Custom Computer Generated Implants

Although you hear a lot of people discussing custom facial implants, it is really not a new technique.  I believe I performed some of the first custom facial implants in the State of Virginia as evidenced by the balding young doctor in the 1990 article below.

Although the process is similar, a lot has changed in the past 22 years.  The CT scanning has become much more finite and accurate and the implant modeling technology has also advanced.  Today it is possible to make extremely accurate models of human facial anatomy from office CT scans.  In the past, patients had to go to the hospital for an expensive scan.  Our practice now owns two scanners and we can perform in office scanning that is very accurate.

The reason people choose custom facial implants is all in the name; it is custom!  Some patients choose this to simply have a 100% personalized implant that they can have a say in designing.  Others choose a custom implant because they have some type of asymmetry or similar problem that an “off the shelf” facial implant won’t address.  It is similar to buying a tailor made suit.  A man or woman could probably find a really nice fitting suit on the rack at a store, but no matter what, it would not fit as well as one that was custom designed.  Same with the facial implants.  I will say, that after placing over 1,000 facial implants since 1990 that the stock (off the shelf) ImplanTech silicone implants fit the average patient extremely well.  This is because they are designed on human skulls and are anatomically averaged for most patients.  Usually they work fine, but again, there are those patients that want or need more customization and this is the power of custom facial implants fabricated from a CT generated model.

The actual scan takes about a minute and is very similar to having a panoramic dental Xray (Panorex).

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Dr. Niamtu is shown with some custom facial implant cases and the office CT scanner is show on the right.

The scan can then be interpreted by the surgeon and sent off to a medical modeling company.  The company I primarily work with is Medical Modeling in Golden, Colorado as they have been a leader in the business for decades.  The company takes the digital information from the CT scan and enables an anatomic model to be fabricated by complex laser modeling technology.

The CT scan shows the facial structures, this data is then sent off for model fabrication.

The actual anatomic model is then sent back to the surgeon to study and begin the custom facial implant fabrication.  I, personally, like to involve the patient and if they are local they can come in and provide hands on fabrication with modeling clay.  We use polymer clay to determine the general outline and contour of the facial implant.  We may also use wax or silicone in the fabrication.  For our of town patients, we do it virtually via Web.

The above image shows the custom implants being fabricated from clay and silicone to the exact dimensions of the model.

Once the surgeon and patient agree on the implant it is sent back to ImplanTech, Inc. for preliminary fabrication.  They then send back the preliminary implant and again the patient and surgeon to approve.  Sometimes this takes several trials and one negative thing about custom implants is the fact that there is time lost sending preliminary trials back and forth to the company.  Fortunately, experienced surgeons and realistic patients, usually get it on the first trial.At this point, the final implants are sent back to the surgeon in sterilized packaging and the surgery is performed.

The above image shows final implants ready to be sterilized and placed in the patient.

Custom facial implants are more expensive than stock implants due to the obvious steps of having a CT scan, an anatomic model, and surgeon time in case planning.  The process usually adds approximately $2,500 to the normal stock implant fee.