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Copyright (c) 2025 Bandar Madshar Mansor Alaanazi, Anoud Theyab Dubul Alanazi, Meznah Zuqm Sulobi AldaFeeri, Sufuq Ali M. Alshammari, Fahad Yahya A. Madkhali, Mohammed Talal Ahmed Al Refaei, Abdulrahman Khalid Ghayib Alghbaywi, Abrar Shaya Alasairi, Mansour Qasem A. Majmi, Yasir Hussain H. Tumayhi, Manal Nasser Alqahtani, Safia lbrahim ALFIFI
This work is licensed under a Creative Commons Attribution 4.0 International License.
Clinical Evaluation, Imaging, and Anesthetic Considerations in Facial Implant Procedures: An Interdisciplinary Approach for Dentistry, Radiology, and Anesthesia
Corresponding Author(s) : Bandar Madshar Mansor Alaanazi
Saudi Journal of Medicine and Public Health, Vol. 2 No. 2 (2025)
Abstract
Background: Facial implants are increasingly used across cosmetic and reconstructive dentistry and maxillofacial surgery to restore projection, symmetry, and contour—most commonly at the chin, malar eminence, and mandibular angle. Contemporary data show overall complication rates of ~4%–11% and highlight the need for rigorous anatomic, imaging, and anesthetic integration to optimize safety and outcomes.
Aim: To synthesize an interdisciplinary, practice-oriented framework that unifies clinical evaluation, imaging workflows, and anesthetic decision-making for facial implant procedures, with emphasis on anatomy-driven risk mitigation and team-based care.
Methods: Narrative, interdisciplinary review and consolidation of current operative anatomy (trigeminal and facial nerve danger zones; infraorbital/mental neurovascular bundles; muscular attachments), imaging modalities (2D cephalometry, CBCT, stereophotogrammetry, digital planning), materials science (HDPE, silicone, titanium, and patient-specific implants), perioperative anesthesia, and complication profiles.
Results: High-value risk zones include the supraorbital/supratrochlear, infraorbital, zygomaticofacial/zygomaticotemporal, and mental foramina, and the temporal, zygomatic–buccal, and marginal mandibular branches of CN VII. 3D imaging (CBCT + surface scanning) refines diagnosis, fit, and fixation, while cephalometric metrics and AI-assisted planning guide implant choice and position. Intraoral approaches with subperiosteal dissection, secure fixation (screws/sutures), and layered closure limit migration and soft-tissue ptosis. Reported infections occur in ~2%–5%, displacement in ~1%–3%, mental nerve injury near ~2.4%, and porous polyethylene shows less bony resorption than solid silicone. Tailored anesthesia (IV sedation or general), antibiotic prophylaxis, and postoperative compression further reduce morbidity.
Conclusion: A standardized, anatomy- and imaging-led pathway—coupled with vigilant anesthetic planning and interprofessional execution—improves safety, predictability, and aesthetics in facial implant surgery. Future multicenter studies and registries should refine risk stratification, material selection, and patient-reported outcomes.
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- Binder WJ, Azizzadeh B. Malar and submalar augmentation. Facial plastic surgery clinics of North America. 2008 Feb:16(1):11-32, v
- Abdulaziz MKB, Kamal M, Kolaityte V, Aziz H. Complications of alloplastic facial skeletal implants in aesthetic surgery: A systematic review and meta-analysis. Journal of plastic, reconstructive & aesthetic surgery : JPRAS. 2025 Aug:107():5-18. doi: 10.1016/j.bjps.2025.04.042.
- Cuzalina LA, Hlavacek MR. Complications of facial implants. Oral and maxillofacial surgery clinics of North America. 2009 Feb:21(1):91-104, vi-vii. doi: 10.1016/j.coms.2008.10.009.
- Lutz JC, Assouline Vitale LS, Graillon N, Foletti JM, Schouman T. Standard and Customized Alloplastic Facial Implants Refining Orthognathic Surgery: Outcome Evaluation. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 2020 Oct:78(10):1832.e1-1832.e12. doi: 10.1016/j.joms.2020.05.009.
