Aesthetic Plastic Surgery

, Volume 43, Issue 3, pp 625–636 | Cite as

Alloplastic Facial Implants: A Systematic Review and Meta-Analysis on Outcomes and Uses in Aesthetic and Reconstructive Plastic Surgery

  • Jeremie D. OliverEmail author
  • Annica C. Eells
  • Elias S. Saba
  • Daniel Boczar
  • David J. Restrepo
  • Maria T. Huayllani
  • Andrea Sisti
  • Michael S. Hu
  • Daniel J. Gould
  • Antonio Jorge Forte
Systemic Review Facial Surgery



Alloplastic materials in facial surgery have been used successfully for various applications in the reconstructive restoration or aesthetic augmentation of the facial skeleton. The objective of this study was to conduct a comprehensive systematic review of alloplastic implant materials utilized to augment the facial skeleton stratified by anatomical distribution, indication, specific material used, and respective outcomes.


A comprehensive systematic review on alloplastic facial implant data was conducted utilizing Medline/PubMed database. Articles were stratified by (1) anatomic localization in the face, as well as (2) alloplastic material.


A total of 17 studies (n = 2100 patients, follow-up range = 1 month–27 years) were included. Overall, mersilene mesh implants were associated with the highest risk of infection (3.38%). Methyl methacrylate implants were associated with the highest rate of hematoma (5.98%). Implants placed in the malar region (2.67%) and frontal bones (2.50%) were associated with the highest rates of infection. Implants placed in the periorbital region were associated with the highest rate of inflammation (8.0%), explantation (8.0%), and poor cosmetic outcome (17.0%). Porous implants were shown to be more likely to potentiate infection than non-porous implant types.


Alloplastic facial implants are a reliable means of restoring facial symmetry and achieving facial skeletal augmentation with a relatively low complication profile. It is important for plastic surgeons to understand the relative risks for each type of implant to develop postoperative complications or poor long-term cosmetic results. Interestingly, porous implants were shown to be more likely to potentiate infection than non-porous implant types.

Level of Evidence III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors


Face Alloplast Implant Aesthetic Reconstructive Augmentation Outcomes Review 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Human and Animal Rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed Consent

For this type of study, informed consent is not required.

Supplementary material

266_2019_1370_MOESM1_ESM.docx (29 kb)
Supplementary material 1 (DOCX 28 kb)


