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Secondary Malar Implant Surgery

Yaremchuk, Michael J. M.D.

Plastic and Reconstructive Surgery: February 2008 - Volume 121 - Issue 2 - p 620-628
doi: 10.1097/01.prs.0000298094.57441.63

Background: Iatrogenic problems may occur after malar implant surgery. These include asymmetry, displeasing contours (too wide, too large, too low, or too prominent) with time, and symptoms related to infraorbital nerve damage.

Methods: Implant removal at the time of secondary surgery leaves depressions in the cheek resulting from implant-induced bone erosion and soft-tissue contracture. Secondary surgery requires implant removal, implant replacement with appropriately positioned and sized implants, and cheek resuspension (subperiosteal midface lift) to mask and redistribute implant-induced soft-tissue distortions.

Results: Twenty of the 22 patients were satisfied with their secondary operation. One patient requested another revision and, later, implant removal. Another patient who had been previously treated for infection developed another infection requiring implant removal.

Conclusion: Malar implant–related midface deformities can be corrected by implant removal, deficiency-specific implant replacement, and subperiosteal midface resuspension.

Boston, Mass.

From the Division of Plastic Surgery, Department of Surgery, Massachusetts General Hospital, and Harvard Medical School.

Received for publication July 26, 2006; accepted September 12, 2006.

Michael J. Yaremchuk, M.D., Massachusetts General Hospital, Wang Ambulatory Care Center, Suite 453, 15 Parkman Street, Boston, Mass. 02114,

Disclosure:In 2005 to 2006, Porex Surgical supported basic science research (cartilage tissue engineering using porous polyethylene scaffolds) performed under the direction of Dr. Yaremchuk in the plastic surgery research laboratories at Massachusetts General Hospital. In 2007, Dr. Yaremchuk became a paid consultant for Porex Surgical, with no royalties or stock.

©2008American Society of Plastic Surgeons