Advertisement

Facial Implant Cosmetic Augmentation Using Digital Technologies

  • Alex M. Greenberg
  • Barry Eppley
Chapter

Abstract

Facial beauty has been studied since ancient times and has been recorded in various art forms, whether as classical sculpture, modern art, or scientific analysis. Surgeons who perform facial cosmetic procedures need to have an understanding of both visual and radiographic images that can help them to properly evaluate and diagnose patient’s facial form to allow the development of a treatment plan that will provide the appropriate cosmetic result that will be satisfactory to the patient. Facial beauty is objective to the surgeon and objective to the patient, and there needs to be a high level of communication and understanding in the relationship to ensure a satisfactory outcome. Facial implants are an important aspect of facial cosmetic and reconstructive surgery, and they are available as both stock and custom types. This chapter will review various methods for the fabrication of custom facial implants based on stereolithographic anatomic models for the chin, mandibular angles, and zygomas. Custom facial implants have many advantages over stock implants in that they are preplanned, are patient specific, usually require no further shaping, reduce operating time, and can have superior cosmetic outcomes when compared to stock implants. Different materials can be utilized, but solid silicone has many advantages which includes flexibility for placement into the surgical site, improved feathering of edges, decreased cost, low rate of infection, and durability. Custom facial implants can be used as individual, in combinations, and simultaneous to other procedures such as orthognathic surgery or facial esthetic soft tissue procedures.

Keywords

3-D modeling Stereolithographic Custom Implant Silicone Chin Angle Zygomatic Augmentation Facial Esthetics Cosmetic 

