Cheek asymmetries, inadequate primary cheek implant results and infraorbital rim deficiencies create the main reasons for the fabrication of custom cheek implants. Custom cheek implants come in two basic styles, 1) implants that cover the cheek and zygomatic arch areas (which are placed intraorally) and 2) infraorbital-malar Implant designs that encompass the infraorbital rim and turn the corner to extend out into the zygomatic arch. (which are usually placed through a lower eyelid incision) Both of these custom cheek implant styles exist because they cover and augment more bony surface areas than standard cheek or any other type of midface implant. Many think that a custom cheek implant design means an implant that is bigger or has more projection, (and this is occasionally the case) But a custom cheek implant approach usually means an extended surface area coverage of the zygomatic-orbital bones that creates a unique augmentation effect not obtainable with performed cheek implant styles.
Style 1 custom cheek implants is most commonly done when the patient has had an unsatisfactory result using standard cheek implant styles. The most problem with standard cheek implants is that they create an anterior full ness or apple cheek effect. While this may be fine for some women it almost never is for a male. Many patients today seek a more contemporary cheek augmentation effect that has the augmentation going more posterior back along the zygomatic arch. This follows the natural shape of the zygomatic bone as it covers most of the zygomatic arch. This is often referred to as the ‘high cheekbone look’ but anatomically is a more complete coverage of the zygomatic bone.
For patients with infraorbital rim recession, there are no standard implants that can even be modified to use for augmentation. The limited bone surface of the orbital rim area requires an implant that is specifically made for it to sit properly along its edges and feather into the medial and lateral orbital rim areas without palpable or visible step-offs. But almost all cases of infraorbital rim recessions and negative orbital vectors have malar deficiency as well. Thus the style 2 custom cheek implant is an infraorbital rim implant that almost always has a malar extension. (custom infraorbital-malar implant also known as a custom IOM implant) How much infraorbital rim augmentation is done and how far back along the cheek/arch it extends and its various thicknesses along the way will differ based on each patient’s aesthetic needs.
Custom Midface Implants
While midface implants are typically envisioned as cheek or infraorbital types, a custom implant approach allows augmentation designs not previously seen or imagined for this part of the face. The entire midface can be covered in a variety of designs that can replicate what LeFort advancement osteotomies (minus the tooth movements) can traditionally do. Whether it is more limited premaxillary-paranasal or an an inferiorly extended infraorbital-malar implant designs or a total midface mask design, custom implants for the midface open up potential new methods of facial augmentation effects.
Custom Orbital Implants
Custom orbital implants are used to augment or correct deficiencies of the orbital rims and orbital floor. Providing precise augmentation to the delicate contours of the orbital rims and infraorbital volume are good indications for a custom implant approach using the patient’s 3D CT scan. Tear troughs and undereye hollows due to infraorbital bone recession are common aesthetic indications for their use. Reconstructive indications are orbital rim asymmetries, infraorbital rim-orbital floor asymmetries due to vertical orbital dystopia and correction of depressed infraorbital rim-floor from prior orbito-zygomatic (ZMC) fractures.
Custom Nasal Implants
Designing implants for the small area of the nose is the least commonly performed custom facial implant. When it is done it is usually done as part of an extension from a brow bone or forehead-brow bone implant. While designed as an extension from the brow bone above, it is manufactured and placed as a separate implant.
Eppley Plastic Surgery
12188-A North Meridian St.
Carmel, IN 46032