Best Way to Avoid Cheek Implant Infection?

Question

Hi. What is the best way to avoid cheek implant infection; having them inserted through the mouth, or the hair line? When will they usually become infected if they WERE dirty at insertion? Could it be years and years after? I want to get these, but I'm worried about the infection risk.

Richard H. Tholen, MD, FACS · Answer

Cheek implants are generally placed via one of two common incisions--the lower eyelid, or through the mouth and upper gum line. Hairline incisions are usually not used since there is the possibility of damage to the frontotemporal branch of the facial nerve (causing inability to blink or raise one's eyebrow).

	The mouth incision has the highest likelihood for infection (because of lots of nasty mouth bacteria, and despite antibiotics), though this is still relatively uncommon. If infection DOES occur, the implant(s) must almost always be removed, the infection resolved, and adequate time allowed to elapse for scar tissue to soften before reinsertion of new implants.

	The eyelid incision has the least likelihood for infection, but there can be scar tension on the lower eyelid which can affect the eyelid position, eye dryness, and require additional surgery. These complications are also uncommon, but the implant(s) can remain in place even if additional surgery is needed to address these lid problems.

	The best approach is the one your chosen surgeon is most comfortable using, and the one which has the best success in his or her hands. Implants are always sterile at the time of insertion, unless contaminated during surgery (such as with mouth bacteria). Late infections are extremely rare, but I have seen one case in 25 years of practice, so it is possible. Overall, infection is one of the least likely complications; malposition is much more common, for example, though still unusual. Best wishes!

Larry S. Nichter, MD, MS, FACS · Answer

The infection rate theoretically is lower by avoiding the mouth insertion site due to all of the mouth bacteria. The implant itself is sterile when it comes out of the package. Although all implants are foreign bodies and subjected to infection, it would be very unusual to occur after the first year. Fat injection would avoid the above risk in almost all cases.

Elliot M. Heller, MD · Answer

The insertion through the mouth usually gives a better result, but there is more room for infection.

Toby Mayer, MD · Answer

Cheek implant infection risk is low. If placed thru the eyelid the risk is lower but some patients could have the eyelid pulled down. Starting antibiotics the day before surgery has lowered the risk of infection in our practice.

William Portuese, MD · Answer

The chance of an infection after a cheek implant procedure is exceedingly rare. The implants are placed through an intraoral approach after the patient’s mouth has been completely prepped with surgical scrub soap. The best method of placement for cheek implants is through the intraoral approach above the upper canine teeth whereby the implants are placed directly over the maxillary bone. Patients are given antibiotics at the time of the surgery through the intravenous line and patients also receive a prescription for oral.

Michael Law, MD · Answer

A wide variety of facial implants are currently available for the enhancement of the skeletal elements of facial aesthetics. The most commonly used facial implants are used to enhance the profile of the chin and the cheeks. Facial implants very widely not only in shape and style, but also in terms of the materials from which they are fabricated.

	My preference is to use structural fat grafting, as much as possible, to enhance facial features. In many cases, the need for a solid implant can be eliminated by the careful and meticulous grafting of a patient's own fat. While the incidence of complications with facial implants is not high, certain problems may develop which require implant removal including infection and implant migration. Bone resorption (bone loss) has also been reported below solid facial implants. Neither of these problems are an issue with structural fat graftin

Robert E. Zaworski, MD (retired) · Answer

To avoid infection ask your surgeon where he/she operates. Having this done at an hospital affliated outpatient center is a safe way to go. Antibotics are almost always given for a few days after surgery. Be sure to follow your post operative instructions.

Francis R. Palmer, III, MD (retired) · Answer

I perform many Cheek Augmentations using fillers and Cheek Implants.  IMHO, Cheek Implants should always be placed through the mouth and in my hands do not require fixation with sutures or screws.  It does however require meticulous layered tissue closure which isn't possible for the remote hairline location.  

	 In my experience, over the past 22 years, infections of cheek implants are quite rare if the standard post op instructions are followed.  The time to avoid strenuous activity after Cheek Implants is the first month post op.

	 The main issue with Cheek Implants is the aesthetic judgement of the plastic and cosmetic surgeon performing the Cheek Implant Surgery.  There are many different sizes, shapes and materials of Cheek Implants however, in my aesthetic judgement only a few of these are appropriate.

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