Facial Implant FAQ

Frequently Asked Questions About Facial Implant Surgery

Question:  “I have heard that facial implant surgery is minimally invasive, is that true?” 

Answer: Yes.  It certainly is true.  Unfortunately, people get nervous about the idea of having surgery on their face.  This is a normal reaction.  However, in our present culture where people are living longer and stronger and with better faces and figures, the more common attitude is that life is for the living and most young people are willing to sacrifice a bit to get a lot. 

Implants placed into the cheek are a 30-minute procedure, which requires enough anesthesia so that your blood pressure and possible bleeding are well controlled to ensure an accurate successful placement. 

It only requires a ½-inch to ¾-inch incision high up in your mouth under your cheek that is like a dental procedure.  There is no pain following this cheek implant procedure, only a certain amount of unnatural swelling, which last for only a few weeks. Many patients who do not wish people to know about their surgery explain this as dental surgery, dental infections or wisdom tooth removal.

A chin implantation procedure is most often done through a small ½ to ¾-inch incision in the fold underneath the chin.  The scar becomes invisible after a few months and is not noticeable by anyone.  Many patients who wish to have chin implants also have fullness or sloping under the neck and jaw line that they wish to have corrected with fat removal and muscle sculpting.  In these cases there the need for a slightly longer ¾-inch to 1-inch incision, which also becomes invisible. 

A chin implant procedure is also 30 minutes.  There is some discomfort following it but no extreme, unbearable, constant, persistent long-term pain.  A few mild painkillers or analgesics for the first day or two are all that may or may not be necessary.  The swelling subsides to the point that people will never recognize that the operation was performed on you in 2 weeks or less, but the shape continues to improve for 3-6 months.

If the neck muscle and fat procedures are done at the same time, the operation is extended by another 60-90 minutes.  In this case, there is a feeling of tightness underneath the neck and perhaps some discomfort in chewing or swallowing.  This lasts for only several days and is quite tolerable especially when one uses a soft liquid or soft food diet.

A small chin implant can often be done through an incision inside the mouth of ½ to ¾ inch.  This is done in the area where you can stick your tongue down towards your chin and feel the bottom of the fold where the gum line meets the upper lip.  Scars inside the mouth become invisible and are not bothersome to patients.  However, the stitches used are absorbable and require a month or 5 weeks to be eliminated by the body.

No bandages are needed or used after a cheek or an implant procedure.  It is advised to use cold treatments for 24-48 hours only.  Activity, however, must be limited for about a month.

Question:  I have heard all kinds of different opinions regarding silicone rubber implants and a material called Medpor or Porex.  Which one is the most satisfactory and safe?

Answer:  You are correct in learning that there have been several materials over the last 50 years tried or used for facial implant or volume adding surgeries.  Traditional plastic surgery has taught us to use materials, which are hard and similar to bone.  Also, traditional thinking would say that the best thing to do is to have an implant that grows into or is integrated by the tissues of your body growing into implant material to stabilize it and make it solid.  Many plastic surgeons also believe that implants need to have fixation with screws such as are used in trauma reconstructions or oral surgery procedures where bones are broken or have to be cut and put back together again.

Nothing is further from the truth regarding these traditional ideas.  Silicone rubber implants have been used in the face for 50 years.  The material silicone has been proven to every scientist’s satisfaction, as well as the Food and Drug Administration’s satisfaction to be safe in human bodies, nonreactive, and not dangerous or disease forming.

The original silicone rubber or silicone gel implants for facial augmentation and contouring in the 1950s were small little buttons that produced very abnormal unnatural funny looking disfiguring appearances.  When I began my practice, the “Rolls Royce” of a chin implant was an oval silicone gel implant, which did not fit snugly to the bone and was not shaped anatomically like a normal chin.  This is why I decided to design new anatomic style implants from silicone rubber since they, in my hands, were relatively trouble free.

The body fixes the implant to the underlying bone with scar tissue around the implant.  This scar tissue does not grow into the implant such as it does into porous or spongy materials such as Medpor.  Therefore, if it is necessary or desirable to remove a silicone implant, only a small opening in the pocket of scar tissue surrounding the implant needs to be made for easy pain‑free and trouble-free removal of an implant.  Then a different implant, which the patient may wish to have, can easily be slipped back into the pocket with a minor modification of the pocket under local anesthesia if there is a desire for another shape or size.

