Some Doctors Say Cheek Implants Don’t Work!

From time to time I hear patients say that their surgeon told them that cheek implants are not a good option because “they don’t work” or they “dissolve bone” or they have “taken out more than they have put in”.

Having placed hundreds and hundreds of implants and having cheek implants in my own face, I whole heartedly disagree and feel that there are common problems with the technique of some surgeons that leads to implant failure.  Let’s examine some.

  1. Improper Diagnosis- to have a successful implant result, the surgeon must make the correct diagnosis and utilize the correct configuration of implant. Placing a submalar implant in a patient with later malar deficiency may not look normal and placing a combined submalar shell in a patient with only submalar deficiency may look worse.  It is key for the surgeon to understand the various midface deficiency patterns and understand the proper style and size of the correct implant.  Good oral hygiene without dental or periodontal disease is also important.  Although implants can be placed in smokers, they may have a higher rate of complications.

    Figure 3
    Diagnosis of the patients condition and proper implant choice are paramount for a great result.

  2. Unrealistic Patient Expectations- all cheek implants can make a great impact on facial rejuvenation, they are not a panacea for all patients. Some patients present with full faces thinking implants will give them a chiseled look.  This will not happen.  In other situations, a patient can present with severe facial wasting and think implants will fill out the entire face.  Finally, some patients think that a cheek implant will lift the jowls and lower face.  This won’t happen.  It is important to have patients with realistic expectations.
  3. Incorrect Implant Material– cheek implants come in numerous materials and nothing has more advantages than silicone.  It is very biocompatible, very easy to bend to the contours of the facial bones, very easy to penetrate with fixation screws and very easy to trim.  Perhaps the most important quality is that they are easy to remove.  We rarely need to remove cheek implants, but if desired or necessitated, silicone implants come out in seconds.  Some materials such as plastic or polyethylene are not as forgiving.  They do not bend to the underlying contours, they can fragment when drilling or trimming and they can be difficult if not impossible to remove.  These implants become ingrown to the tissues and when removed usually fragment into many pieces.  In addition, they can be very damaging to surrounding tissues which can tear or come out do to being ingrown to the implant.
  4. “Floating Implants”- for decades I have advocated securing all implants to the underlying bone with micro fixation screws. Yes, it is possible to have successful implants that are not screwed in, but I can testify that I have treated many failed implants placed by other surgeons that migrated due to lack of fixation.  Cheek implants are subject to movement by the powerful facial muscles and it is not uncommon for them to migrate, especially in the early post-operative period.  If an implant is fixated with micro screws, it won’t migrate; it can’t.  Also, I feel that there is definitely increased bone resorption with non-fixated implants.  Moving the face day in and day out can produce micro movements to non-fixated implants which can dissolve underlying bone.  Finally, if a non-fixated implant becomes infected, it has to be removed.  Implants that are screw fixated can frequently be salvaged with antibiotics and open antibiotic irrigation.  I have done this numerous times.

    Nappi, Robert Not my patientThe image above shows an implant placed by another surgeon that was not screw fixated and has eroded through the tissues into the mouth.  I have never seen this happen with an implant secured with a screw.

    Figure 28
    The above image shows typical screw retention of silicone implants placed by Dr. Niamtu.  These implants will not float, move or extrude through the tissues.

  5. Improper Placement- Successful cheek implants require a surgeon who truly understands midfacial anatomy, biomaterials and possess good surgical skills. Generally, the more implants a surgeon has placed the better his or her experience.  Proper placement requires close observation to natural landmarks such as the infraorbital foramen, pyriform aperature, orbital rim and teeth.  The implant must be placed so it follows the natural contours of the face and lie symmetric on both sides in the three dimensions.  Failure to understand this can produce unbalanced and unnatural results.

    Figure 33 tail bend

    Close attention must be paid to the placement and alignment to ensure a symmetric result.  Experienced surgeons such Dr. Niamtu appreciate this concept.  The lower sided picture shows how an implant can “roll under” if close attention is not paid to proper placement.

  6. Numbness and Facial Pain- I hear patients say that their surgeon told them that there is a high incidence of numbness and facial pain from cheek implants. Most patients will have minor post-operative pain and numbness for the first week or so, but it is EXTREMELY RARE to have permanent nerve problems.  Experienced surgeons know where the nerves lie and also can relieve the implant to prevent it from rubbing on the nerve.

    P5190070
    The above image shows an implant placed by Dr.  Niamtu.  Notice how the implant is retained by a micro screw and notched to prevent impingement on the supraorbital nerve.

    The following cases show successful cheek implant cases by Dr. Joe Niamtu, III.  Some of these patients also had other simultaneous cosmetic facial surgery procedures.  Study their midface and you will appreciate how the cheek implants enhanced the rejuvenation.

    Figure 41 Figure 37 Figure 42 Figure 43

Like everything else in life, knowledge and experience usually produce great things and this is true with implants.  When the above five parameters are understood and followed, facial implants are an easy, effective, permanent and reversible means of producing a youthful midface.  Experienced surgeons with realistic patients and great surgical technique rarely have implant failures.

A screw fixated implant can last a lifetime, but be removed in 10 minutes or changed in size in about 25 minutes, making silicone facial implants a mainstay of cosmetic facial surgery.  Cheek implants are a simple, effective, customizable,  permanent and reversible procedure.

Some doctors say “cheek implants don’t work”.  I have successfully treated hundreds of patients over the last 20 years with cheek implants and have them in my own face.  I say “cheek implants work great in experienced hands”.

For more information about facial implants by Dr. Joe Niamtu, III visit   www.lovethatface.com 

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia