Facial Implants – Are They Right for You?

Reviewed by: Barry L. Eppley, MD, DMD

Facial implants play a greater role in aesthetic plastic surgery today than ever before. Following the widespread demand and use of off-the-shelf injectable fillers and fat injections, demand has grown for a more permanent option that can cater to the same aesthetic goals. Enter facial implants. They are composed of solid materials — like silicone — that are compatible with human tissues.

In the past this type of cosmetic treatment was limited to a few standard-sized implants for the chin and cheeks. But today’s implants come in many shapes, styles and sizes, meaning there is now a treatment solution for virtually all areas of the face — from the temple to the jawline and everything in between.

In addition, the use of 3D CT scans now facilitates custom facial implant procedures such as those aimed at addressing facial asymmetry or treating uncommon aesthetic needs. This technology also facilitates reconstructive facial surgeries involving implants. Facial implant procedures may be standalone or part of other facial rejuvenation procedures such as facelift and blepharoplasty.

Best Candidates for Facial Implants

The best way to find out if you are a candidate for facial implants is to set up a consultation with a qualified plastic surgeon. In general, the best facial implant candidates have naturally weak facial bones around the eyes, cheeks, midface, or chin and jawline. The use of synthetic injectable fillers can be used as a trial method to see if a more permanent implant option is right for you.

The Procedure

Facial implant surgery is usually performed by a board-certified plastic surgeon. The procedure typically takes place in an office surgical suite, outpatient surgery center or hospital, depending on the overall plan. Time-in-surgery depends on the specifics of the treatment area and number of facial implants, as well as what — if any — additional facial procedures are being performed. Treatment could last anywhere from 30 minutes to several hours. Most facial implant cases are done on an outpatient basis, but more extensive facial augmentation procedures may require an overnight stay.

The procedure may be performed under local anesthesia (awake, but sedated) or general anesthesia (asleep). You can discuss the appropriate type of anesthesia with your doctor and the anesthesiologist.

The most common facial implants are chin, jaw, cheek, nose, orbital (around the eye) and temporal (sides of the skull) implants. Sometimes more than one type of implant is needed. Your doctor can help make this determination during your consultation.

Chin Implants

Chin implants come in many different styles that provide horizontal, vertical and square width that extends back along the jawline. A chin implant can be placed through an incision under your chin or inside your lower lip depending on size and preference. The chin implant is inserted and secured to the bone by sutures or small screws. The procedure takes roughly 30 to 45 minutes if performed on its own.

Jaw Angle/Jawline Implants

Jaw-angle implants — often called jaw or jawline implants — augment the back part of the jaw. They are available in different styles including a widening jaw-angle implant and a vertically lengthening jaw-angle implant to help create a stronger and more defined jaw. They are placed inside the mouth via incisions made behind the molars and under the large jaw muscle. Jaw implants usually need to be secured in place with small screws to prevent displacement. Jaw-angle implants are often done in combination with a chin implant — particularly with men — to enhance lower face aesthetics. The procedure takes 60 to 90 minutes to perform.

Cheek Implants

Cheek implants are available in many different styles to augment the cheekbone (malar) and/or the area on its underside (submalar). Different effects can be created using the various implant styles. Cheek implants are placed via small incisions made high under the upper lip. In some cases, they may even be placed through eyelid incisions if eyelid surgery is being done simultaneously. They can be placed on the front part of the cheekbone or further back along the tail depending on implant style and the desired effect. The procedure takes approximately 60 minutes to perform on its own.

Nose Implants

Nasal implants can help elevate the bridge or dorsal line, and/or improve tip projection. They can be done alone, but more often are done as part of an overall nose reshaping surgery.

Augmentation of the base of the nose is done using paranasal implants. This implant wraps around the pyriform aperture (heart- or pear-shaped opening in the human skull) of the nose to provide midface projection by pushing the base of the nose outward. It is usually placed via an incision crafted inside the mouth below the upper lip. It can also be placed with an incision inside the nose during rhinoplasty.

Orbital Rim/Tear Trough Implants

Permanent augmentation of undereye hollows or infraorbital rim weakness can be done using orbital rim or tear trough implants. Placed through any one of a variety of lower eyelid incisions, these implants are positioned along the infraorbital rim to add projection and undereye fullness. While they can be placed by themselves, tear trough implants are often part of a more complete lower eyelid rejuvenation.

