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While the incidence of infection in facial implants is fairly low, 1% to 2%, it is not zero. The definitive treatment for any facial implant infection is removal. This works 100% of the time for a successful resolution of the infection. But more times than not the patient will want an implant eventually replaced whether it was the original implant removed or a new custom implant made. The question then is how long to wait before placing a new implant and what will be done differently to lower the risk as much as possible of recurrent infection.

There is no standard time period to wait for re-implantation but longer is better than shorter. I prefer the minimum time of at least 3 months.

But regardless of the time period the reality is the risk of recurrent infection is higher with the next implant when there has been a prior implant infection. With that I understanding I like to do an additional strategy of infection prevention. Prior to placement the implant(s) are prepared with antibiotic wells. These are placed into the implants by dermal punches, cutting full or partial thickness holes into the implant.

The implants are then coated with antibiotic Vancomycin powder pushing as much of it into the holes as possible. This makes the implant a carrier for some level of antibiotic that would be released after surgery for a limited time period. The goal is to reduce as much as possible the ability to attach to an implant’s surface which is the first necessary step in the development of a subsequent infection.

There is no magic method which will assuredly prevent all facial implant infections. But the importance of preventing bacterial adhesion to an implant’s surface isn the one intraoperative maneuver than surgeons can do. ( besides the typical IV antibiotics and washing the implant in an antibiotic solution. While some surgeons talk about washing or bathing an implant in an antibiotic solution this is not s effective as one would think given the hydrophobic nature of an implant’s surface. Changing the surface of the implant where an antibiotic can cling to (antibiotic well) is a potentially useful strategy.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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