  1. 1.
    Frodel JL, Lee S (1998) The use of high-density polyethylene implants in facial deformities. Arch Otolaryngol Head Neck Surg 124(11):1219–1223Google Scholar
  2. 2.
    Cuzalina LA, Hlavacek MR (2009) Complications of facial implants. Oral Maxillofac Surg Clin N Am 21(1):91–104Google Scholar
  3. 3.
    Gear AJ, Lokeh A, Aldridge JH, Migliori MR, Benjamin CI, Schubert W (2002) Safety of titanium mesh for orbital reconstruction. Ann Plast Surg 48(1):1–9Google Scholar
  4. 4.
    Klawitter JJ, Bagwell JG, Weinstein AM, Sauer BW, Pruitt JR (1976) An evaluation of bone growth into porous high density polyethylene. J Biomed Mater Res 10(2):311–323Google Scholar
  5. 5.
    Winkler AA, Soler ZM, Leong PL, Murphy A, Wang TD, Cook TA (2012) Complications associated with alloplastic implants in rhinoplasty. Arch Facial Plast Surg 14(6):437–441Google Scholar
  6. 6.
    Wellisz T (1993) Clinical experience with the Medpor porous polyethylene implant. Aesthetic Plast Surg 17(4):339–3448273538Google Scholar
  7. 7.
    Türegün M, Sengezer M, Güler M (1998) Reconstruction of saddle nose deformities using porous polyethylene implant. Aesthetic Plast Surg 22(1):38–419456353Google Scholar
  8. 8.
    Romo T III, Sclafani AP, Sabini P (1998) Use of porous high-density polyethylene in revision rhinoplasty and in the platyrrhine nose. Aesthetic Plast Surg 22(3):211–2219618188Google Scholar
  9. 9.
    Ahn J, Honrado C, Horn C (2004) Combined silicone and cartilage implants: augmentation rhinoplasty in Asian patients. Arch Facial Plast Surg. 6(2):120–123Google Scholar
  10. 10.
    Bertossi D, Galzignato PF, Albanese M et al (2015) Chin microgenia: a clinical comparative study. Aesthet Plast Surg 39(5):651–658Google Scholar
  11. 11.
    Chang C, Kong WK (2014) Clinical effectiveness and safety of collagen sheet for dorsal augmentation in rhinoplasty. J Craniofac Surg 25(5):1852–1854Google Scholar
  12. 12.
    Demirkan F, Arslan E, Unal S, Aksoy A (2003) Irradiated homologous costal cartilage: versatile grafting material for rhinoplasty. Aesthetic Plast Surg 27(3):213–220Google Scholar
  13. 13.
    Erol OO, Enacar A (2003) Augmentation mentoplasty using a custom-design wire cage. J Craniofac Surg 14(6):884–892Google Scholar
  14. 14.
    Fanous N, Tournas A, Côté V et al (2017) Soft and firm alloplastic implants in rhinoplasty: why, when and how to use them: a review of 311 cases. Aesthetic Plast Surg 41(2):397–412Google Scholar
  15. 15.
    Gross EJ, Hamilton MM, Ackermann K, Perkins SW (1999) Mersilene mesh chin augmentation. A 14-year experience. Arch Facial Plast Surg. 1(3):183–189 (discussion 190) Google Scholar
  16. 16.
    Hollier LH, Rogers N, Berzin E, Stal S (2001) Resorbable mesh in the treatment of orbital floor fractures. J Craniofac Surg 12(3):242–246Google Scholar
  17. 17.
    Holmes AD, Lee SJ, Greensmith A, Heggie A, Meara JG (2010) Nasal reconstruction for maxillonasal dysplasia. J Craniofac Surg 21(2):543–551Google Scholar
  18. 18.
    Hopping SB, Joshi AS, Tanna N, Janjanin S (2010) Volumetric facelift: evaluation of rhytidectomy with alloplastic augmentation. Ann Otol Rhinol Laryngol 119(3):174–180Google Scholar
  19. 19.
    Lustica I, Velepic M, Cvjetković N et al (2001) Polymethyl-methacrylate implants in forehead and supraorbital arches reconstruction: retrospective study. Coll Antropol 25(Suppl):137–143Google Scholar
  20. 20.
    Niechajev I (2012) Facial reconstruction using porous high-density polyethylene (medpor): long-term results. Aesthetic Plast Surg 36(4):917–927Google Scholar
  21. 21.
    Nocini PF, Boccieri A, Bertossi D (2009) Gridplan midfacial analysis for alloplastic implants at the time of jaw surgery. Plast Reconstr Surg 123(2):670–679Google Scholar
  22. 22.
    Park DK, Song I, Lee JH, You YJ (2013) Forehead augmentation with a methyl methacrylate onlay implant using an injection-molding technique. Arch Plast Surg 40(5):597–602Google Scholar
  23. 23.
    Robiony M, Costa F, Demitri V, Politi M (1998) Simultaneous malaroplasty with porous polyethylene implants and orthognathic surgery for correction of malar deficiency. J Oral Maxillofac Surg. 56(6):734–741 (discussion 742) Google Scholar
  24. 24.
    Shadfar S, Farag A, Jarchow AM, Shockley WW (2015) Safety and efficacy of expanded polytetrafluoroethylene implants in the surgical management of traumatic nasal deformity. JAMA Otolaryngol Head Neck Surg 141(8):710–715Google Scholar
  25. 25.
    Yaremchuk MJ (2003) Improving aesthetic outcomes after alloplastic chin augmentation. Plast Reconstr Surg 112(5):1422–1432 (discussion 1433-4) Google Scholar
  26. 26.
    Alonso N, de Pochat VD, de Barros AR, Tavares LS (2013) Long-term complication after rhinoplasty using porous polyethylene implant: cutaneous fistula of the forehead. J Craniofac Surg 24(6):2176–2178Google Scholar
  27. 27.
    Bain CJ, Odili J (2012) Late infection of an alloplastic chin implant masquerading as squamous cell carcinoma. J Plast Reconstr Aesthet Surg 65(6):e151–e152Google Scholar
  28. 28.
    Emsen IM, Benlier E (2008) A new approach on reconstruction of frontonasal encephalomeningocele assisted with medpor. J Craniofac Surg 19(2):537–539Google Scholar
  29. 29.
    Eufinger H, Wehmöller M, Scholz M, Harders A, Machtens E (1999) Reconstruction of an extreme frontal and frontobasal defect by microvascular tissue transfer and a prefabricated titanium implant. Plast Reconstr Surg 104(1):198–203Google Scholar