References

  1. 1.
    O’Ryan F, Lassetter J. Optimizing facial esthetics in the orthognathic surgery patient. J Oral Maxillofac Surg. 2011;69(3):702–15CrossRefPubMedGoogle Scholar
  2. 2.
    Holland E. Marquardt’s Phi mask: pitfalls of relying on fashion models and the golden ratio to describe a beautiful face. Aesthetic Plast Surg. 2008;32(2):200–8CrossRefPubMedGoogle Scholar
  3. 3.
    Marquardt SR. Dr. Stepehn R. Marquardt on the golden decagon and human facial beauty interview by Dr. Gottlieb. J Clin Orthod. 2002;36(6):317–8Google Scholar
  4. 4.
    Goldsmith D, Horowitz A, Orentlicher G. Facial skeletal augmentation using custom facial implants. Atlas Oral and Maxillofac Surg Clin N Am. 2012;20:119–34Google Scholar
  5. 5.
    Millard DR. Sir Harold Gillies. Ann Plast Surg. 1979;3(5):454–63.CrossRefPubMedGoogle Scholar
  6. 6.
    Glicenstein J. Aesthetic surgery history. Ann Chir Plast Esthet. 2003;48(5):257–72.CrossRefPubMedGoogle Scholar
  7. 7.
    Aufricht G. Combined plastic surgery of the nose and chin: resume of twenty-seven years experience. Am J Surg. 1958;95(2):231–6CrossRefPubMedGoogle Scholar
  8. 8.
    Rubin CR, Robertson GW, Shapiro RN. Polyethylene in reconstructive surgery. Plast Reconstr Surg. 1948;3:586CrossRefGoogle Scholar
  9. 9.
    Yaremchuk MJ. Facial skeletal reconstruction using porous polyethylene implants. Plast Reconstr Surg. 2003;111:1818–27CrossRefPubMedGoogle Scholar
  10. 10.
    Flowers RS. Alloplastic augmentation of the anterior mandible. Clin Plast Surg. 1991;18(1):107–38.PubMedGoogle Scholar
  11. 11.
    Eppley BL, Sadove AM, Holmstrom H. HTR polymer facial implants: a five year clinical experience. Aesthetic Plast Surg. 1995;19:445–50CrossRefPubMedGoogle Scholar
  12. 12.
    Farkas LG, Katic MJ, Hreczko TA, Deutsch C, Munro IR. Anthropometric proportions in the upper lip-lower lip-chin area of the lower face in young white adults. Am J Orthod. 1984;86:52–60CrossRefPubMedGoogle Scholar
  13. 13.
    Farkas LG, Hreczko TA, Kabe MJ. Craniofacial Norms in North American Caucasians from Birth (One Year) to Adulthood. In: Farkas LG, editor. Anthropometry of the Head and Neck. 2nd ed. New York: Raven Press; 1994. Appendix A.Google Scholar
  14. 14.
    Burstone CJ. Lip posture and its significance in treatment planning. Am J Orthod. 1967;53:262CrossRefPubMedGoogle Scholar
  15. 15.
    Burstone CJ, James RB, Legan H, Murphy GA. Norton a cephalometrics for orthognathic surgery. J Oral Surg. 1978;36(4):269–77PubMedGoogle Scholar
  16. 16.
    Legan HL, Burstone CJ. Soft tissue cephalometric analysis for orthognathic surgery. J Oral Surg. 1980;38:744–51PubMedGoogle Scholar
  17. 17.
    Ricketts RM. Esthetics, environment, and the law of lip relation. Am J Orthop. 1968;54(2):272–89CrossRefGoogle Scholar
  18. 18.
    Steiner CC. Cephalometrics for you and me. Am J Orthod. 1953;39:729CrossRefGoogle Scholar
  19. 19.
    Steiner CC. The use of cephalometrics as an aid to planning and assessing orthodontic treatment. Am J Orthod. 1960;46:721–35CrossRefGoogle Scholar
  20. 20.
    Gonzalez-Ulloa M. Ptosis of the chin: the Witch’s chin. Plast Reconstr Surg. 1972;50:54CrossRefPubMedGoogle Scholar
  21. 21.
    Gonzalez-Ulloa M, Stevens SE. The role of the chin in profile plasty. Plast Reconstr Surg. 1968;41:477CrossRefPubMedGoogle Scholar
  22. 22.
    Gonzalez-Ulloa M. Planning the integral correction of the human profile. J Int Coll Surg. 1961;36:364–73PubMedGoogle Scholar
  23. 23.
    Powell N, Humphreys B. Proportions of the Aesthetic Face. New York: Thieme-Stratton; 1984.Google Scholar
  24. 24.
    Romo T, Millman AL, editors. Aesthetic Facial Plastic Surgery: a Multidisciplinary Approach. New York: Thieme; 2000. p. 332–5.Google Scholar
  25. 25.
    Kiekens RM, Kvijpers-Jagtman AM, Van’t Hof MA. Putatative golden proportions as predictors of facial esthetics in adolescents. Dentofacial Orthop. 2008;134(4):480–3CrossRefGoogle Scholar
