Occasionally, the desired multicurvilinear line of beauty (double ogee) cannot be achieved solely with the volume-enhancing soft-tissue techniques described earlier in the chapter. Under these circumstances, alloplastic augmentation of the craniofacial skeleton should be considered. A variety of alloplastic facial implants are currently available that allow correction of residual volume deficiencies. Rubber polysiloxane (silicone) and high-density porous polyethylene implants are currently the most common alloplastic materials available for facial augmentation procedures.
Solid silicone implants are manufactured in a wide variety of shapes and sizes. The implants are soft and pliable and can be inserted with ease. However, the smooth surface of silicone implants does not permit vascular or soft-tissue in-growth. Fibrous tissue encapsulation is characteristic of solid silicone implants. Morbidity related to silicone implants includes infection, extrusion, and displacement, as well as bone erosion by the implants . The process of encapsulation makes removal of silicone implants technically less challenging when necessary.
High-density porous polyethylene implants such as Medpor (Porex Surgical, Newnan, GA, USA) are also manufactured in a variety of shapes and sizes. (Fig. 43.12). In contrast to silicone, the porous nature of these implants allows in-growth of both soft tissue and bone . The morbidity related to porous polyethylene implants includes infection, extrusion, and seroma formation. The incorporation of the polyethylene implant into native tissue accounts for a significantly lower risk of infection and extrusion compared with the risks with silicone implants . However, morbidity can be significantly increased when removal of porous polyethylene implants is necessary. Bone and fibrous tissue in-growth can make implant removal a formidable task. Patients must be informed of these characteristics when considering alloplastic facial augmentation with porous polyethylene im-
plants. We prefer to use porous polyethylene implants based on the aforementioned characteristics in addition to the fact that the implants can be easily shaped (by scalpel) to fit anatomic skeletal variations. We have used preformed porous polyethylene implants along the superolateral orbital rim and/or the malar area to create the optimal convexities of the double ogee when soft-tissue augmentation alone is insufficient. (Fig. 43.13). Placement of mandibular angle and chin implants is also considered, selectively, to maintain an aesthetic balance between the upper two thirds and the lower third of the face. Use of the superolateral orbital rim implant is demonstrated in the patient example shown in Figs. 43.14 and 43.15.
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