What is Facial implants?
Facial implantation or augmentation is done for reconstructive or cosmetic purposes. It has become increasingly popular for the 'normal' everyday person to seek facial augmentation to remove or improve existing acne scars and facial lines or to enhance a specific facial area.Over the years many filling (implant) agents have been developed. However, the search is still on for the ideal facial implant material. The ideal product should have the following properties:
- physiologically acceptable: incorporates itself with the body's tissues
- free of complications or side effects
- permanent: does not degrade with time
- easy to use: simple and quick procedure, e.g. injectable.
What are facial implants used for?
Facial implants can be used in reconstructions for areas that may have been scarred or altered by trauma. This may be done in conjunction with minor or major plastic surgery. The other increasing use of facial implants is in cosmetic surgery where patients seek these treatments to improve their appearance.They are mainly used for the removal or improvement of scars caused by acne, correction of facial (wrinkle) lines, and enhancement or "filling in" of certain specific facial features such as the lips or chin.
Facial lines and features that can be corrected using implants
- Frown lines (glabellar lines)
- Smoker's lines (perioral lines)
- Marionette lines (oral commissures)
- Worry lines (forehead lines)
- Crow's feet (periorbital lines)
- Deep smile lines (nasolabial furrows)
- Smile lines (nasolabial lines)
- Cheek depressions
- Lip enhancement
- Witch's chin (chin augmentation)
- Acne scars
- Facial scars
What products are available?
There are numerous implant substances that add bulk to tissue. Manufacturers of these products will claim theirs to have certain advantages over others. The decision as to which you should use will depend on what you are trying to achieve and on the expert advice of your dermatologist. Each has their place and specific uses in facial augmentation. See individual implant types for specific details regarding use. The list below includes some older products that are no longer in general use.| Implant type | Product names |
| Fat grafting | |
| Collagen | Zyderm™, Zyplast™, Alloderm™, CosmoDerm™, CosmoPlast™ |
| Hyaluronic acid | Hylaform™, Restylane™, Captique™, Perlane™, Juvederm™, Prevelle™, Puragen™, Elevess™ |
| Hydroxyapatite | Hydroxyapatite (HA), Coralline Hydroxyapatite (CH), Radiesse™ |
| Silicone | Popular manufacturers include Implantech, Allied Biomedical, Advanced Bio-Technologies, Inamed Aesthetics |
| Expanded polytetrafluoroethylene (ePTFE) | Gore-Tex™, SoftForm™ |
| Polyethylene | Medpor™ |
| Polymethyl-methacrylate (PMMA) | Artecoll™, MetaCrill™, Artefill™ |
| Hydrophilic polyacrylamide | Hydrogel™, HPG™, Argiform™, Bioformacryl™, DermaLive™, Aquamid™ |
| Poly-L-lactic acid | Sculptra™ |
Of the implant types described above, the following are injectable augmentation products:
- Collagen (excluding Alloderm®)
- Hyaluronic acid
- Polymethyl-methacrylate (PMMA)
- Hydrophilic polyacrylamide gel
- Poly-L-lactic acid
These products provide facial augmentation with less downtime. Collagen and hyaluronic acid provide only a temporary solution as they are reabsorbed into the body over time (3 to 12 months); top-up treatments are necessary to maintain the desired correction. PMMA and hydrophilic polyacrylamide gel are recent additions of injectable augmentation products and give more long-lasting results (months to years).
Are there any side effects from using facial implants?
All facial implants currently used have some side effects that preclude them from being the ideal
agent. Some of the side effects and complications that may occur include:
- tenderness, bleeding and bruising
- Lumps, nodules, overcorrection, blue appearance from too superficial injection
- allergic reactions
- non-allergic inflammatory reactions eg granulomatous reactions weeks to years after injection: nonpainful lumps
- numbness due to nerve palsy
- vascular injury
- infections e.g., reactivation of herpes virus, staphylococcal infection, infectious granulomas and biofilms: painful fluctuating lump
- movement or extrusion of implant
See individual implant types for specific problems.
Prevention of side effects
Proper knowledge of facial anatomy, training in injection technique and supervision of new injectors will reduce the risks.
- Caution is necessary for any injection in patients with a history of bleeding disorder or taking aspirin, warfarin, ginseng, vitamin e or other anticoagulant agent.
- Prophylactic antivirals, e.g. oral aciclovir, should be prescribed if there is a history of herpes infection (cold sores).
- Lumps can be removed by puncturing the overlying skin to squeeze out the gel, injecting hyaluronidase to dissolve filler and massage to spread it out.
- Minimise filler in thin skinned areas: tear trough, eyelids, lips.
- Avoid intravascular injection in glabella and nasolabial folds (limited collateral circulation): aspirate prior to injection, use tiny amounts of filler, inject superficially.