  26. 26.
    Ricketts RM. Divine proportions in facial esthetics. Clin Plast Surg. 1982;9:401PubMedGoogle Scholar
  27. 27.
    Shell TL, Woods MG. Facial esthetics and the divine proportion: a comparison of surgical and nonsurgical class II treatment. Aust Orthod J. 2004;20(2):51–63PubMedGoogle Scholar
  28. 28.
    Greenberg AM. Cone beam computed tomography scanning and diagnosis for dental implants. Oral Maxillofac Surg Clin North Am. 2015;27(2):185–202CrossRefPubMedGoogle Scholar
  29. 29.
    Greenberg AM. Basics of cone-beam CT and CT guided dental implant surgery. Selected Readings in Oral and Maxillofacial Surgery. 2011;19(5):1–48Google Scholar
  30. 30.
    April E, Erickson A, Montano S. Clinical Anatomy. 3rd ed. Baltimore: Williams and Wilkins; 1997.Google Scholar
  31. 31.
    Filo K, Schneider T, Locher MC, Kruse AL, Lubbers HT. The inferior alveolar nerve’s loop at the mental foramen and its implications for surgery. J Am Dent Assoc. 2014;145(3):260–9.sCrossRefPubMedGoogle Scholar
  32. 32.
    Zide B, Pfeifer TM, Longaker MT. Chin surgery: I. Augmentation-the allure and the alerts. Plast Reconstr Surg. 1999;104:1843–53CrossRefPubMedGoogle Scholar
  33. 33.
    Profitt WR, Phillips C, Turvey TA. Stability after mandibular setback: mandible only versus 2-jaw surgery. J Oral Maxillofac Surg. 2012;70(7):e408–14CrossRefGoogle Scholar
  34. 34.
    De Lir AL, de Moura WL, Oliveira Ruellas AC, Gomez Souza MM, Nojima LI. Long term skeletal and profile stability after surgical orthodontic treatment of class II and class III malocclusion. J Craniomaxillofac Surg. 2013;41(4):296–302CrossRefGoogle Scholar
  35. 35.
    Xu M, Chan FC, Jin X, Xu J, Lu J, Zhang C, Teng L. Hemimandibular hyperplasia: classification and treatment algorithm revisited. J Craniofac Surg. 2014;25(2):355–8CrossRefPubMedGoogle Scholar
  36. 36.
    Reddy PS, Kashyap B, Hallur N, Sikkerimath BC. Advancement genioplasty-cephalometric analysis of osseous and soft tissue changes. J Oral Maxillofac Surg. 2011;10(4):288–95CrossRefGoogle Scholar
  37. 37.
    Erbe C, Mulie RM, Ruf S. Advancement genioplasty in class I patients: predictability and stability of facial profile changes. Int J Oral Maxillofac Surg. 2011;40(11):1258–62CrossRefPubMedGoogle Scholar
  38. 38.
    San Miguel Moragas J, Oth O, Buttner M, Mommaerts MY. A systemic review on soft to hard tissue ratios in orthognathic surgery part II: chin procedures. J Craniomaxillofac Surg. 2015;43(8):1530–40CrossRefPubMedGoogle Scholar
  39. 39.
    Aston SJ, Smith DM. Taking it on the chin: recognizing and accounting for lower face asymmetry in chin augmentation and genioplasty. Plast Reconstr Surg. 2015;135(6):1591–5CrossRefPubMedGoogle Scholar
  40. 40.
    Guyuron B, Raszewski RL. A critical comparison of osteoplastic and alloplastic augmentation genioplasty. Aesthetic Plast Surg. 1990;14:199–206CrossRefPubMedGoogle Scholar
  41. 41.
    Terino EO, Edwards MC. Customizing jawlines: the art of alloplastic premandible contouring. Facial Plast Surg Clin N Am. 2008;16:99–122CrossRefGoogle Scholar
  42. 42.
    Rieck KL. Taking on the chin-the art of genioplasty. Selected Readings in Oral and Maxiloofacial Surgery. 2013;21(2):1–51Google Scholar
  43. 43.
    Manji Z, Payami A, Greenberg A. Genioplasty. In: Greenberg A, Schmelzeisen R, editors. Craniomaxillofacial Reconstructive and Corrective Bone Surgery. New York: Springer Verlag; In press.Google Scholar
  44. 44.
    Frodel JL. The use of high density polyethylene implants in facial deformities. Arch Otolaryngol Head Neck Surg. 1998;124:1219–23CrossRefPubMedGoogle Scholar
  45. 45.
    Zeph RD. Custom-designed chin augmentation. Facial Plast Surg Clin N Am. 2008;16:79–85CrossRefGoogle Scholar
  46. 46.