Temporal Implants

New temporal implants — when placed through a small incision in the temporal hairline — can address temporal hollowing. They are placed on top of the temporal muscle, just under its enveloping tissue. These muscle augmentation implants are available in two basic styles: standard — filling in the hollowing to the side of the eye — and extended — from the side of the eye up to the side of the forehead. Often performed as an isolated procedure, placing temporal implants takes approximately one hour to perform.

Lip Implants

Made of a soft, spongy cylindrical implant, lip implants are designed to mimic the soft tissue feel of the lips. They come in different lengths and thicknesses to accommodate all manner of facial aesthetics. The implants are placed from small incisions inside the corners of the mouth under local anesthesia, often in an office setting.

Custom-designed Facial Implants

The array of facial implants has grown due to new designs as well as the desire for permanent results that mimic those seen with temporary fillers, but off-the-shelf implant styles and sizes are not right for everyone. Facial asymmetries, failed or inadequate aesthetic outcomes from preformed implants and demand for unique shapes paved the way for custom-designed facial implants. Technological advances in image acquisition and computer design have made the use of custom implants easy and affordable. High-quality 3D CT scanning at a relatively low cost is widely available at just about any CT scanning facility. From a 3D CT scan, facial implants can be computer designed and manufactured in any size and shape. The final facial implant is created using a 3D printer.

Facial Implant Recovery

Recovery from facial implant surgery is primarily related to how much swelling occurs and how long it lasts. Fifty percent of the swelling is typically gone within 10 days of surgery; 75 percent is gone by three weeks and up to 95 percent should be clear by six weeks after the procedure. There are no physical restrictions after surgery. The results of any facial implant plastic surgery aren’t fully visible until two to three months after surgery when most of the swelling has subsided.

Complications and Risks

The most significant medical risks are infection and permanent sensory loss. However, it should be noted that such medical risks are rare. The far more common risks are aesthetic in nature and include malpositioning/displacement of the implant(s), over/under correction of the augmented area, and dissatisfaction with the cosmetic results. Most aesthetic concerns require further revision surgery.

Facial Implant Cost

Costs for facial implant surgery consist of anesthesia, facility and surgeon’s fees, as well as the cost of the implants. The total fees for facial implants could range from $3,500 for a single implant site up to $7,500 (or more) for two or more implants. Your surgeon can help you evaluate a more accurate cost estimate during your treatment consultation.

Insurance

Almost all facial implant surgeries are considered cosmetic and are not covered by insurance. Reconstructive facial surgery involving implants may be covered as these can be viewed as a medical necessity. This would need to be determined through an insurance pre-approval process.

Consult a Qualified Surgeon

Choose a board-certified plastic surgeon from the American Board of Plastic Surgery with extensive experience with face implants and facial-reshaping procedures. Board certification may not always guarantee the best results, but it lets you know that the surgeon has undergone specific and rigorous surgical education and training which improves the odds of a successful outcome.

The type of certification is also important. There are more than 150 self-designated boards, but only a handful that are designated by the American Board of Medical Specialties (ABMS), such as the American Board of Plastic Surgery.

Here are some tips to consider when consulting a plastic surgeon:

• Review credentials, education, training, type of certification held, and number of times the procedure has been performed in the practice.
• View before-and-after photos of patients who received different types of surgical procedures with facial implants.
• Bring a photo that shows the appearance you are looking for. This will help the surgeon understand your expectations and develop a treatment plan.
• Ask about the type of equipment and implant to be used, where the procedure will be performed, and the extent of the procedure.
• Discuss the impact of smoking, dental problems, and gum disease on your surgery.
• Ask about complications and possible side effects of the procedure.
• The recovery period and your activities after surgery should be explained to you as well.

During your consultation, the doctor will complete a medical evaluation. The doctor will also provide a list of instructions to follow before the procedure. Instructions might include no eating or drinking after midnight, an antibiotic for both before and after the procedure, stopping the use of certain medications, and having someone drive you home after the procedure. Also during your consultation with a plastic surgeon you can ask about other implant enhancement procedures for the body, such as calf implants, buttock implants and breast augmentation with implants.