Synthetic implants play a valuable role in the treatment of both aesthetic and reconstructive facial problems. While there are a large variety of preformed off-the-shelf facial implants which can be placed in their initial shape or modified during surgery, some patient’s bone and soft tissue volume deficiences are not ideally treated in this manner. While a plastic surgeon’s eye and experience goes a long way, standard implants may only result in facial improvement that may still be wanting in ideal volume and symmetry correction.
The use of computer technology to make custom facial implants has been around for over two decades. Using a 3D CT scan, an actual hand-held facial skeletal model is made out of a polymer material. Off of this model, an implant design can be fashioned by hand or one can be computer-designed. The most common implant materials used is that of either silicone or HTR (hard tissue replacement, Biomet Microfixation, Jacksonville, FL) I haved used this approach for the successful reconstruction of multiple craniofacial and maxillofacial deformities since 1991.
The application of such computer-generated implants has historically not been considered for purely aesthetic facial concerns. The cost of obtaining a 3D CT scan and the model/implant fabrication process was both expensive and time consuming. While the reconstructive facial patient is having all or most of their surgery paid through insurance, the purely aesthetic patient is paying out of their pocket.
In my Indianapolis plastic surgery practice, I have made custom made facial implants for years. Using computer-generated facial skeletal models, a patient’s implant designs were made out of a clay or silicone elastomer material based on my experience, calipers for measurments and my own eyes. Those implant designs were then shared with the patient, any modifications subsequently done and then sent for implant fabrication. (Implantech, Ventura, CA)
But the concept of computer-generated custom facial implants has evolved due to several recent developments. The availability of 3D CT scanning technology, once reserved for large hospitals and university centers, is now readily available in any facility that offers CT scanning. The cost of obtaining a 3D CT scan has dropped dramatically over the past decade. A 3D CT scan that used to cost thousands of dollars can now be obtained for a few hundred dollars. This now makes it affordable for just about anyone anywhere.
In addition, computer software is now available where an implant design can be done exclusively on screen and communicated with the doctor online. The three-dimensional shape of the facial implant(s) and perfect symmetry (if two sides are being done) can be obtained. (Medical Modeling, Golden, CO) This can bypass the time-consuming need to hand make the implant designs. The computer-generated designs can then be sent to a facial implant manufacturer for fabrication. (3D Accuscan, Implantech, Ventura, CA)
Aesthetic facial implant patients have a better option today than in the past. For those patients that have aestheic facial needs for which standard facial implants do not have the right size or shape or have indwelling implants that are inadequate, the 3D Accuscan process now makes it possible and affordable to make truly custom computer-designed facial implants.
Dr. Barry Eppley
Indianapolis, Indiana