Facial implants can dramatically change facial balance, but the difference between a natural result and an operated look comes down to planning, positioning, and fixation. In this episode, we break down the core principles of facial skeletal augmentation with implants for the plastic surgery resident.

We review the major implant materials, the anatomic targets across the midface and mandible, and the operative concepts that matter most in real cases. This includes why subperiosteal placement is preferred, why screw fixation remains a key technical principle, and how to think through chin augmentation versus sliding genioplasty. We also cover common causes of poor outcomes, including malposition, asymmetry, poor transition zones, and technique-related complications rather than material toxicity.

Key takeaways:

• Facial skeletal morphology is a major determinant of facial aesthetics
• Anthropometric normals are more useful than rigid neoclassical canons for planning

• Subperiosteal dissection improves visualization, precision, and safety during implant placement
• Screw fixation helps eliminate implant-bone gaps and reduces migration risk
• Infraorbital rim and paranasal implants can be powerful tools in midface deficiency

• Chin implants and sliding genioplasty each have distinct advantages and tradeoffs

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References

1. Farkas LG, Hreczko TA, Kolar JC, Munro IR. Vertical and horizontal proportions of the face in young adult North American Caucasians: revision of neoclassical canons. Plast Reconstr Surg. 1985;75(3):328-338. doi:10.1097/00006534-198503000-00005. PMID: 3883374.
2. Rubin JP, Yaremchuk MJ. Complications and toxicities of implantable biomaterials used in facial reconstructive and aesthetic surgery: a comprehensive review of the literature. Plast Reconstr Surg. 1997;100(5):1336-1353. doi:10.1097/00006534-199710000-00043. PMID: 9326803.
3. Yaremchuk MJ, Israeli D. Paranasal implants for correction of midface concavity. Plast Reconstr Surg. 1998;102(5):1676-1684. doi:10.1097/00006534-199810000-00055. PMID: 9774030.
4. Yaremchuk MJ. Infraorbital rim augmentation. Plast Reconstr Surg. 2001;107(6):1585-1592. doi:10.1097/00006534-200105000-00047. PMID: 11335841.

Disclaimer: This content is for educational purposes only and is not medical advice.
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