The effectiveness of standard facial implants is based on their ability to improve the natural convexities of the facial bones. The bony projections of the chin, jaw angles and cheeks make up the majority of available facial implant types. These three prominences make up the important bony triangle of the face which together make a major contribution to its appearance.
But not all facial augmentations are to improve convexities, some are to change the shape of a concavity. Such facial areas for implants are less recognized but can be augmented nonetheless. The midface is the largest concavity of the face and lies between the more prominent infraorbital rim superior and the maxillary alveolus inferiorly. It has a completely concave shape due to the underlying maxillary sinus and transmits masticatory forces through its somewhat thicker buttresses.
The only standard alloplastic midface method is that of the paranasal implant. Its purpose is to provide improved projection to the overlying base of the nose. It is one of the smallest facial implants and its midface effect is limited.
Custom implants create the opportunity for major midface augmentation. By designing an implant that can cover most or all of the midface, improving horizontal midface projection can be can be achieved. Once seen as only obtainable by various types of midface osteotomies, a custom midface implant does so more effectively. (minus the forward teeth movement) Placed through a intraoral approach such midface implants are placed around the infraorbital nerve through an implant splitting technique.
For patients that are seeking to improve their midface projection, decreasing the natural concavity of the midface by changing its shape can be very effective. Changing a concave shape to a more flat surface improves external projection. This has value in flatter midfaces from either congenital/ethnic origin, traumatic deformities or significant facial lipoatrophies.
Dr. Barry Eppley
Indianapolis, Indiana