Facial Implants, Part II
Introduction
Last month I mentioned that people choose facial implants because they want to improve
their facial contour. Implants may be used for correction of deformities caused by birth
defects, or as a result of trauma. Then there are those who would like implant enhancement
of certain facial features.
The type of implant used must imitate the feel of real life tissue. Many types of implants
are now available including tissue taken from the body called autogenous implants which
include bone and cartilage, fat, skin or synthetic material including artificial bone,
silicone, gortex, (Teflon), and plastic (polyethylene). Natural tissue will be partially
absorbed and become smaller with time in many cases. Synthetic material will usually
maintain the form and size but there is a small risk of infection requiring its removal.
Whatever the patient and the surgeon decide has to be individualized according to the
benefits versus risks. The article last month talked about noses, this month we are going
to talk about cheeks and chins.
Cheek
People with flat cheeks because of their racial background, arrested development as a result
of a disease syndrome, or trauma. Others feel they would look better if they had an
enhancement of the prominence of their cheek.
In most cases the flat cheek is not lack of flesh but rather lack of bone under
the flesh. It is therefore quite common for the surgeon to choose a very firm
material such as the person's own bone, or artificial bone, or a synthetic
material such as hard silicone or polyethylene. Other surgeons may choose to use
a softer material such as Gortex placed directly on the bone. By far, the most
common implant that has been used is silicone.
Case #1 shows a lady that has a very flat mid-face. Often it is described as a
"dish-face". Both she and I agreed on the use of silicone implants because of the ease of
obtaining them and shaping them to the dimensions desired. The implants were placed through
incisions made in the mouth under the upper lip into tunnels over the cheekbones. The
incisions were closed with absorbable stitches that did not need removal. The patient was
asked to eat soft foods for about two weeks. She also took antibiotics for several days
after surgery to prevent infection. You can see from the postoperative pictures that she
looked like an entirely different person, which gave her a tremendous boost in
self-confidence.
Chin
The next is of a person who had receding chin. In some cases it is not always the chin
that is small but the upper jaw that juts forward too far. It is important for the surgeon
to make the correct diagnosis and correct the real culprit causing facial deformity.
In this case the patient's teeth were in proper occlusion and balance with regards to
the rest of the face. The only disharmony of the face was the small chin. After a good
discussion with the patient it was decided to use a firm silicone chin implant that would
cover the whole chin and extend to the sides of the chin. This implant as seen in the
picture is called and anatomic implant. Other implants that are smaller correct just the
middle of the chin.
The implant is placed through the mouth by an incision inside the lower lip peeling the
lower lip off the chin bone. Care is taken to preserve the nerves that give feeling to the
lower lip. Going in the mouth creates no outward visible scar. However in patients who
undergo a facelift the surgeon may have already made an incision under the chin to tighten
the neck muscle and it would be not difficult to place a chin implant though this incision.
Postoperatively the patient is asked not to eat hard foods for a couple of weeks
postoperatively this patient looked like a totally different person. She no longer had
chubby cheeks, which were chubby, only when the chin was disproportionately smaller. She
was another happy camper to be sure.
Comment
It is easy for most people to see in these two cases illustrated that the facial
implants performed a tremendous social service for them. Cosmetic surgery can improve not
only the physical appearance of a person but the psychological health of a person making
the person less self-conscious and a greater asset to society by improved interaction with
other people.
(This article will be continued in Facial Implants,
Part III, which will explain about lip, as well as fat injections for the face).
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