Some implants are manufactured from biological materials such as collagen (Dermaplant) and hyaluronic acid (Dermadeep, Dermalive). Most implants, however, are made from synthetic materials. Numerous substances have been used to augment facial contours for cosmetic purposes.
Two of the most commonly used are described below:
• ePTFE (expanded polytetrafluorethylene, Gore-Tex, Softform,Advanta):
Several manufactured synthetic polymer fillers are available that are formed as medical-grade implants rather than injectable substances, including Gore-Tex (yes, the same stuff your boots are lined with). These implants can fill deeper lines than can collagen and are sometimes used for lip enhancement. They are truly permanent and may become too noticeable over time. They can be difficult if not impossible to remove.
• Solid silicone: Solid silicone implants come “off the rack” in many shapes and sizes.
A surgeon can also fabricate a custom implant from a silicone block. The operation to insert a silicone implant is usually fairly straightforward, and the most commonly augmented sites are the chin and the cheek prominences. Either local or general anesthesia may be used, and incisions are often made inside the mouth or eyelid to avoid external scars. Some type of splinting, such as taping or an elastic garment, may be used to minimize swelling and bruising. Patients will have diffi- culty talking, eating, and brushing their teeth in the early period after surgery. Patients usually resume normal activities within a few days. The final effect of the implant will not be evident for months, until the swelling has entirely subsided.
Most complications after implant insertion are related to the presence of the foreign body or to technical factors, such as poor positioning or improper choice of implant size or shape. Implants can also shift into undesirable positions. Eyelid problems and chin numbness can result from surgery in these areas. Implants can become infected or over time cause deformity if the scar around the implant distorts adjacent normal tissues. Any of these compli-cations can result in the need for further surgery and temporary or permanent removal of the implant. Synthetic implants are more likely to cause problems than are autografts. However, autografts can be absorbed or change shape, especially in the presence of infection.