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.


CONCLUSIONS
Malar implant-related midface deformities can be corrected by implant removal, deficiency-specific implant replacement, and subperiosteal midface resuspension.
Yaremchuk
Michael J
MJ
Boston, Mass. From the Division of Plastic Surgery, Department of Surgery, Massachusetts General Hospital, and Harvard Medical School.
D000328:Adult; D020878:Device Removal / Q000379:methods*; D005146:Facial Asymmetry / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D019736:Prostheses and Implants / Q000009:adverse effects*; D019919:Prosthesis Implantation / Q000009:adverse effects*; D012086:Reoperation; D012189:Retrospective Studies; D015361:Rhytidoplasty / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D015050:Zygoma / Q000601:surgery*