NOV-DEC 2015

MedEsthetics—business education for medical practitioners—provides the latest noninvasive cosmetic procedures, treatment trends, product and equipment reviews, legal issues and medical aesthetics industry news.

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60 NOVEMBER/DECEMBER 2015 | Surgical Aesthetics PERMANENT DEFINITION means immediate results, no incisions and no downtime. However, there are select cases where implants are the better option. "We know the mid- and upper face are high risk areas for fi llers—fat injections especially," she says. "So for the temple and undereye area, I recommend implants to start and view off-the-shelf fi llers as a second option." Dr. Morgan will also suggest an implant over injectable fi llers if the cost of fi ller injection is prohibitive for the patient and for patients at high risk of allergic reaction. Patients who are happy with the results they have obtained with dermal fi llers but want a longer-lasting solution may also benefi t from autologous fat grafts in lieu of an implant, adds Dr. Eppley, though he cautions that different parts of the face respond differently. "You have to look at each area on the face individually and determine the optimum solution because they often may not have the same identical effect," he says. "If you're looking for a chin augmentation, for example, we know an implant provides the best looking outcome. Since an implant is harder, it sits on top of the bone and pushes the chin out to create a more defi ned result." For patients who need more volume and defi nition in the midface, particularly in the lower part of the cheeks, there are currently no implant options available, so dermal fi llers or fat injections are the only options, notes Dr. Eppley. "On the other hand, if you're trying to accentuate your jawline, you can add fi llers or fat but it's not going to give you the sharp detail of a jaw implant," he says. Dr. Rizk, who offers a variety of dermal fi llers as well as autologous fat grafting, fi nds that the facial implants he reaches for most often are chin implants in both male and female patients. "It's a simple procedure with high patient satisfaction and is often performed with rhinoplasty to improve the patient's profi le and proportions," he says. He estimates that about 30% of his rhinoplasty patients also receive a chin implant. Other patients who benefi t from chin implants include those with weak projection undergoing liposuction in the neck and some neck lift and facelift patients. "It can signifi cantly improve facial balance and produce an aesthetically pleasing effect," he says. "Now that people are learning the limitations of fi llers, there is an increasing demand for implants, which are a per- manent solution," says Dr. Morgan. "Surgeons have learned an enormous amount about implants, and the technology of implant manufacture has made huge advances." One of the most signifi cant advances is the ability to create custom implants at a much lower cost. "We're now using patients' 3D CT scans to customize and design any type of facial silicone implants we want. Not only are there new styles and sizes available, but the ability to customize them The temporary nature of dermal fi llers is also a drawback for some patients who, happy with their fi ller results, now desire a more permanent solution. "Over the past 10 years, the use of facial implants as a permanent volumetric facial skeletal enhancer is greater than ever," says Barry Eppley, MD, a board-certifi ed plastic surgeon based in Indianapolis. "Since you can put an injectable fi ller anywhere in the face, more patients will try a fi ller fi rst to see if they like it, and then seek out a permanent solution. As a result, implant manufacturers are trying to meet patient needs by creating various types and styles of facial implant aesthetics." Today, surgeons have a wide variety of off-the-shelf options, including chin, mandibular, midface and even temporal implants. The majority are made of soft silicone. "Other implant choices that are less commonly used are Medpor and polytetrafl uoroethylene," says Sam Rizk, MD, a New York City-based facial plastic surgeon. "These are more porous than silicone which makes them more diffi cult to remove if they become displaced or infected." PATIENT SELECTION The key considerations when recommending a fi ller or implant include: the amount of defi nition desired, the patient's budget in terms of both money and downtime, and the desired longevity of results. Elizabeth Morgan, MD, of Morgan Cosmetic Surgery in Atlanta certainly understands why fi ller injections are currently more common. No surgery © GETTY IMAGES SURGICAL AESTHETICS The cost of custom implants, made using the patient's CT scan, has come down signifi cantly in recent years.

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