Malpositions of custom facial implants can be visible externally or can only be palpable. This is a really useful way to think about it, because not every “miss” actually shows—and some that are barely measurable can be surprisingly visible.
I’ll break it down by visible vs. palpable vs. both, then give you the patterns by region.
Quick framework
Visible errors
- Affect light, shadow, symmetry, or silhouette
- Usually involve position, projection, or rotation
Palpable-only errors
- You can feel them, but they don’t change surface contours enough to see
- Usually involve edges, step-offs, or minor seating issues
Both visible + palpable
- Larger or strategically placed errors
- Often along borders or high-contour areas
Chin (Mentum)
Highly visible
1. Midline shift (even 1–2 mm)
- Very noticeable, especially from the front
- Humans are extremely sensitive to midline asymmetry
2. Rotation (one side more projected)
- Shows as uneven chin fullness or asymmetrical shadow
Visible + palpable
3. Too low placement
- Visually: heavier, elongated lower face
- Palpable: you can feel the inferior edge sitting too low
Often palpable-only
4. Minor inferior border step-off
- Small mismatch along the bottom edge
- Usually not visible unless thin skin + strong lighting
Jawline (Mandibular angle/body)
Highly visible
1. Posterior misplacement (angle too forward/back)
- Changes facial width and jaw “sharpness”
- Very noticeable in ¾ view
2. Vertical asymmetry (one side lower)
- One side of the jaw looks heavier or longer
- Often seen in photos before patients feel it
Visible + palpable
3. Inferior border step-off
- Visible as a contour irregularity in lean patients
- Palpable as a ridge or discontinuity
4. Rotation along the body
- Subtle visually (slight width or flare difference)
- Palpable as uneven thickness or edge position
Often palpable-only
5. Small seating gaps along the body
- Tiny areas where implant isn’t perfectly flush
- Felt as slight irregularity, rarely seen
Cheek (Malar/Submalar)
This is where things get interesting—small changes are often visible before they are palpable.
Highly visible
1. Too lateral vs. too medial
- Affects facial width immediately
- Even small differences change how “wide” or “flat” the face looks
2. Too high vs. too low
- Alters lower eyelid-cheek junction
- High = unnatural fullness near eye
- Low = bottom-heavy cheek
3. Anterior–posterior misplacement
- Changes perceived projection
- Shows in profile and ¾ views
Visible + palpable
4. Edge visibility in thin patients
- You may both see and feel the implant margin
Often palpable-only
5. Minor asymmetries in thickness or seating
- Usually not visible unless they cross a key highlight zone
Patterns that aren’t obvious at first
1. Midline errors are the most visible per millimeter
- Chin midline shift: very visible
- Same 2 mm error on jaw body: often subtle
2. Vertical errors show more than horizontal in the lower face
- A 2–3 mm vertical drop in the jawline = noticeable
- Same horizontal shift = often less obvious
3. Cheeks amplify small errors
- Because they affect light reflection, not just structure
- Even slight misplacement changes highlights and shadows
4. Borders are where palpable becomes visible
- Inferior mandibular border
- Chin edge
- Zygomatic edge (in thin patients)
If an error crosses a transition line, it often becomes visible.
5. Some things you feel will never be seen
- Tiny gaps between implant and bone
- Very small step-offs under thicker soft tissue
- Slight internal asymmetries masked by skin and fat
Simple mental model
- Position errors (where it sits) ? usually visible
- Projection errors (how far it sticks out) ? visible
- Edge/fit errors (how it contacts bone) ? often palpable
- Rotation errors ? often both
Bottom line
- Chin: small errors = very visible (especially midline)
- Jawline: moderate tolerance; border issues can show
- Cheek: small errors can be surprisingly visible due to lighting and contour
Dr. Barry Eppley
Plastic Surgeon