Secondary malar implant surgery.

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.