Candidancy for Custom Midface Mask Implants in the Asian Patient

Ideal candidate selection for custom midface mask implants is less about “wanting more cheek volume” and more about having a true structural midface deficiency that benefits from unified skeletal augmentation.

Good Candidates (Who benefits most)

1. Global midface deficiency (key indication)

• Flat or retrusive midface when viewed from profile
• Poor anterior projection of:
  • Infraorbital rim
  • Maxilla
  • Paranasal region
• Often described as a “sunken” or “concave” midface

These patients benefit most because the implant restores forward projection as a unit, not just spot volume.

2. Prominent tear troughs due to bone deficiency

• Deep tear troughs that:
  • Don’t respond well to fillers
  • Recur quickly after treatment
• Caused by lack of infraorbital support (not just soft tissue)

Midface implants address the underlying skeletal problem, not just camouflage it.

3. Flat paranasal region

• Weak support around the base of the nose
• Deep nasolabial folds from skeletal deficiency (not aging alone)

Especially relevant in many Asian patients where paranasal retrusion is common.

4. Patients who look “tired” despite good skin quality

• Hollow under-eyes
• Lack of light reflection in midface
• Disproportion between lower eyelid and cheek

This is often structural—not a skin or aging issue.

5. Failed or insufficient prior treatments

• Fillers requiring frequent maintenance
• Fat grafting with poor retention
• Standard cheek implants that look:
  • Too lateral
  • Disconnected from infraorbital region

Custom implants provide a more continuous, anatomical correction.

6. Desire for permanent, structural change

• Patient understands:
  • This is not subtle like filler
  • Results are long-lasting and not easily reversible (especially with Medpor/PEEK)

Borderline Candidates (Proceed cautiously)

1. Primarily soft tissue aging (not skeletal deficiency)

• Mild tear troughs
• Good bone structure but:
  • Skin laxity
  • Fat descent

? Better treated with:

• Lower blepharoplasty
• Fat repositioning
• Skin tightening

2. Patients seeking subtle or “trial” enhancement

• Unsure about permanent change
• Prefer reversible options

Start with fillers to simulate projection first.

3. Very thick soft tissue envelope

• Can blunt implant definition
• May require larger implant ? risk of overcorrection

Poor Candidates (Who should NOT get them)

1. Normal or already prominent midface

• Adequate or strong projection already
• Risk: unnatural “overfilled” or “protrusive” look

2. Wide bizygomatic face with lateral cheek prominence

• Common in some Asian facial types
• Adding volume laterally worsens facial width

These patients often need:

• Reduction (zygoma reduction), not augmentation

3. Unrealistic aesthetic expectations

• Want dramatic transformation beyond anatomical limits
• Desire “Westernization” without regard for facial harmony

4. Poor understanding of permanence

• Especially important with:
  • Porous implants (Medpor)
  • PEEK implants

5. Active infection or poor oral hygiene

• Intraoral approach increases infection risk

6. Medical contraindications

• Poor healing capacity
• Immunocompromised states
• Smoking (relative risk factor)

Key Clinical Decision Framework

Comprehensive preoperative evaluation includes:

1. Profile analysis (most important)

• Is the midface retrusive relative to:
  • Forehead
  • Lower face?

2. Infraorbital–cheek junction

• Smooth vs hollow vs step-off

3. Paranasal support

• Nasolabial angle
• Base of nose projection

4. Facial width vs projection balance

• Especially critical in Asian patients:
  • Avoid increasing width
  • Focus on forward projection

Simple Rule of Thumb

• Flat + hollow + forward deficiency ? GOOD candidate
• Full + wide + only wants contour ? BAD candidate
• Aging-only problem ? WRONG procedure

Dr. Barry Eppley

Plastic Surgeon