    Mittelman H, Spencer JR, Chrzanowski DS. Chin region: management of grooves and mandibular hypoplasia with alloplastic implants. Facial Plast Surg Clin N Am. 2007;16:445–60CrossRefGoogle Scholar
  47. 47.
    Romo T, Lanson BG. Chin augmentation. Facial Plast Surg Clin N Am. 2008;16:69–77CrossRefGoogle Scholar
  48. 48.
    Simons RL. Adjunctive measures in rhinoplasty. Otolaryngol Clin North Am. 1975;8:717PubMedGoogle Scholar
  49. 49.
    Safian J. Progress in nasal and chin augmentation. Plast Reconstr Surg. 1966;37:446CrossRefPubMedGoogle Scholar
  50. 50.
    Haug RH. Design and function of implants. In: Ehrenfeld M, Manson P, Prein J, editors. Principles of Internal Fixation of the Craniofacial Skeleton, Trauma, and Orthognathic surgery. New York: Thieme; 2012. p. 53–80.Google Scholar
  51. 51.
    Thomson ERE. Sagittal genioplasty: a new technique of genioplasty. Br J Plast Surg. 1985;38:70–4CrossRefPubMedGoogle Scholar
  52. 52.
    Terino EO, Edwards MC. Customizing jawlines: the art of alloplastic premandible contouring. Facial Plast Surg Clin North Am. 2008;16(1):99–122, vi.CrossRefPubMedGoogle Scholar
  53. 53.
    Terino EO. Implants for male aesthetic surgery. Clin Plast Surg. 1991;18(4):731–49PubMedGoogle Scholar
  54. 54.
    Naini FB. The origin of the zero-meridian used in facial esthetic analysis. Aesthetic Surg J. 2014;34(7):NP 72–3.Google Scholar
  55. 55.
    Avelar KL, Sa CD, Esses DF, Becker OE, Soares EC, de Oliveira RB. Unusual complication after genioplasty. J Craniofac Surg. 2014;25(2):180–2CrossRefGoogle Scholar
  56. 56.
    Hoenig JF. Sliding osteotomy genioplasty for facial aesthetic balance: 10 years of experience. Aestehtic Plast Surg. 2007;31(4):384–91CrossRefGoogle Scholar
  57. 57.
    Lindquist CC, Obeid G. Complications of genioplasty done alone or in combination with sagittal split-ramus osteotomy. Oral Surg Oral Med Oral Pathol. 1988;66(1):13–6CrossRefPubMedGoogle Scholar
  58. 58.
    Zide B, MacCarthy J. The mentalis muscle: an essential component of chin and lower lip position. Plast Reconstr Surg. 1989;83(3):413–20CrossRefPubMedGoogle Scholar
  59. 59.
    Rose EH. Autogenous fascia lata grafts: clinical applications in reanimation of the totally or partially paralyzed face. Plast Reconstr Surg. 2005;16(1):20–32. discussion 33–5CrossRefGoogle Scholar
  60. 60.
    Zide BM. Chin disfigurement following removal of alloplastic chin implants. Plast Reconstr Surg. 1991;88:68. (Discussion)CrossRefGoogle Scholar
  61. 61.
    Yaremchuk MJ. Improving aesthetic outcomes after alloplastic chin augmentation. Plast Reconstr Surg. 2003;112(5):1422–32. discussion 1433-4CrossRefPubMedGoogle Scholar
  62. 62.
    Cohen SR, Mardach OL, Kawamoto HK Jr. Chin disfigurement following removal of alloplastic chin implants. Plast Reconstr Surg. 1991;88(1):62–6. discussion 67-70CrossRefPubMedGoogle Scholar
  63. 63.
    White JB, Dufresne CR. Management and avoidance of complications in chin augmentation. Aesthet Surg J. 2011;31(6):634–42.CrossRefPubMedGoogle Scholar
  64. 64.
    Semergidis TG, Migliore SA, Sotreanos GC. Alloplastic augmentation of the mandibular angle. J Oral Maxillofac Surg. 1996;54(12):1417–23CrossRefPubMedGoogle Scholar
  65. 65.
    Bastidas N, Zide BM. The treachery of mandibular angle augmentation. Ann Plast Surg. 2010;64(1):4–6CrossRefPubMedGoogle Scholar
  66. 66.
    Ousterhout DK. Mandibular angle augmentation and reduction. Clin Plast Surg. 1991;18(1):153–61PubMedGoogle Scholar
  67. 67.
    Roncevic R. Masseter muscle hypertrophy. Aetiology and therapy. J Maxillofac Surg. 1986;14(6):344–8CrossRefPubMedGoogle Scholar
  68. 68.
    Ozkan BT, Tabrizi R, Cigerim L. Management of bilateral masseter muscle hypertrophy. J Craniofac Surg. 2012;23(1):e14–6CrossRefPubMedGoogle Scholar
  69. 69.
    Lee DH, Jin SP, Cho S, Feneran A, Youn CS, Won CH, Park GH, Kim BW, An J, Chang SE, Lee MW. Rimabotulinum toxin B versus Onabotulinum toxin a in the treatment of masseter hypertrophy: a 24 week double-blind randomized split face study. Dermatology. 2013;226(3):227–32CrossRefPubMedGoogle Scholar
