Change of Face by Elvira Maricic Facial implants can add balance and harmony to your face, and sometimes, your life print article      send to a friend

While most people undergoing facial implants aim for a subtler and less talked-about end result than Roseanne's, many agree that high cheekbones and a strong chin convey both youth and beauty. In addition, the changes brought about as a result of this surgery can greatly enhance self-esteem.

Improving on Nature

Today's celebrities and non-celebrities alike aren't the first to take advantage of these procedures. In fact, facial implants have been providing balance to facial features for nearly 40 years. Currently, as in the past, silicone remains the implant material of choice. "Silicone is the most widely used facial implant for chin and cheek implants," says Paul R. Weiss, MD.  "There are other alloplastic materials that have been used, but I would say that silicone is the most commonly used. Silicone is an inert material that is usually well tolerated. [The implants] are applicable to correct deficiencies in both the cheek or malar area as well as the chin," adds Dr. Weiss, a spokesperson for the American Society of Plastic Surgeons (ASPS).

Both cheek and chin implant surgery is most often done on an outpatient basis under local or regional anesthesia. "They are often combined with other surgeries," says Dr. Weiss. "For example, a chin implant is often combined with a rhinoplasty, or a face lift with cheek implants. Those are commonly combined procedures, although they are sometimes done as sole procedures," he notes.

For cheek surgery, which takes 30 to 45 minutes to perform, the implant is inserted through an incision made either inside the upper lip or the lower eyelid. If the surgery is combined with another facial procedure, the implant can be inserted through the incision made for that procedure.

Chin implant surgery, which takes approximately 30 minutes to an hour, involves making a small incision either in the mouth or in the skin under the chin area. The implant is then inserted through the incision, and the resulting scar is usually not noticeable.

Additionally, says Dr. Weiss, the chin can also be augmented through a procedure called the "sliding geneoplasty." In this procedure, the surgeon cuts the lower portion of the jawbone, slides it forward, and fixes it in place in a forward position. "This will achieve the same effect as the chin implant with the advantage of having the muscles of the face that were originally attached to that portion of the chin remain attached. That brings that whole chin forward, aligned with the musculature, so in some situations it will give a better appearance than an implant alone," Dr. Weiss says.

Recovery from surgery is fairly rapid. "Within the period of a week, the majority of the swelling is gone, the surgical incision--which is very often intra-oral--has healed, and, aside from some residual swelling and discoloration of skin (which can be hidden with camouflage makeup), people are really pretty much back to normal in a short period of time," says Dr. Weiss.

Since implant surgery is surgery, it, like other procedures, carries some uncertainty and risk. There is a risk of infection, but, according to Dr. Weiss, the infection rate is very small. Another common complication is malposition, where an implant can shift out of alignment and an additional operation may be necessary to place it in the proper position.  "I think malposition may be a somewhat larger complication risk, especially when you're doing something on both sides, like the cheek implants," he says.

After the Fact

After the healing has taken place, many people may not be aware that you've had surgery--only that you look better. But how will the implants hold up over time? Rather well, according to Dr. Weiss.

"If you have an implant in for a long period of time, for example, a chin implant, you can see on an x-ray that there's often an indentation in the bone in the mandible as a result of the long-standing compression by the silicone implant, but that doesn't have any health implications and it doesn't usually make any significant change in the appearance," Dr. Weiss explains. "Once the implant has healed in place and a scar forms around it, it's very unusual for it to migrate. If a young person has cheek implants put in, as their face ages there will be descent of the soft tissue and, as a result, the implant's appearance may change somewhat. It may become more prominent or more noticeable, but the implant itself is unlikely to undergo any significant change over time."

Facial implant surgery can produce amazing results, but like many surgeries, it's not feasible for everyone.  "If someone has a significant underlying medical problem, that person is not a candidate for any type of elective aesthetic surgery," says Dr. Weiss.  Individuals with severe cardiac conditions, severe hypertension, or other conditions that may interfere with the healing process should avoid the surgery. Additionally, according to Dr. Weiss, those who are on anticoagulants due to a heart murmur or because they're had previous vascular surgery should not have the procedure done. "The risk of taking them off their anticoagulants to allow the surgery would be a reason to reject them as a candidate for such surgery because of the significant increase in risk, " he says.

Viable candidates for the surgery, however, can expect pleasant results. Although these results are often dramatic, patients should be aiming for a subtle change, according to Dr. Weiss. After all, "You're trying to enhance appearance, not change it," he says.