Complications after the insertion of facial implants

Complications of facial contouring implants include bleeding, hematoma formation, infection, exposure, dislocation, malposition, displacement, fistula formation, seroma, persistent edema, inadequate projection, persistent inflammation, pain, and nerve damage. However, most of these complications are rarely related solely to the implant material. It is very difficult to separate the general surgical technique from the circumstances of the specific procedure, as well as from individual risk factors unrelated to the implant.

If the technical rules are followed, dislocation should not occur. The large surface area of enlarged or extended implants, tailored to the contours of the midface and mandible, minimizes the risk of malposition. Dissection of the subperiosteal space sufficient to create adequate posterolateral and midlateral tunnels in the mandible or pockets in the midface will hold the implant in the correct position. With enlargement in the mandible, the mandibular branch of the facial nerve passes just anterior to the midjaw in the midlateral area. It is important not to traumatize the tissues that cover this area. The mental nerve is anatomically directed superiorly into the lower lip, which also helps protect it from injury during dissection. Transient hyperesthesia due to contact with the mental nerve may occur for several days to several weeks after surgery. Permanent nerve injury is extremely rare - in one study it was less than 0.5% of statistically significant cases. If, as a result of displacement or incorrect placement, contact of the nerve with the implant is noted, the implant should be moved downwards as quickly as possible.

The temporal branch of the facial nerve passes posterior to the mid-zygomatic arch and care must also be taken when working in this area. The risk of infection can be minimized by rinsing the pocket at the end of the procedure with either saline or Bactracin (50,000 U/L sterile saline). Soaking the implants in an antibiotic solution is also recommended. Drainage is usually not necessary after mandibular augmentation but may be necessary after midface augmentation if there is increased bleeding. We have found that immediate compression of the entire midface with compression garments significantly reduces the risk of hematoma, seromas, edema, and therefore postoperative complications related to pocket fluid.

Bone resorption occurs more frequently after mandibular augmentation than after other alloplastic procedures. Erosions following chin implantation were reported in 1960.

Discussion

Understanding the principles of zonal anatomy, defining facial shape types and paying attention to basic technical points lead to predictable changes in facial contours. Meticulous analysis of the patient’s face and precise communication between the surgeon and the patient produce optimal results. There are many different types of facial implants available, allowing the surgeon to create a variety of contours to suit most needs. More complex contour defects can be reconstructed using custom-made implants modeled from 3D computer reconstructions and manufactured using CAD/CAM (computer-aided design/computer-aided manufacturing) technology. The recent increase in the number of HIV-positive patients taking proteolytic enzyme inhibitors has made this technique necessary for the effective treatment of such cosmetically disturbing conditions.

If the implant is positioned correctly over compact bone, the condition usually stabilizes without any noticeable loss of prominence or cosmetic improvement.

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