MIDFACE CUSTOM IMPLANTS
Cheek asymmetries and the inadequate primary cheek implant results create the main reasons for the fabrication of custom cheek implants. Implant designs that encompass more of the surrounding areas such as the upper maxilla, zygomatic arch and extensions over onto the lower orbital rim are benefits of a custom cheek implant approach. Bigger cheek implants may be desired but this usually means broader surface area skeletal coverage and not necessarily thicker than performed styles.
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 an infraorbital rim implant almost always needs a malar extension. It is important when designing this extension that the malar augmentation not go too far posterior as this will make it have an unnatural lateral protrusion and will make the face wider.
Custom cheek implant for 25 year-old Asian male that wanted more forward facial projection of the malar and infraorbital areas.
Deficiences at the maxillary or LeFort I level are often part of an overall flatter face that has inadequate projection. Such central face deficiencies have historically been treated by paranasal augmentation using only one available implant style, the peripyriform implant. This paranasal implant, while effective for some patients, has an isolated augmentative effect right under the nasal base around the pyriform aperture. Its rounded edges, however, often makes it feel more like a bump by the side of the nose as the concave canine fossa drops off below it. A custom paranasal implant can be made that provides a more smooth transition out on the face of the maxilla which creates a more complete paranasal-maxillary augmentation effect.
The need for a patient-specific nasal implant is the rarest of all custom facial implants. Between the wide array of preformed nasal implants in both dorsal and dorso-columellar designs, almost any nasal augmentation need can be met. In the very infrequent need for a custom nasal implant it is almost always because the implant must provide significant radix augmentation and is often used to join to a custom brow bone implant for a smooth transition from the glabellar region of the forehead into the upper nose.
Custom nasal implant in 33 year-old male to provide increased dorsal length and height that fit onto up against a custom brow bone implant.
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.
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.