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Traditional and well known facial implants are that of the chin, cheeks, or nose. Implants work by extending the outer boundary of bony prominences, resulting in visible external facial changes. They can be used to correct an underlying bony deficiency or cosmetically enhance a more normal bony prominence. Implants have now developed so they can be used for the nose, jaw angle, and the maxilla as well.

Most facial implant use is to enhance one area as single implant, such as the chin, or two implants when used bilaterally, such as the cheeks. Multiple facial sites can be implanted at the same time to create a more significant change if the anatomy merits it. Common combinations include cheek and chin augmentation which I call a facial duet. When chin, cheek and jaw angle augmentation are simultaneously done, this is known as a facial trio.

Another good facial implant combination is to augment a total midface deficiency, thus increasing facial convexity. Midface deficiencies appear as a flatter face or a midface that may even be concave. It is seen as the middle of the face having flatter cheekbones and a recessed base to the nose. (paranasal region) The entire midface is more shallow from below the eyes down to the upper teeth. When the midface lacks enough forward projection, it impacts how the rest of the face looks making the nose and chin look bigger and the upper lip look smaller and thinner. One may also see an underbite when looking inside the mouth or an edge-to-edge bite at the incisors. (if not already orthodontically compensated)

The combination of cheek and paranasal implants can be a good treatment approach for midface flattening. By bringing out the cheeks and the base of the nose, facial convexity in profile is increased. This is done by using four implants (two cheek and two paranasal) placed through incisions inside the mouth under the upper lip. In my Indianapolis plastic surgery practice, I always secure these implants to the underlying bones to ensure their position after surgery. Implant migration and displacement is the number on complication after any facial implant surgery. While some plastic surgeons feel that the choice of implant material is important, I do not. Proper zones of augmentation combined with good sizing and placement, however, is more important for an uncomplicated outcome.

With better facial profile convexity, the nose may appear smaller and may not need any change. Most such patients, in my experience however, do benefit from simultaneous rhinoplasty for optimal facial balance. Midfacial recession is often characterized by a nose that has a wider base and poor tip projection. Computer imaging prior to surgery can answer the question as to whether any changes in the nose are aesthetically advantageous.

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