  70. 70.
    Binder WJ. Custom-designed facial implants. Facial Plast Surg Clin N Am. 2008;16:133–46CrossRefGoogle Scholar
  71. 71.
    Bell WH, Proffitt WR, White RP. Surgical Correction of Dentofacial Deformities, vol. 238. Philadelphia: WB Saunders; 1980. p. 271Google Scholar
  72. 72.
    Thomas MA. Masseter muscle reattachment after mandibular angle surgery. Aesthet Surg J. 2009;29(6):473–6CrossRefPubMedGoogle Scholar
  73. 73.
    Epker BN. Cosmetic Maxillofacial surgery. Philadelphia: Lea and Feabiger; 1994. p. 79–94Google Scholar
  74. 74.
    Innocenti A, Andretto Amodeo C, Ciancio F. Wide undermining neck liposuction: tips and tricks for good results. Aesthetic Plast Surg. 2014;38(4):667–9CrossRefGoogle Scholar
  75. 75.
    Adamson PA, Cormier R, Tropper GJ, McGraw BL. Cervicofacial liposuction: results and controversies. J Otolaryngol. 1990;19(4):267–73PubMedGoogle Scholar
  76. 76.
    Metzinger SE, McCollough EG, Campbell JP, Rousso DE. Malar augmentation: a 5-year retrospective review of the silastic midfacial malar implant. Arch Otolaryngol Head Neck Surg. 1999;125:980–7CrossRefPubMedGoogle Scholar
  77. 77.
    Mladick RA. Alloplastic cheek augmentation. Clin Plast Surg. 1991;18(1):29–38PubMedGoogle Scholar
  78. 78.
    Terino EO, Edwards MC. Alloplastic contouring for suborbital, maxillary, zygomatic deficiencies Facial Plast Surg Clin North Am. 2008;16(1):33–67, v.CrossRefPubMedGoogle Scholar
  79. 79.
    Hinderer U. Profileplasty. Int Macro J Aesthetic Plast Surg Sept. 1971;1:12Google Scholar
  80. 80.
    Wilkinson T. Complications in aesthetic malar augmentation. Plast Reconstr Surg. 1983;71:643CrossRefPubMedGoogle Scholar
  81. 81.
    Silver WE. The use of alloplast material in contouring the face. Facial Plast Surg. 1986;3:81CrossRefGoogle Scholar
  82. 82.
    Powell NB, Riley RW, Lamb DR. A new approach to evaluation and surgery of the malar complex. Ann Plast Surg. 1988;20:206–14CrossRefPubMedGoogle Scholar
  83. 83.
    Prendergast M, Schoenrock LD. Malar augmentation. Arch Otolaryngol Head Neck Surg. 1989;115:964CrossRefPubMedGoogle Scholar
  84. 84.
    Binder WJ. Submalar augmentation. Arch Otolaryngol Head Neck Surg. 1989;115:797CrossRefPubMedGoogle Scholar
  85. 85.
    Binder WJ, Azizzadeh B. Malar and submalar augmentation. Facial Plast Surg Clin North Am. 2008;16(1):11–32. vCrossRefPubMedGoogle Scholar
  86. 86.
    Zou C, Niu F, Yu B, Liu JF, Gui L. Zygomatic complex change after reduction malarplasty and its geometric model: a retrospective clinical study. J Oral Maxillofac Surg. 2015;73(11):2196–206CrossRefPubMedGoogle Scholar
  87. 87.
    Layoun W, Guyot L, Richard O, Gola R. Augmentation of cheek bone contour using malar osteotomy. Aesthetic Plast Surg. 2003;27(4):269–74CrossRefPubMedGoogle Scholar
  88. 88.
    Tessier P. The definitive plastic surgical treatment of the severe facial deformities of craniofacial dysostosis: Crouzon’s and Apert’s diseases. Plast Reconstr Surg. 1971;48(5):419–42CrossRefPubMedGoogle Scholar
  89. 89.
    Quatela VC, Chow J. Synthetic Facial Implants. Facial Plast Surg Clin N Am. 2008;16:1–10CrossRefGoogle Scholar
  90. 90.
    Waite PD, Matukas VJ. Zygomatic augmentation with hydroxyapatite: a preliminary report. J Oral Maxillofac Surg. 1986;44(5):349–52CrossRefPubMedGoogle Scholar
  91. 91.
    Guevera-Rojas G, Figl M, Schicho K, Seeman R, Traxler H, Vacariu A, Carbon CC, Ewers R, Watzinger F. Patient-specific polyetheretherketone facial implants in a computer-aided planning workflow. J Oral Maxillofac Surg. 2014;72(9):1801–12CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Oral and Maxillofacial SurgeryColumbia University College of Dental MedicineNew YorkUSA

Personalised recommendations