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Traditionally augmentation of the midface was perceived as that of cheek implants. Or it could have meant premaxillary/paranasal or tear trough implant augmentation. These associations are made because these facial implants are what is available as standard or off-the-shelf midface style implants. As a result surgeons have been forced to mix and match these standard implant types when trying to make various types of midface augmentation changes.  

But custom implant designing changes the entire perception and capability of midface implants. It is possible to create any amount of bony surface area coverage from the infraorbital rims down to the maxillary alveolus and even out onto the zygomatic arches as a single implant. This opens whole new possibilities when thinking about changing midface shapes.

One unique application of custom midface implants is to create  anterior or sagittal projection of the midface. This is historically only capable of being done through LeFort type osteotomies at their various levels. But a custom midface implant can be designed to build up the infraorbital rim down to the maxillary alveolus and around the base of the nose….but without any addition to the cheeks which avoids any midface/cheek widening. This creates the ability to ‘pull the central midface forward.

This type of custom midface implant can be placed exclusively through an intraoral approach. But if the infraorbital rim component saddles the bone to any degree the intraoral approach will need to be supplemented with a lower eyelid incision as well.

The key in its placement is to get it around the infraorbital nerve. The implant is designed with the location of the infraorbital foramen in it which is cut out during surgery. Then a medial or lateral slot is cut out from the nerve opening so the implant can be opened up and stretched around the nerve during placement. The elastic deformation property of the material allows it to snap back closed around the slot once positioned.

For those patients that have adequate facial width but with lack of adequate forward midface projection this custom implant style creates complete bony surface coverage which no standard implant stye can do. Having a smooth and continuous augmentation more closely resembles what the natural bone would be like if it had a more forward position.   

Dr. Barry Eppley

Indianapolis, Indiana 

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