Malar augmentation with silicone implants.
This study is a retrospective review of all consecutive surgeries involving insertion of silicone malar implants performed at the Manhattan Eye, Ear and Throat Hospital from January 1, 1985 to April 30, 1993. Sixty-four patients underwent placement of 126 silicone malar implants. Three different sizes were utilized: 23 size 1, 85 size 2, and 18 size 3. Eleven patients underwent unilateral implant placement, all for reconstructive purposes. The average and median ages of the patients were 43 and 44 years, respectively, with a range of 18 to 83 years. Malar implants were inserted for the following reasons: hypoplasia, post-traumatic deformity, post-tumor resection deformity, and correction of hemifacial microsomia. In 79 percent of the patients, malar augmentation was performed in conjunction with other surgical procedures. All implants were placed in a subperiosteal pocket by either the intraoral, subciliary, or preauricular approach. Forty-one percent were fixed in place by percutaneous sutures. Malar augmentation with silicone implants for both aesthetic and reconstructive purposes is an increasingly common surgical procedure. Good results are obtained with few complications. Infection is rare even with transoral placement. Silicone malar implants should be placed in a subperiosteal pocket and can be inserted safely through various routes. Malpositioning of implants is infrequent, and fixation sutures are not required. The most common problem is improper size selection. Patient satisfaction is high, in that no patient underwent permanent removal of a malar silicone implant once inserted.