There are many areas in the face, which are amenable for augmentation or enhancement with the use of implants. Isolated facial augmentation or contouring may be required to correct facial asymmetries or to augment certain areas of the face.
The most common area in the face where implants are used is the nose which is dealt in the section on Augmentation Rhinoplasty.
The other areas for facial augmentation in decreasing order of preference are
Malar area ( Cheek / Zygomatic Area)
Mandibular ( Lower jaw)
There are various kinds of implants used for facial augmentation and the choice maybe dictated by the patients or the surgeons preference. The two most commonly used implants are SILICONE implants and MEDPOR implants.
These are biocompatible implants with minimal side effects if any. Though they have been used for almost 2-3 decades or more, the quality and the manufacturing processes have seen a sea change in the last many years making them better tolerated and with less problems of silicon leakage into the body.
Problems with silicone implants are infection as with any implant & displacement. The advantage of the silicone implant is that it is soft so can be used quite easily in contoured areas and can be inserted through smaller incision. The second major advantage is the ease of removal if it gets infected or rejected.
This is a newer implant used mainly for bony augmentations. The implant structure is unique in the sense that it is porous and through these pores normal tissue can grow inside and hold the implant firmly in place. But the drawback of this is that in case it has to be removed it has to be cut out from the area and hence is more difficult to remove. There is presently a problem of availability of MEDPOR implants in India
The search for an ideal implant for all places is still on.
Sometimes natural materials are used like Bone, Cartilage, Fat or Dermafat graft for different areas in the face which are discussed in specific sections.
Chin Implant or Chin Augmentation or Genioplasty :
In many cases the chin plays a major part in the facial profile as a whole. A weak chin changes the whole facial profile making it look imbalanced. Sometimes clients come for a rhinoplasty seeking correction for a “big nose or projecting nose” where the problem is a weak chin which makes the nose look bigger and a chin correction will bring the face back into balance. So, many a times a chin implant is an added procedure after a rhinoplasty. Increasing the projection of your chin will not affect your bite or jaw function.
The procedure can be carried out through the mouth or through the undersurface of the chin with a small scar. The procedure takes around 1-2 hours depending on the type of implant and the placement.
Problems in the healing period maybe pain, swelling and numbness which usually recover in the next few weeks. Infection is a problem as with any implant and if it gets infected, the implant will have to be removed. Rarely there may be prolonged numbness because of nerve compression.
Malar implants or Cheek Augmentation:
This is done to improve the malar highlights in the mid face especially around the eyes and the cheekbones can be made fuller, creating a more sculpted look, using implants, giving a “High Cheek boned ” look to the face. Both Silicone and Medpor implants can be used for malar augmentation.
The procedure is done usually through the upper gingivolabial sulcus inside the mouth. The implant is placed on the zygomatic bone to augment it. Another approach is through the lower eyelid and the implant is introduced through this. The scar eventually heals very well. The medpor implants are usually fixed with screws to the bone underneath.
The problems with malar augmentation are with displacement, infection and bleeding most commonly. Rarely the implant may compress on the Infra Orbital nerve causing numbness in the upper lip and nose tip.
This is done usually for the angles of the lower jaw to make them more prominent and to make the face have a more square shape commonly called the “manly square jawline”. Usually done in males and the Medpor implants give very good results. Also done in older people where there is bone resorption leading to increase in hollowness and jowls in the lower face.
The approach is through the mouth and after making the cut in the mucosa space is created around the bone where the implant is placed.
Problems are the same as with other implants.
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