Of course, it is rare to have to change or re-operate on successful facial implants of the cheek, chin, jaw line, or anywhere else, but it is comforting to the patient and the surgeon to know how easy and pain free it is to do so and with only slightly greater risk than the first operation.  The Medpor implants become solidified by the healing scar tissue surrounding and growing into them.  This makes it very difficult to remove them easily without a lot of bleeding and unnecessary damage to surrounding tissues.  Since chin implants and cheek implants are very close to important facial nerves that give sensation and feeling to the cheeks and chin region, a surgeon would not desire to damage these nerves in any way by inserting or removing implants.  The Medpor implants are very, very firm and hard as opposed to the soft rubbery flexible silicone implants.  Therefore, the surgeons who use Medpor implants admit that they are indeed more difficult to insert and remove. Therefore, they do have more problems and complications especially if it is necessary to remove them as compared to silicone implants.

Silicone rubber implants also have the advantage of being able to be “saved” in the event that an inflammation or even an infection occurs around the implant.  Of course it is not always possible to preserve the implant in the presence of inflammation or infection, but I have found it to be true most of the time.

Medpor and any other implants that have a porous composition with small holes allows for the ingrowth of body tissues, as well as germs that can cause infection.  When this type of material becomes infected, it is very difficult, if not nearly impossible, to cure without removing the implant.  This is acknowledged, as well by the users of Medpor or other materials.

The design of my implants in the cheek, chin, upper lip, and around the eyes are very anatomical and therefore provide natural unnoticeable appearances.  I have many patients who communicate to me by fax, e-mail, or letters about their dissatisfaction with the shape of Medpor implants, which can give them a bit of an artificial look like a “cartoon character.”

These are the main reasons why I feel that silicone is a far better material than Medpor to use as facial implants. And do not forget, they retain their shape and size and do not dissolve or change over years and years.  This is a very big advantage over contemporary fillers that are injected in the face slowly are absorbed by the body and still have considerable expense.  Remember, silicone rubber implants can be removed and reversed totally or exchanged fairly easily, but they always do have a permanent size, shape, and position that will last throughout the patient’s life.

Question:  “How much pain is associated with a cheek implant procedure?”

Answer:  After cheek implant surgery, the patient can expect no pain.  Yes, there is swelling, which looks unnatural and there is also some degree of stiffness and even difficulty smiling and moving your mouth. This may last for a few weeks, but all of these symptoms resolve in my experience. I have not seen any permanent situations with any change in speaking, talking, or smiling. 

Question:  “How much pain is there with the chin implant procedure?” 

Answer: A chin implant procedure done only in the front of the chin has a certain amount of tenderness and aching for some hours after surgery.  Then, the discomfort becomes very tolerable and the patients need only minimal pain medications over the next day or two.  The swelling is much less than for the back part of the jaw or “angle of the jaw” implants, and for cheeks, it resolves a lot faster to see the real improvement.  Probably, one can expect to see their new chin and profile within 1-2 weeks following surgery in a way that they can fully appreciate.  With the cheek region and the angle of jaw region, the swelling to the point of achieving a completely natural appearance takes longer.

Question:  “How long after surgery before I can exercise and get back to normal physical activity?” 

Answer: The human body consists of 85% water that is full of chemicals.  The remaining cells (muscle, bone, fat, skin, etc.) also consist of chemical structures.  When these are disrupted during surgery, chemicals are released that start the process of making mother nature’s “epoxy glue” called scar tissue to heal the body and put it back together as strongly as ever. 

This process is not an overnight one or even a week or two as most people think following surgery.  There is only 10% healing after 1 week from surgery and things can come apart or be pulled apart without effort.  By the second week, there is only 20% healing and the third week, 30%.  Therefore, during the first 3 weeks, it would be very easy to have something be pushed out of place by hands, sleeping, exercise, or accidents. 

By 1 month, however, mother nature’s glue is extremely solid and unable to be disrupted and as strong as it was before it was operated on.  At this point, there are healing feelings and the tissues, scar, wound, etc. are somewhat tight, solid, and lumpy.  There can be occasional aches, sharp shooting pains, pins and needles, itching, etc. that all go along with the healing process for the next few months.

