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Background: There are only two effective surgical methods for creating a complete midface augmentation effect. The most well known are the variety of LeFort osteotomies. They work by moving whatever amount of bone that remains attached to the dentoalveolar complex based on the location of the osteotomy line. In a Lefort III the osteotomy line crosses the infraorbital rim and includes part of the cheek bone. Its effects can be limited as amount of midface augmentation depends on where the attached teeth can be moved. While this is a good operation for more severe midface retrusions and those associated with malocclusions, its use  has substantial limitations in the aesthetic midface deficient patient.

In the custom midface implant the dentoalveolar arches are left intact. The bone above the arches can be augmented over any part of the midface and by almost any amount desired using an onlay augmentation approach. It is more versatile than a LeFort osteotomy as the implant design can have any thicknesses throughout its large surface area of coverage. While most custom midface implants can be placed completely through an intraoral approach, the higher the level of the infraorbital-malar coverage the more likely a lower eyelid incision may be needed as well.  

Case Study: This male desired a complete or extended midface augmentation from the infraorbital-malar line down to the nasal base. A midface implant was designed that had complete coverage even out onto the zygomatic arches.

The greatest thickness of the implant was over the infraorbital rim, anterior cheeks and premaxillary-paranasal areas…the convex areas of the midface.

Because of the size of the midface implant it was designed to be made with a horizontal split line that went through the infraorbital nerve opening.

As a result it was a three-piece implant that used a combination intraoral and lower eyelid incisions for placement.

When seen 3 years after the procedure the midface augmentation effect was complete and natural looking.

 Of all the custom facial implants the more complete midface styles are the least well known…and probably underutilized.

Case Highlights:

1) When the occlusion is acceptable the entire midface can be brought forward/augmented with a custom midface implant.

2) A extended custom midface implant is similar to a LeFort III osteotomy with the exception of a smoother effect across the infraorbital rims out across the zygomatic arches.

3) In the extended custom midface implant a split design is used with a resultant three piece implant placed through three separate incisions.

Dr. Barry Eppley

Indianapolis, Indiana

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