  30. 30.
    Graham BS, Thiringer JK, Barrett TL (2001) Nasal tip ulceration from infection and extrusion of a nasal alloplastic implant. J Am Acad Dermatol 44(2 Suppl):362–364Google Scholar
  31. 31.
    Greene AK, Warren SM, McCarthy JG (2008) Onlay frontal cranioplasty using wire reinforced methyl methacrylate. J Craniomaxillofac Surg 36(3):138–142Google Scholar
  32. 32.
    Hoffmann C, Schuller-Petrovic S, Soyer HP, Kerl H (1999) Adverse reactions after cosmetic lip augmentation with permanent biologically inert implant materials. J Am Acad Dermatol 40(1):100–102Google Scholar
  33. 33.
    Pak MW, Chan ES, van Hasselt CA (1998) Late complications of nasal augmentation using silicone implants. J Laryngol Otol 112(11):1074–1077Google Scholar
  34. 34.
    Saray A (2003) Porcine dermal collagen (Permacol) for facial contour augmentation: preliminary report. Aesthetic Plast Surg. 27(5):368–375Google Scholar
  35. 35.
    Scolozzi P (2012) Maxillofacial reconstruction using polyetheretherketone patient-specific implants by “mirroring” computational planning. Aesthet Plast Surg 36(3):660–665Google Scholar
  36. 36.
    Stalder MW, St Hilaire H (2012) Immediate osseous genioplasty with Kirschner wire fixation for revision of infected alloplastic chin implant. J Craniofac Surg 23(5):e446–e447Google Scholar
  37. 37.
    Tieghi R, Consorti G, Clauser LC (2012) Contouring of the forehead irregularities (washboard effect) with bone biomaterial. J Craniofac Surg 23(3):932–934Google Scholar
  38. 38.
    Raghavan U, Jones NS, Romo T 3rd (2004) Immediate autogenous cartilage grafts in rhinoplasty after alloplastic implant rejection. Arch Facial Plast Surg 6(3):192–196Google Scholar
  39. 39.
    Quatela VC, Chow J (2008) Synthetic facial implants. Fac Plast Surg Clin N Am 16(1):1–10Google Scholar
  40. 40.
    Sclafani AP, Romo T III (2000) Biology and chemistry of facial implants. Facial Plast Surg 16(01):003–006Google Scholar
  41. 41.
    Dale EL, Sargent LA (2015) Bilateral erosion of malar implants into the maxillary sinuses. Plast Surg Case Stud 1(2):32–34Google Scholar
  42. 42.
    Wellisz T, Lawrence M, Jazayeri MA, Golshani S, Zhou ZY (1995) The effects of alloplastic implant onlays on bone in the rabbit mandible. Plast Reconstr Surg 96(4):957–963Google Scholar
  43. 43.
    Ren W, Wu B, Mayton L, Wooley PH (2002) Polyethylene and methyl methacrylate particle-stimulated inflammatory tissue and macrophages up-regulate bone resorption in a murine neonatal calvaria in vitro organ system. J Orthop Res 20(5):1031–1037Google Scholar
  44. 44.
    Peled IJ, Wexler MR, Ticher S, Lax EE (1986) Mandibular resorption from silicone chin implants in children. J Oral Maxillofac Surg 44(5):346–348Google Scholar
  45. 45.
    Peled ZM, Warren AG, Johnston P, Yaremchuk MJ (2008) The use of alloplastic materials in rhinoplasty surgery: a meta-analysis. Plast Reconstr Surg 121(3):85e–92eGoogle Scholar
  46. 46.
    Deva AK, Merten S, Chang L (1998) Silicone in nasal augmentation rhinoplasty: a decade of clinical experience. Plast Reconstr Surg 102:1230–1237Google Scholar
  47. 47.
    Graham BS, Thiringer JK, Barrett TL (2001) Nasal tip ulceration from infection and extrusion of a nasal alloplastic implant. J Am Acad Dermatol 44(2):362–364Google Scholar
  48. 48.
    Park DK, Song I, Lee JH, You YJ (2013) Forehead augmentation with a methyl methacrylate onlay implant using an injection-molding technique. Arch Plast Surg 40(5):597Google Scholar
  49. 49.
    Kiechel SF, Rodeheaver GT, Klawitter JJ, Edgerton MT, Edlich RF (1977) The role of implant porosity on the development of infection. Surg Gynecol Obstet 144(1):58–62Google Scholar
  50. 50.
    Lohuis PJFM, Watts SJ, Vuyk HD (2001) Augmentation of the nasal dorsum using Gore-Tex®: intermediate results of a retrospective analysis of experience in 66 patients. Clin Otolaryngol Allied Sci 26(3):214–217Google Scholar
  51. 51.
    Adams JR, Kawamoto HK (1995) Late infection following aesthetic malar augmentation with proplast implants. Plast Reconstr Surg 95(2):382–384Google Scholar
  52. 52.
    Staffel G, Shockley W (1995) Nasal implants. Otolaryngol Clin North Am 28(2):295–308Google Scholar
  53. 53.
    Rubin JP, Yaremchuk MJ (1997) Complications and toxicities of implantable biomaterials used in facial reconstructive and aesthetic surgery: a comprehensive review of the literature. Plast Reconstr Surg 100(5):1336–1353Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2019

Authors and Affiliations

  • Jeremie D. Oliver
    • 1
    Email author
  • Annica C. Eells
    • 2
  • Elias S. Saba
    • 1
  • Daniel Boczar
    • 5
  • David J. Restrepo
    • 5
  • Maria T. Huayllani
    • 5
  • Andrea Sisti
    • 5
  • Michael S. Hu
    • 3
  • Daniel J. Gould
    • 4
  • Antonio Jorge Forte
    • 5
  1. 1.Mayo Clinic School of MedicineMayo ClinicRochesterUSA
  2. 2.Mayo Clinic School of MedicineMayo ClinicScottsdaleUSA
  3. 3.Department of Plastic SurgeryUniversity of Pittsburgh Medical CenterPittsburghUSA
  4. 4.Division of Plastic and Reconstructive SurgeryUniversity of Southern California Keck School of MedicineLos AngelesUSA
  5. 5.Division of Plastic Surgery and Robert D. and Patricia E. Kern Center for the Science of Health Care DeliveryMayo ClinicJacksonvilleUSA

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