The solid part of the healing process lasts for 3 months. Then tissues start to soften, stretch, and become flexible again.  At that point, the appearance of the surgery is much better than it was the first month and the tissues start to become soft, pliable, and more normal in appearance and feel.

Question: How much choice do I have over the shape and size of my cheeks or chin or jaw line if I have facial implant surgery?

Answer: Not only do you have a lot to say about it, but I feel that you, as the patient, should be in the driver’s seat with regard to choosing the shape and size that you personally prefer.  In order to help you do that, I ask you to provide a “homework assignment,” which includes a personal detailed description of the “look” you are trying to achieve along with photographic images either of yourself at an earlier age, or a photograph of yourself modified by you or someone on Adobe Photoshop. Also helpful are magazine photos of models, actors, and actresses who have certain features that you wish to have me try to imitate as closely as possible. 

Then through our personal consultation, we modify your own picture with an image program on my computer to also help determine what precise shape you are interested in achieving. 

After the consultation imaging, we sit down together and look at the various types of implants which I have designed over the years.  I have studied faces my entire life as a young man when I was planning to be a portrait artist.  I have found that there are six basic face types. I, therefore, have developed implants to assist with each of these types.  I also developed a number of sizes, as well as shapes to help as much as possible with facial asymmetries, a natural condition which everybody has to some degree or another and which many if not most people wish to improve upon.

I have also learned from my thousands of facial implant patients how to modify and shape the implants when necessary at the time of surgery to make them more likely to produce what look the patient is aiming to achieve.  As mentioned, in some unique situations and when a patient can afford it, custom-made implants can be made by a commercial company to suit a patient’s needs at some increased expense.

I have discussed these facial variations and the many types of implants that I  have designed in my two classic textbooks and have had commercially manufactured for me, as well as many other book chapters I have written and given hundreds of lectures I have also given on the subject nationally, as well as internationally.  My goal is to have happy satisfied patients who experience the thrill of feeling better by looking better with a face shape that looks 100% natural, undetectable, and as if made by God.

Question:  “I have heard that facial implant surgery is minimally invasive, is that true?” 

Answer: Yes.  It certainly is true.  Unfortunately, people get nervous about the idea of having surgery on their face.  This is a normal reaction.  However, in our present culture where people are living longer and stronger and with better faces and figures, their more common attitude is that life is for the living and most young people are willing to sacrifice a bit to get a lot. 

Implants placed into the cheek are a 30-minute procedure, which requires enough anesthesia so that your blood pressure and possible bleeding are well controlled to ensure an accurate successful placement. 

It only requires a ½-inch to ¾-inch incision high up in your mouth under your cheek that is like a dental procedure.  There is no pain following this cheek implant procedure, only a certain amount of unnatural swelling, which last for only a few weeks. Many patients who do not wish people to know about their surgery explain this as dental surgery or dental infections or wisdom tooth removal.

A chin implantation procedure is most often done through a small ½ to ¾-inch incision in the fold underneath the chin.  The scar becomes invisible after a few months and is not noticed by anyone.  Many patients who wish to have chin implants also have fullness or sloping under the neck and jaw line that they wish to have corrected with fat removal and muscle sculpting.  Therefore, the need for a slightly longer ¾-inch to 1-inch incision, which also becomes invisible. 

A chin implant procedure is also 30 minutes.  There is some discomfort following it but no extreme, unbearable, constant, persistent long-term pain.  A few mild painkillers or analgesics for the first day or two are all that may or may not be necessary.  The swelling subsides to the point that people will never recognize that the operation was performed on you in 2 weeks or less, but the shape continues to improve for 3-6 months.

If the neck muscle and fat procedures are done at the same time, the operation is extended by another 60-90 minutes.  In this case, there is a feeling of tightness underneath the neck and perhaps some discomfort in chewing or swallowing.  This lasts for only several days and is quite tolerable especially when one uses a soft liquid or soft food diet.

A small chin implant can often be done through an incision inside the mouth of ½ to ¾ inch.  This is done in the area where you can stick your tongue down towards your chin and feel the bottom of the fold where the gum line meets the upper lip.  Scars inside the mouth become invisible and are not bothersome to patients.  However, the stitches used are absorbable and require a month or 5 weeks to be eliminated by the body.