- Niamtu J 3rd. Essentials of cheek and midface implants. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 2010 Jun:68(6):1420-9. doi: 10.1016/j.joms.2009.12.004.
- Romano N, Federici M, Castaldi A. Imaging of cranial nerves: a pictorial overview. Insights into imaging. 2019 Mar 15:10(1):33. doi: 10.1186/s13244-019-0719-5.
- Hazani R, Rao A, Ford R, Yaremchuk MJ, Wilhelmi BJ. The safe zone for placement of chin implants. Plastic and reconstructive surgery. 2013 Apr:131(4):869-872. doi: 10.1097/PRS.0b013e3182818e6c.
- Hu KS, Yun HS, Hur MS, Kwon HJ, Abe S, Kim HJ. Branching patterns and intraosseous course of the mental nerve. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 2007 Nov:65(11):2288-94
- Azizzadeh B, Mashkevich G. Nerve injuries and treatment in facial cosmetic surgery. Oral and maxillofacial surgery clinics of North America. 2009 Feb:21(1):23-9, v. doi: 10.1016/j.coms.2008.10.003.
- Mendelson B, Wong CH. Changes in the facial skeleton with aging: implications and clinical applications in facial rejuvenation. Aesthetic plastic surgery. 2012 Aug:36(4):753-60. doi: 10.1007/s00266-012-9904-3.
- Fattahi T. The prejowl sulcus: an important consideration in lower face rejuvenation. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 2008 Feb:66(2):355-8. doi: 10.1016/j.joms.2006.11.032.
- Cronin RJ Jr, Oesterle LJ, Ranly DM. Mandibular implants and the growing patient. The International journal of oral & maxillofacial implants. 1994 Jan-Feb:9(1):55-62
- Op Heij DG, Opdebeeck H, van Steenberghe D, Quirynen M. Age as compromising factor for implant insertion. Periodontology 2000. 2003:33():172
- Yaremchuk MJ. Mandibular augmentation. Plastic and reconstructive surgery. 2000 Sep:106(3):697-706
- Birgfeld C, Heike C. Craniofacial Microsomia. Clinics in plastic surgery. 2019 Apr:46(2):207-221. doi: 10.1016/j.cps.2018.12.001.
- Schwaiger M, Echlin K, Atherton D, Haers P. The use of Medpor implants for midface contouring in cleft patients. International journal of oral and maxillofacial surgery. 2019 Sep:48(9):1177-1184. doi: 10.1016/j.ijom.2019.02.008.
- Aarts BE, Convens J, Bronkhorst EM, Kuijpers-Jagtman AM, Fudalej PS. Cessation of facial growth in subjects with short, average, and long facial types - Implications for the timing of implant placement. Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery. 2015 Dec:43(10):2106-11. doi: 10.1016/j.jcms.2015.10.013.
- Hardin AM, Knigge RP, Oh HS, Valiathan M, Duren DL, McNulty KP, Middleton KM, Sherwood RJ. Estimating Craniofacial Growth Cessation: Comparison of Asymptote- and Rate-Based Methods. The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association. 2022 Feb:59(2):230-238. doi: 10.1177/10556656211002675.
- Stringer D, Brown B. Correction of mandibular asymmetry using angled titanium mesh. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 2009 Aug:67(8):1619-27. doi: 10.1016/j.joms.2008.12.068.
- Maas CS, Merwin GE, Wilson J, Frey MD, Maves MD. Comparison of biomaterials for facial bone augmentation. Archives of otolaryngology--head & neck surgery. 1990 May:116(5):551-6
- Oliveira RV, de Souza Nunes LS, Filho HN, de Andrade Holgado L, Ribeiro DA, Matsumoto MA. Fibrovascularization and osteogenesis in high-density porous polyethylene implants. The Journal of craniofacial surgery. 2009 Jul:20(4):1120-4. doi: 10.1097/SCS.0b013e3181abb4ab.
