Implant materials and infection. What material should I go for?

Question

I'm considering cheek implants. However, facial implants made of silicone and medpor have a high risk of infection. Medpor in particular is difficult to remove because of rapid ingrowth. Also, there is a risk of bone erosion underneath the implant. These two materials are out of the question for me. Because of these limitations, I am thinking of other materials like bioglass, PEEK and titanium (expensive). Anyone have any experience with implants made of these materials? Thanks!

Michael P. Morrissette, DDS, FACS · Answer

I perform many cheek implant surgeries and you are correct in that infection is the most frequent complication. However, the use of pre-operative antibiotics, oral antibiotic mouthrinses, and post-operative antibiotics have made the occurrence of infection very low. I have not found a superior material to silicone. In the case of an infection, the implant can be easily reomed and after several weeks a new one placed. Good luck

Mehryar (Ray) Taban, MD, FACS · Answer

I recommend solid silicone implant over all these other options. It is least reactive, easily removed, and lowest infection risk.

Barry L. Eppley, MD, DMD · Answer

To provide clarity on your questions, all implantable materials carry similar low rates of infection. There is no synthetic material that carries any higher or lower risk of infection. Also  Medpor implants are not difficult to remove and I have removed any of them. Having placed custom facial implants composed of both PEEK and titanium, you are correct in that they are considerately more expensive.

Jeffrey Jumaily, MD · Answer

Sillicon implants are the safest (the bone erosion is not major) but infections do occur. The other option that is good for a lot of people is fat grafting. it's long lasting, no risk of infection and you can make a big difference with it. Consult a facial plastic surgeon

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

Hi, I have used silastic cheek, chin and lip implants for over 30 years.  They are the "gold" standard by which all other facial implants are measured.  Medpore becomes integrated into the bone as soon as 1 month making removal or replacement very difficult should you ever choose to do so.  In addition, aesthetically, I prefer the silastic implants and for those two reasons I do not use Medpore facial implants.  The rate of infection with properly placed silastic implants (cheek, chin or lip) is quite rare.
 There are many different shapes and sizes and this is where experience as an expert facial shaping surgeon comes into play.
 I have performed many facial shaping procedures using dermal fillers, facial implants (cheek, chin), liposuction and/or facelifts for over 30 years.  Following my beauty principles, men look chiseled and handsome with angularity in the cheeks, chin and mandibular angles.
 Cheek implants can be placed using several different approaches but using a small incision on the inside of the mouth remains the "gold standard" and most accepted manner of placement.  This technique places the silastic "cheek implant" on the cheek bone itself below the tissue covering of the bone in what is called an "implant pocket or space".  The tissues are closed in layers from the inside outward and a double water tight closure is done along the incision line. 
 I have placed silastic cheek implants for 30 years in military, SWAT, LE, professional fighters, as well as actors and many regular people who are active.  When placed below the covering of the bone and when the layers of the cheek are closed from the inside out, there is no need for fixation screws or sutures in my humble opinion.  I do ask that all my cheek implant and chin implant patients sleep on a U-shaped pillow for 1 month following the surgery.  In addition, I have had the opportunity on numerous occasions to replace silastic cheek implants (placed by others) that had been screwed into the cheek bone.  During the replacement it was evident that the metal screws pushed right through the soft implant as it was tightened down on the hard cheek bone.  Which makes perfect sense.  So in the long run, these fixation methods alone are no guarantee that the implant won't move.  Proper placement, proper implant pocket creation and meticulous closure of all the tissues layers is what is required in my humble opinion.
 In contrast, a sub-malar cheek implant is as the name applies placed below the cheek bone thereby being incapable of actually changing the shape of the cheek bone itself and since the implant isn't placed below the periosteum, the implant must be sutured to the tissues themselves which is why I do not use or recommend sub-malar cheek implants.  Hope this helps.

Gerald Wittenberg, MSc, DMD (retired) · Answer

Cheek implants have a relatively low infection rate compared to other intraoral placed materials - location and ability to easily 'seal' the incision with little tension. However, any material placed through an 'oral' access will have an infection rate greater than via a skin incision. The material is 'foreign' to the body but accepted and documented over years. Medpor is less ideal as you note, but the use of silastic and eg gortex are more logical. Many factors also determine which material 'looks better' for your case since they vary. An incision via the lower eyelid/skin incision is another option for you to consider

Implant materials and infection. What material should I go for?

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Answers (6)

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