No bandages are needed or used after a cheek or an implant procedure.  It is advised to use cold treatments for 24-48 hours only.  Activity, however, must be limited for about a month.

 

Question:  I have heard all kinds of different opinions regarding silicone rubber implants and a material called Medpor or Porex.  Which one is the most satisfactory and safe?

Answer:  You are correct in learning that there has been several materials over the last 50 years tried or used for facial implant cosmetic or volumizing surgeries.  Traditional plastic surgery has taught us to use materials, which are hard and similar to bone.  Also, traditional thinking would say that the best thing to do is to have an implant that grows into or is integrated by the tissues of your body growing into implant material to stabilize it and make it solid.  Many plastic surgeons also believe that implants need to have fixation with screws such as are used in trauma reconstructions or oral surgery procedures where bones are broken or have to be cut and put back together again.

Nothing is further than truth regarding these traditional ideas.  Silicone rubber implants have been used in the face for 50 years.  The material silicone has been proven to every scientist’s satisfaction, as well as the Food and Drug Administration’s satisfaction to be safe in human bodies, nonreactive, and not dangerous or disease forming.

The original silicone rubber or silicone gel implants for facial augmentation and contouring in the 1950s were small little buttons that produced very abnormal unnatural funny looking disfiguring appearances.  When I began my practice, the “Rolls Royce” of a chin implant was an oval silicone gel implant, which did not fit snugly to the bone and was not shaped anatomically like a normal chin.  This is why I decided to design new anatomic style implants from silicone rubber since they, in my hands, were relatively trouble free.

The body fixes the implant to the underlying bone with scar tissue around the implant.  This scar tissue does not grow into the implant such as it does into porous or spongy materials such as Medpor.  Therefore, if it is necessary or desirable to remove a silicone implant, only a small opening in the pocket of scar tissue surrounding the implant needs to be made for easy pain‑free and trouble-free removal of an implant.  Then a different implant, which the patient may wish to have, can easily be slipped back into the pocket with a minor modification of the pocket under local anesthesia if there is a desire for another shape or size.

Of course, it is rare to have to change or re-operate on successful facial implants of the cheek, chin, jaw line, or anywhere else, but it is comforting to the patient and the surgeon to know how easy and pain free it is to do so and with only slightly greater risk than the first operation.  The Medpor implants become solidified by the healing scar tissue surrounding and growing into them.  This makes it very difficult to remove them easily without a lot of bleeding and unnecessary damage to surrounding tissues.  Since chin implants and cheek implants are very close to important nerves that give sensation and feeling to the cheeks and chin region, a surgeon would not desire to damage these nerves in any way by inserting or removing implants.  The Medpor implants are very, very firm and hard as opposed to the soft rubbery flexible silicone implants.  Therefore, the surgeons who use Medpor implants admit that they are indeed more difficult to insert and remove. Therefore, they do have more problems and complications especially if it is necessary to remove them as compared to silicone implants.

Silicone rubber implants also have the advantage of being able to be “saved” in the event that an inflammation or even an infection occurs around the implant.  Of course it is not always possible to preserve the implant in the presence of inflammation or infection, but I have found it to be true most of the time.

Medpor and any other implants that have a porous composition with small holes allows for the ingrowth of body tissues, as well as germs that can cause infection.  When this type of material becomes infected, it is very difficult, if not nearly impossible, to cure without removing the implant.  This is acknowledged, as well by the users of Medpor or other materials.

The design of my implants in the cheek, chin, upper lip, and around the eyes are very anatomical and therefore provide natural unnoticeable appearances.  I have many patients who communicate to me by fax, e-mail, or letters about their dissatisfaction with the shape of Medpor implants, which can give them a bit of an artificial look like a “cartoon character.”

These are the main reasons why I feel that silicone is a far better material than Medpor to use as facial implants. And do not forget, they retain their shape and size and do not dissolve or change over years and years.  This is a very big advantage over contemporary fillers that are injected in the face slowly are absorbed by the body and still have considerable expense.  Remember, silicone rubber implants can be removed and reversed totally or exchanged fairly easily, but they always do have a permanent size, shape, and position that will last throughout the patient’s life.

