Facial implants are synthetic materials that are inserted into the face in order to change contours more permanently and dramatically than can be achieved with injections. Facial implants can alter a person’s appearance in a way that can be quite different from the changes created by a facelift or related procedure, largely by appearing to alter the bone structures that determine a person’s physical identity.
Implants can be small, flexible, and inserted through tiny incisions using a large-bore needle or may be larger and constructed of more rigid materials like solid silicone.
Autografts: Autografts are tissues taken from a patient’s own body and inserted elsewhere. Many tissues, including dermis, dermis-fat composites, fat, fascia, cartilage, and bone, have been used. For example, cartilage from the ear is commonly used to change the contours of the nose. Obtaining an autograft usually requires a separate incision and thus an additional scar. The limited availability of donor areas, especially for large implants, makes the use of manufactured implants more appealing for most cosmetic procedures.
Manufactured Implants: Some implants are manufactured from biological materials such as collagen (Dermaplant) and hyaluronic acid (Dermadeep, Dermalive). Most implants, however, are made from synthetic materials. Numerous substances have been used to augment facial contours for cosmetic purposes. Two of the most commonly used are described below:
ePTFE (expanded polytetrafluorethylene, Gore- Tex, Softform, Advanta): Several manufactured synthetic polymer fillers are available that are formed as medical-grade implants rather than injectable substances, including Gore-Tex (yes, the same stuff your boots are lined with). These implants can fill deeper lines than can collagen and are sometimes used for lip enhancement. They are truly permanent and may become too noticeable over time. They can be difficult if not impossible to remove.
Solid silicone: Solid silicone implants come “off the rack” in many shapes and sizes. A surgeon can also fabricate a custom implant from a silicone block. The operation to insert a silicone implant is usually fairly straightforward, and the most commonly augmented sites are the chin and the cheek prominences. Either local or general anesthesia may be used, and incisions are often made inside the mouth or eyelid to avoid external scars. Some type of splinting, such as taping or an elastic garment, may be used to minimize swelling and bruising.
Patients will have diffi- culty talking, eating, and brushing their teeth in the early period after surgery. Patients usually resume normal activities within a few days. The final effect of the implant will not be evident for months, until the swelling has entirely subsided.
Most complications after implant insertion are related to the presence of the foreign body or to technical factors, such as poor positioning or improper choice of implant size or shape. Implants can also shift into undesirable positions. Eyelid problems and chin numbness can result from surgery in these areas. Implants can become infected or over time cause deformity if the scar around the implant distorts adjacent normal tissues. Any of these complications can result in the need for further surgery and temporary or permanent removal of the implant. Synthetic implants are more likely to cause problems than are autografts. However, autografts can be absorbed or change shape, especially in the presence of infection.
The bottom line: Cosmetic surgeons have long used fillers and implants to fine-tune the results of major operations, and these products can also be used alone to correct lesser contour irregularities. Temporary fillers are popular, mainly because poor results are selfcorrecting and because permanent fillers can be extremely difficult if not impossible to remove without creating a new deformity. However, the cumulative costs of multiple temporary treatments can be significant.
Permanent implants present more surgical risks, and large implants can substantially alter a person’s appearance. Injectable fillers are increasingly used by the unqualified and unscrupulous. Unapproved and nonmedical- grade substances injected into the body can cause complications ranging from painful lumps, serious infections, or hepatitis to death from improper injection into a blood vessel.
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