There are many different materials that are used for facial implants. Each of them has some positive and negative features. The main types of facial prostheses are silicone, various plastics, metal and ceramic.

 

Silicone or silastic implants are usually formed into rubber and are the most commonly used type of implants. These implants can be shaped with a scalpel immediately prior to insertion. Smooth solid silicon does not stimulate the body’s natural immune system to any great degree so the body ignores its presence, more or less. Instead of reacting with the silicone, the body forms a barrier around the implant. This barrier aids in implant removal if that procedure ever becomes necessary. Solid silicone is used because liquid silicone reacts with the immune system. Silicone implants are associated with relatively high rates of extrusion—as high as one operation in twenty.

 

Various plastics have been used over the years with variable results. For areas that undergo repetitive motion and stresses, plastic implants may not be the best choice. However, if the implant is needed in an area that is not subject to a great deal of sustained force, plastic offers some advantages. Plastic facial implants can be shaped right before implantation and they do not react with the patient’s immune system. Certain plastics such as high-density polytetrafluoroethylene resist being absorbed or broken down by the body so they are very long-lasting. Other plastics like aliphatic polyesters are completely reabsorbed after one year. A plastic known as methylmethacrylate takes decades to break down and is therefore nearly permanent. Unfortunately this material can react with the immune system and those that are allergic to the material can have a quite severe allergic reaction. Allergy testing is usually done before the procedure to reduce the risk of serious allergic reactions with facial implants.

 

Titanium as emerged as the premier metal choice of bone prostheses. It is an elemental metal, does not corrode, is durable and non-toxic. Humans do not seem to be allergic to the metal nor does it cause any known ill effects, such as cancer. Titanium has been shown to integrate directly with bone at the microscopic level. This type of implant is incredibly long-lasting and, in some ways is its downfall. Once it is put in place directly on bone and has fused, removal becomes terribly difficult, if not practically impossible. Also, titanium does not allow any reshaping during the procedure therefore all measurements must be accurately made prior to implantation.

 

Ceramic is used occasionally because its primary component, hydroxyapatite is the primary inorganic (non-carbon based) compound naturally found inside bone. This material can be made into a solution with many tiny nooks and crannies which permit blood vessels and tissue to grow through the implant. It can also be mixed and shaped immediately prior to surgery. Hydroxyapatite implants tend to crack rather easily, especially very porous (full of holes) mixtures so it should not be used for load bearing structures on in places that will be subject to a lot of force. Ceramic implants are also more likely to become infected than other materials since these holes also allow bacteria to enter and stay. This increased risk of infection limits the widespread use of ceramic as a material for facial implants.

 

Your surgery may be performed under local or general anesthesia, depending on the size of the implant, the position and the surgical approach. The procedure may last as little as 30 minutes to two hours and perhaps more if it is combined with other procedures. Facial implant surgery can be performed anywhere from a surgeon’s private surgical suite to a major hospital. The surgeon will choose an implant size and shape that is most appropriate for your face and desired result. Certain materials can be shaped and sterilized at the time of the procedure allowing extra flexibility and decreased infection rates. For chin implants, the surgeon may either make a small incision below the chin or just inside the mouth, below the lower lip. For cheek implants, the incision can be made inside the mouth or inside the bottom eyelid to prevent visible scars. Jaw implants are placed through incisions made either inside or outside of the mouth. When entering the area from inside the mouth, any scar will be hidden inside the mouth, however, this approach is more prone to infections. A pocket is made using a blunt instrument or spacer and the implant is placed snugly inside. The pocket should not be too tight as this will increase the risk of implant extrusion. Ideally, the material should be porous enough that surrounding material can grow into it to help stabilize the implant in the pocket but not prone to becoming infected. The implant material should be completely non-reactive with the surrounding tissue and should not stimulate the immune system. Some surgeons will affix the implant to the surrounding tissue with sutures or screws, though this is not always done. In general, jaw implants are most likely to be secured by screw or suture followed by chin implants, then cheek implants least often. The decision of whether to use a screw or suture rests with the individual surgeon. If you have strong feelings about which type of procedure is performed, you should discuss this with your prospective plastic surgeon in advance of the procedure.