Changing Mandible Contour Using Computer Designed/Computer Manufactured (CAD/CAM) Alloplastic Implants

Background The shape of the mandible is the fundamental determinant of the appearance and sexual dimorphism of the lower third of the face. The use of computer-aided design/computer-aided manufactured (CAD/CAM) alloplastic implants provide unparalleled planning and sophistication in the correction of skeletal deficiencies, irregularities and asymmetry. Objectives This study presents the rationale, indications, techniques, and results of the senior author’s (MJY) 15-year experience using CAD/CAM alloplastic implants to correct deficiencies and asymmetries of the mandible. Methods A retrospective review of a prospectively maintained database was reviewed of all patients who underwent aesthetic augmentation of the mandible using CAD/CAM alloplastic implants by the senior author. Results Over a 15-year period, 123 patients underwent mandibular augmentation using CAD/CAM alloplastic implants. The majority of patients were men (76.4%) with an average age of 31 years (24-63 years). All implants were bilateral. Complications included infection requiring implant removal (2.4%) and patient dissatisfaction resulting in either implant revision (4.1%) or implant removal (2.4%). Conclusions As described here, CAD/CAM alloplastic implants are an effective modality to augment aesthetic mandible contour deficiencies.

Alloplastic Facial Implants

As the face ages, there is thinning of the epidermis, volume loss and rearrangement of the soft tissues, and malabsorption of the skeletal framework. It is essential to have a thorough understanding of the aging process for successful facial augmentation and rejuvenation. Alloplastic implants can be used to provide a long-lasting solution for augmentation of skeletal deficiencies, restoration of facial irregularities, and rejuvenation of the face. In this study, we describe the ideal implant characteristics along with the advantages and disadvantages of various implant materials. We also present techniques in nasal and premaxillary augmentation, midface augmentation, mandibular augmentation, and lip augmentation. Additionally, computer-aided design and manufacturing as well as bioprinting are emerging technologies with growing applications in facial plastic and reconstructive surgery. We discuss their role in the creation of patient-specific custom implants. The overall goal of facial rejuvenation is to address multiple aspects of the facial aging process including deficiencies in the skin, soft tissues, and skeletal framework. The use of alloplastic implants alone or synergistically with additional surgical procedures can restore a wide range of anatomical deficits that occur with age.

Complications of Alloplast Rhinoplasty and Their Management: A Comprehensive Review

In Asian countries, augmentation rhinoplasty is especially common, where alloplastic implants are used much more commonly than autologous tissues. In rhinoplasty, such artificial materials include silicone, expanded polytetrafluoroethylene (ePTFE), porous high-density polyethylene (pHDPE), and acellular human dermis. As the use of implants has become increasingly common in rhinoplasty, more adverse effects such as infection, extrusion, movement, irregularities, absorption, prolonged swelling, seroma, and contracture have been recognized and reported in the literature. Surgeons should be able to recognize these probable complications and manage them successfully. Early detection and prompt management of the complication are essential for minimizing the severity of the deformity. Proper management of complications is key for the success of dorsal augmentation using alloplastic implants.

Premaxillary Deficiency: Techniques in Augmentation and Reconstruction

Progressive premaxillary retrusion is a common sequela of the facial aging process. In most cases, this manifests with central maxillary recession. Central maxillary insufficiency is also commonly encountered within certain ethnic communities, or in cleft lip nasal deformity, and may represent a challenge for the plastic and reconstructive surgeon attempting correction in the setting of facial contouring, rhinoplasty, or reconstruction following oncologic resection or trauma. Aesthetically, premaxillary retrusion may be coincident with an acute nasolabial angle and ptotic nasal tip. Minor deformities may be addressed with use of either alloplastic implants, autogenous tissue, lipotransfer, or injectable filler. Larger composite defects may require reconstruction with implementation of free tissue transfer. Herein, we describe techniques that aim to augment, or reconstruct, the premaxillary region in the context of nasal deformity, osseous resorption, or composite maxillofacial defects.

Correction of Facial Asymmetry Using Patient-Specific Implants: A Case Report

Dentofacial deformities can have a profound impact on patients’ function and facial aesthetics. Traditionally, dentofacial deformities and malocclusion have been managed with growth modification, orthodontic therapy, and orthognathic surgery, or a combination of these modalities. The aim of this article is to discuss the use of patient-specific alloplastic implants as an adjunct or alternative to orthognathic surgery in patients with dentofacial deformities. A 40-year-old man who previously underwent surgically assisted rapid palatal expansion followed by LeFort I osteotomy advancement, intraoral vertical ramus osteotomy setback (IVRO), rhinoplasty, and fat transfer to the malar region presented with a chief complaint of dissatisfaction due to significant facial asymmetry. Tear trough deformity, concave nasal dorsum with nasal tip deviation to the left, submalar fullness, chin deviation to the right, and a poorly defined mandibular border outline were all noted on physical examination. The patient was treated with lower lid blepharoplasty with fat repositioning, buccal fat pad reduction (bichectomy), and patient-specific malar and mandibular border implants. In a patient who has a moderate-to-severe malocclusion and dentofacial deformity, traditional treatment includes orthodontic correction and orthognathic surgery. Patients undergoing primary orthognathic surgery can benefit from alloplastic implants. For patients who have residual maxillary or mandibular asymmetry after orthognathic surgery, the treatment options are secondary orthognathic procedures or facial implants. These patients can benefit from treatment with alloplastic facial implants as an adjunct or alternative to orthognathic surgery to normalize skeletal contours and improve facial aesthetics. Patient-specific alloplastic implants can be used as a powerful adjunct or alternative to orthognathic surgery. Patients with mild occlusal and skeletal deformities who have traditionally been treated with orthodontic therapy alone can benefit from evaluation of alloplastic implants. Patients with residual asymmetries after orthognathic surgery can benefit from alloplastic implants as an adjunct with secondary osteotomies or as an alternative altogether.