Indications for facial implants

The shape of the human face is composed of a skeletal bony framework that is covered by a soft tissue envelope. Overall, skeletal proportions are probably the most important component of facial attractiveness. Fritz E. Barton Jr., 2009

Since the skeletal infrastructure of the human face is fundamental to its appearance, its surgical change can be powerful. Conceptually, autogenous bone would be the best material to restore or augment the craniofacial skeleton because it has the potential to be vascularized and, then, incorporated into the facial skeleton. In time, it can be biologically indistinguishable from the adjacent native skeleton. Practically, the use of autogenous bone to augment facial skeletal contours is limited. Donor site morbidity as well as the time and operative costs associated with autogenous bone graft harvest can be significant. Furthermore, the inevitable resorption and the poor handling characteristics of autogenous bone grafts limit the quality and predictability of the aesthetic result. With the exception of interposition grafts used to reconstruct segmental load-bearing defects of the maxilla and mandible, the majority of craniofacial skeleton replacements and, particularly, facial skeleton augmentation is done with alloplastic implants. A diagrammatic survey of the alloplastic implants used for facial skeletal reconstruction and enhancement is presented in Fig. 1.1 . Subsequent chapters will address each anatomic area.

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A diagrammatic survey of the alloplastic implants used for facial skeletal reconstruction and enhancement.

Patients with normal, deficient, and surgically altered or traumatically deformed anatomy may all benefit from implant augmentation of their craniofacial skeleton.

Facial Balance and Definition

Most often, facial skeletal augmentation is done to enhance facial appearance in patients whose skeletal relationships are considered within the normal range. They want more definition and angularity to their appearance. Other patients desire to “balance” their facial dimensions. The woman in Fig. 1.2 underwent chin and mandible angle augmentation at the time of rhytidectomy to provide angularity and balance between her upper and narrower lower face.