While facial implants are commonly used to highlight the convex bony prominences of the cheeks, chin and jaw angle for purely cosmetic purposes, they have applications to other facial regions and problems as well. They can be very useful in bony deficiencies as well such as midface and mandibular hypoplasias as an orthognathic surgery alternative.
In these orthognathic deficiencies, the face is deficient in the cheek, paranasal and jawline regions but their occlusion is perfectly normal…or has already been orthodontically corrected. This obviates the use of maxillary and mandibular osteotomies to correct the facial appearance. But the use of implants can be used to simulate what would otherwise be achieved through bony movements.
Chin implants are the most well known example of an orthognathic surgery alternative. Bringing the bony prominence of the chin forward can virtually replicate the identical lower facial change to that of mandibular advancement osteotomies. While a mandibular osteotomy can only bring the chin forward as far as the distance that makes the occlusion fit, implants are much more versatile. Not only differing in the horizontal thickness of the implants, they also can add width and different shapes to the central chin. (square to more angular) If custom implants are used, the chin can also be vertically lengthened as far back as to the jaw angles.
Some elements of midface or central facial deficiencies are the result of a very concave pyriform aperture shape. This makes the nose undersupported making it appear flat with wide or even flared nostrils. This can also extend onto the base of the nose under the columella where it is supported by the projection of the anterior nasal spine. A short spine or near absent spine allows the columella to be recessed and one have a 90 degree or less nasolabial angle. Augmentation of the paranasal region (pyriform aperture) can simulate the effect of a LeFort I maxillary osteotomy using either paranasal, premaxillary or both implant types. This helps pull out the nose and its base with increased central projection and less flattening.
If one goes above the level of the maxilla, most people quickly think about flat or weak cheek bones. As a general rule, if the cheeks are flat the entire midface below it will also be. But cheek flatness usually also involves the infraorbital rim medial to it as well. This zone is one of the least appreciated areas of midfacial skeletal deficiency. A variety of midface implants are available for the cheek and infraorbital rim that create the visual effect of a LeFort III osteotomy. When the bony deficiency extends across the cheek to the nose, cheek implants alone may accentuate the existing infraorbital rim recession.
Implants can be used to simulate the appearance of facial skeletal osteotomies in patients with either normal or orthodontically corrected occlusions. Often a combination of facial implants is used, particularly in the midface, to create the overall effect of increased skeletal projection.
Dr. Barry Eppley
Indianapolis, Indiana