 

Question:  “How much pain is associated with a cheek implant procedure?”

Answer:  After cheek implant surgery, the patient can expect no pain.  Yes, there is swelling, which looks unnatural and there is also some degree of stiffness and even difficulty smiling and moving your mouth. This may last for a few weeks, but all of these symptoms resolve in my experience. I have not seen any permanent situations with any change in speaking, talking, or smiling. 

 

Question:  “How much pain is there with the chin implant procedure?” 

Answer: A chin implant procedure done only in the front of the chin has a certain amount of tenderness and aching for some hours after surgery.  Then, the discomfort becomes very tolerable and the patients need only minimal pain medications over the next day or two.  The swelling is much less than for the back part of the jaw or “angle of the jaw” implants, and for cheeks, it resolves a lot faster to see the real improvement.  Probably, one can expect to see their new chin and profile within 1-2 weeks following surgery in a way that they can fully appreciate.  With the cheek region and the angle of jaw region, the swelling to the point of achieving a completely natural appearance takes longer.

    

Question:  “How long after surgery before I can exercise and get back to normal physical activity?” 

Answer: The human body consists of 85% water that is full of chemicals.  The remaining cells (muscle, bone, fat, skin, etc.) also consist of chemical structures.  When these are disrupted during surgery, chemicals are released that start the process of making mother nature’s “epoxy glue” called scar tissue to heal the body and put it back together as strongly as ever. 

This process is not an overnight one or even a week or two as most people think following surgery.  There is only 10% healing after 1 week from surgery and things can come apart or be pulled apart without effort.  By the second week, there is only 20% healing and the third week, 30%.  Therefore, during the first 3 weeks, it would be very easy to have something be pushed out of place by hands, sleeping, exercise, or accidents. 

By 1 month, however, mother nature’s glue is extremely solid and unable to be disrupted and as strong as it was before it was operated on.  At this point, there are healing feelings and the tissues, scar, wound, etc. are somewhat tight, solid, and lumpy.  There can be occasional aches, sharp shooting pains, pins and needles, itching, etc. that all go along with the healing process for the next few months.

The solid part of the healing process lasts for 3 months. Then tissues start to soften, stretch, and become flexible again.  At that point, the appearance of the surgery is much better than it was the first month and the tissues start to become soft, pliable, and more normal in appearance and feel.

 

Question: How much choice do I have over the shape and size of my cheeks or chin or jaw line if I have facial implant surgery?

Answer: Not only do you have a lot to say about it, but I feel that you as the patient should be in the drivers seat with regard to choosing the shape and size that you personally prefer.  In order to help you do that, I ask you to provide a “homework assignment,” which includes a personal detailed description of the “look” you are trying to achieve along with photographic images either of yourself at an earlier age, or a photograph of yourself modified by you or someone on Adobe Photoshop. Also helpful are magazine photos of models, actors, and actresses who have certain features that you wish to have me try to imitate as closely as possible. 

Then through our personal consultation, we modify your own picture with an image program on my computer to also help determine what precise shape you are interested in achieving. 

After the consultation imaging, we sit down together and look at the various types of implants which I have designed over the years.  I have studied faces my entire life as a young man when I was planning to be a portrait artist.  I have found that there are six basic face types. I, therefore, have developed implants to assist with each of these types.  I also developed a number of sizes, as well as shapes to help as much as possible with facial asymmetries, a natural condition which everybody has to some degree or another and which many if not most people wish to improve upon.

I have also learned from my thousands of facial implant patients how to modify and shape the implants when necessary at the time of surgery to make them more likely to produce what look the patient is aiming to achieve.  As mentioned, in some unique situations and when a patient can afford it, custom-made implants can be made by a commercial company to suit a persons needs at some increased expense.

I have discussed these facial variations and the many types of implants that I  have designed in my two classic textbooks and have had commercially manufactured for me, as well as many other book chapters I have written and given hundreds of lectures I have also given on the subject nationally, as well as internationally.  My goal is to have happy satisfied patients who experience the thrill of feeling better by looking better with a face shape that looks 100% natural, undetectable, and as if made by God.

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