While implants have been used to aesthetically augment the lower two-thirds of the face, less implant augmentations have been done in the upper third of the face in the forehead. The main reason, of course, is that there are historically no standard forehead implants available and part of the reason for this is that the patent demand is low. As a result the primary method of forehead augmentation today is best done by a custom implant approach due to the varying aesthetic forehead needs of different patients.
Different materials are available for custom forehead augmentation use such as solid silicone, PEEK and Medpor, but few reports exist with their use. While there are stadhard silicone and ePTFE forehead implants available around the world their use is generally limited to small forehead augmentations.
In the February 2024 issue of the Aesthetic Plastic Surgery journal an article was published on this topic entitled ‘Endoscopic-Assisted Forehead Augmentation with Polyetheretheketone (PEEK) Patient-Specific Implant (PSI) for Aesthetic Considerations’. In this clinical study the authors review their experience in eleven (11) patients using custom designed implants. The implants were designed using standard virtual surgical planning (VSP) methods and then manufactured using computer-aided technology which is how PEEK implants are made. Then through a scalp incision the subperiosteal forehead pocket was dissected aided by the endoscope. The implants were placed and fixed by screws.The total operative time averaged less than 90 minutes in most cases.
Their clinical results with adequate long term followup showed no implant exposure, extrusion or removals were reported. (they did not say specifically no infections but I assume that none occurred) Aesthetic satisfaction was generally high by Face Q scores.
What this study fundamentally demonstrates is that the use of PEEK material for aesthetic forehead augmentation with a custom design can be safely and successfully done. Given the track history of PEEK in other inlay skull and onlay facial sites this is to be expected. But the key to placing PEEK implants in the forehead with relative ease is buried in the size of the implant dimensions. The average implant thickness was around 4mm, a fairly small implant thickness in my experience although suited to their Asian patient needs. Thicker and larger surface area implants become more challenging to place and would need a coronal scalp incision to place which few patients would find acceptable for an aesthetic operation.
Dr. Barry Eppley
World-Renowned Plastic Surgeon