MedEsthetics magazines offers business education and in-depth coverage of the latest noninvasive cosmetic procedures for physicians and practice managers working in the medical aesthetics industry.
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PERMANENT DEFINITION 62 NOVEMBER/DECEMBER 2015 | Surgical Aesthetics is really big; the cost has come down precipitously thanks to newer computer technologies," says Dr. Eppley. As with any cosmetic plastic surgery, there are risks and benefi ts for the patient to consider. Dr. Doud Galli points outs that, theoretically, you can get some bone loss underneath the implant due to the constant pressure of the implant on the bone. "When you add a chin implant, there's also a risk of nerve damage, though it's very low," she says. "There is also a low risk of a late-stage infection." REVISIONS & PRECAUTIONS Facial implants have relatively low revision rates, but they do vary widely based on the area implanted and type of implant used. The highest revision rates—about 15% nationally—occur in patients who receive cheek implants, and this rate is largely due to dissatisfaction with the aesthetic result, according to Dr. Doud Galli. "I have removed cheek implants from patients who were just not ready for that look and wanted them removed," she says. "Chin implants have a much lower revision rate, about 3% or 4%. I have changed chin implants to make them bigger or smaller, but have never completely removed them. It's really the cheek implants that have given people problems." "The common reasons for revisions in facial implants are not because the patient had a major problem, such as an infection. That's exceedingly low, less than 1%," says Dr. Eppley. "The risk of revision is the same for any aesthetic surgery. It's about aesthetics—did it create the effect you want, is it big enough or is it too small? And equally important, is it symmetrical?" To avoid complications, such as a displaced implant, surgeons must take care to create a small pocket and secure the implant prior to closure. Dr. Morgan fi nds that temporal implants and most chin implants do not need fi xation because the contour of the bone holds the implant in place. For cheek, jaw and midface implants, she uses a tiny metal screw to keep them in place. Dr. Eppley uses the same technique. "To me, it's simple and quick to take a set of small self-tapping screws, about 1.5mm in size, and screw the implant wherever you want," he says. "When a patient fi rst hears that an implant will be screwed in, they envision large screws being drilled into the bone. But the size of the screws we are using today are the size of a screw in a pair of eyeglasses. So they're quite small, and you do not need a drill. The screws are very sharp; you take a screwdriver to screw it right into the bone." To reduce the risk of infection, Dr. Rizk places his chin implants through a small incision under the chin rather than through an intraoral incision, which exposes the implant to oral bacteria. "This incision is practically invisible as it is placed inconspicuously in a place where scars are common," he says. "This technique allows me to place the implant in a more precise manner and more securely." Dr. Doud Galli creates a precise pocket for her chin implants and puts a dissolvable stitch, instead of a screw, through the implant to hold it in place. MATERIAL PREFERENCES Silicone is the most common material used to make facial implants and the most popular among the physicians we interviewed. Dr. Morgan prefers the smooth, soft silicone implants from Implantech, the largest manufacturer of facial implants, and she specifi cally prefers their Contour implants. "These implants can be lined with Gortex to help hold them in place, but the main implant material is soft, solid silicone," she says. Dr. Doud Galli prefers silicone implants because you can carve them and customize them as needed. "They're still my go-to because the soft silicone is easier for me to work with," she says. "They are also easy to remove later if needed, because you don't have any ingrown tissue. I like the way they look and the way they feel as well. They are very inert and have a low rate of infection compared to other products." Dr. Eppley agrees. "I prefer silicone because it offers the greatest number of styles and options. You can place these implants through smaller incisions because they are smooth. Silicone is also much easier to revise and has the lowest rate of potential infection." Daniel Casciato is a Pittsburgh-based freelance writer. SURGICAL AESTHETICS "We know the mid- and upper face are high risk areas for fillers—fat injections especially. So for the temple and undereye area, I recommend implants to start and view off-the-shelf fillers as a second option."