Alloplastic Facial Implants: A Systematic Review Analyzing Outcomes and Uses in Aesthetic and Reconstructive Facial Surgery
Jeremie D. Oliver, MD, MS Candidate1, Annica C. Eells, MD Candidate2, Daniel Boczar, MD3, Andrea Sisti, MD3, David J. Restrepo, MD3, Maria T. Huayllani, MD3, Brian D. Rinker, MD3, Antonio Jorge Forte, MD, MS PhD3.
1Mayo Clinic, Rochester, MN, USA, 2Mayo Clinic, Scottsdale, AZ, USA, 3Mayo Clinic, Jacksonville, FL, USA.
PURPOSE: Alloplastic materials in facial surgery have been used successfully for various applications in the reconstructive restoration or aesthetic augmentation of the facial skeleton. Among its most popular uses are repairs of the orbital floor, malar augmentation, and auricular reconstruction in the setting of traumatic injury or congenital microtia. The objective of this study was to conduct a comprehensive systematic review of alloplastic implant materials utilized in the face stratified by anatomical distribution, indication, specific material used, and respective outcomes.
METHODS: A comprehensive systematic review of published literature on alloplastic facial implant data was conducted utilizing Medline/PubMed database without timeframe limitations. Articles were stratified by (1) anatomic localization in the face, including the zygoma, nose, mandible, orbit, frontal bone, maxilla, and glabella, as well as (2) indication for use (aesthetic vs reconstructive). All demographics, post-operative complications data, and reported cosmetic outcomes were recorded. Results were considered statistically significant at p < 0.05.
RESULTS: A total of 23 case series' and 32 isolated case reports were identified to meet the inclusion criteria. From the case series' data, 2100 patients were included. Overall, polytetrafluorourethylene implants were associated with a significantly higher risk of developing infection (3.0%) and ultimate need for explantation (6.0%) compared to all other implant types analyzed. Methylmethacrylate implants were associated with the highest rate of poor cosmetic outcomes reported (5.20%), however this value did not achieve statistical significance. By location, implants placed in the malar region (2.67%) and frontal bone (2.50%) were significantly associated with higher rates of post-operative infection. Implants placed in the periorbital region were associated with a significantly higher need for explantation (8.0%) compared to all other regions.
CONCLUSION: Alloplastic facial implants are a reliable means of restoring facial symmetry and achieving facial skeletal augmentation. While many material types have been utilized and reported in the literature, it is important for plastic surgeons to understand the relative risks for each type of implant to develop postoperative complications or poor long-term cosmetic results.
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