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I have read and heard conflicting information on facial implants. I would like to...

Q:

I have read and heard conflicting information on facial implants. I would like to consider including a chin implant with a facelift, but I am concerned about infection/rejection of the implant. Statistically, how common is infection? What are the best implants made of? Do they last indefinitely?

A:

For appropriately selected patients, adding a chin implant at the time of facelift can significantly improve the postoperative neck contour and overall facial appearance. Many surgeons routinely make a small, inconspicuous incision under the chin to recontour the neck. Through the same incision, a chin implant can be placed directly on the mandible (chin bone) to further enhance the appearance of the neck and face. Chin implants come in a variety of sizes and shapes and can be made of different materials. The most popular type of implant is made of solid silicone and wraps around the lower jaw, avoiding the "button" look. These implants have been successfully used for more than 20 years. Infection or implant rejection is very uncommon, but if this occurs, the implant can easily be removed. Usually it can be replaced after suitable healing takes place. Exceptionally large implants are not recommended because of the increased pressure on the mandible as well as a greater chance of malposition. Most implants, if placed without initial problems, can last indefinitely. Chin augmentation with an implant can add subtle, but noticeable improvement in the results of a facelift without adding significant cost, surgical time or recovery.

A:

 

A wide variety of facial implants are currently available for the enhancement of the skeletal elements of facial aesthetics. The most commonly used facial implants are used to enhance the profile of the chin and the cheeks. Facial implants very widely not only in shape and style, but also in terms of the materials from which they are fabricated.

My preference is to use structural fat grafting, as much as possible, to enhance facial features. In many cases, the need for a solid implant can be eliminated by the careful and meticulous grafting of a patient's own fat. While the incidence of complications with facial implants is not high, certain problems may develop which require implant removal including infection and implant migration. Bone resorption (bone loss) has also been reported below solid facial implants. Neither of these problems are an issue with structural fat grafting.

The only setting in which I currently use a solid facial implant is for chin implant augmentation. Some patients with a 'weak' chin profile can be adequately improved by structural fat grafting alone. However, when the chin protrusion needs to be enhanced by a half centimeter or more, a chin implant is absolutely required. I prefer to use a soft, flexible, anatomic chin implant that conservatively enhances the anterior projection of the chin in profile. The chin implant is placed through an incision hidden underneath the chin, an area where many people already have a scar from a fall in childhood.

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