants are placed.

3) Since I don’t know what your goals are for the type of implant that is being considered here I cannot yet say what would be the access to place it.

4) While porous polyethylene is always an option in any type of facial implant augmentation it generally it’s not a good choice in my experience because of its extreme difficulty in secondary modification or removal. And although everybody thinks they would never be the patient who would need their implants revised the reality is there is a 40% risk of that occurring which makes it not rare. In addition if one is having implants in the mid facial area due to the thin tissues porous polyethylene does not have feather edging by virtue of the way it is manufactured which means means there will be a palpable and sometimes visible edge to them. Tissue ingrowth into an implant material always sounds good provided the implant positioning, shape and size is perfect and you never have to touch them again for as long as you live. But when any secondary changes are needed tissue ingrowth becomes a major liability and no longer an asset.

Dr. Barry Eppley

World-Renowned Plastic Surgeon