- Romo T 3rd, Lanson BG. Chin augmentation. Facial plastic surgery clinics of North America. 2008 Feb:16(1):69-77, vi
- Danieletto-Zanna CF, Ferreira GZ, Ferreira O, Pavan AJ, Camarini ET. Infected Silicone Chin Implant After Implant-Supported Jaw Rehabilitation: Case Report and Literature Review. The Journal of oral implantology. 2022 Aug 1:48(4):307-311. doi: 10.1563/aaid-joi-D-20-00112.
- Gafar Ahmed M, AlHammad ZA, Al-Jandan B, Almohammadi T, Khursheed Alam M, Bagde H. Silicone Facial Implants, to Fixate or Not to Fixate: A Narrative Review. Cureus. 2023 Feb:15(2):e34524. doi: 10.7759/cureus.34524.
- Rowe P, Koller A, Sharma S. Physiology, Bone Remodeling. StatPearls. 2025 Jan
- Frodel JL, Lee S. The use of high-density polyethylene implants in facial deformities. Archives of otolaryngology--head & neck surgery. 1998 Nov:124(11):1219-23
- Kattimani V, Sreeram RR, Panga GSK, Vasamsetti DB, Tiwari R. Patient-Specific Implants in Maxillo-Facial Reconstruction: Current Practices and Way Forward-An Overview of Systematic Reviews. Journal of maxillofacial and oral surgery. 2025 Aug:24(4):1075-1089. doi: 10.1007/s12663-025-02440-4.
- Velarde K, Cafino R, Isla A Jr, Ty KM, Palmer XL, Potter L, Nadorra L, Pueblos LV, Velasco LC. Virtual surgical planning in craniomaxillofacial surgery: a structured review. Computer assisted surgery (Abingdon, England). 2023 Dec:28(1):2271160. doi: 10.1080/24699322.2023.2271160.
- Naini FB, Donaldson AN, McDonald F, Cobourne MT. Assessing the influence of chin prominence on perceived attractiveness in the orthognathic patient, clinician and layperson. International journal of oral and maxillofacial surgery. 2012 Jul:41(7):839-46. doi: 10.1016/j.ijom.2012.01.012.
- Fanous N, Yoskovitch A. Estimating implant size in chin augmentation: A simplified approach. The Canadian journal of plastic surgery = Journal canadien de chirurgie plastique. 2003 Fall:11(3):161-5
- Doddamani GM, Swathi PV, Tan KFH. Assessment of anterior malar projection using visual photographs and lateral cephalograms: A comparative study. Journal of orthodontic science. 2018:7():15. doi: 10.4103/jos.JOS_30_18.
- Hinderer UT. Malar implants for improvement of the facial appearance. Plastic and reconstructive surgery. 1975 Aug:56(2):157-65
- Caruso SR, Yamaguchi E, Portnof JE. Update on Antimicrobial Therapy in Management of Acute Odontogenic Infection in Oral and Maxillofacial Surgery. Oral and maxillofacial surgery clinics of North America. 2022 Feb:34(1):169-177. doi: 10.1016/j.coms.2021.08.005.
- Khorasani M, Janbaz P, Rayati F. Maxillofacial reconstruction with Medpor porous polyethylene implant: a case series study. Journal of the Korean Association of Oral and Maxillofacial Surgeons. 2018 Jun:44(3):128-135. doi: 10.5125/jkaoms.2018.44.3.128.
- Oranges CM, Grufman V, di Summa PG, Fritsche E, Kalbermatten DF. Chin Augmentation Techniques: A Systematic Review. Plastic and reconstructive surgery. 2023 May 1:151(5):758e-771e. doi: 10.1097/PRS.0000000000010079.
- Wang MW, Rodman RE. Gender Facial Affirmation Surgery; Techniques for Feminizing the Chin. Facial plastic surgery clinics of North America. 2023 Aug:31(3):419-431. doi: 10.1016/j.fsc.2023.04.006.
- Al-Jandan B, Marei HF. Mandibular angle augmentation using solid silicone implants. Dental and medical problems. 2018 Oct-Dec:55(4):367-370. doi: 10.17219/dmp/99531.
- Rojas YA, Sinnott C, Colasante C, Samas J, Reish RG. Facial Implants: Controversies and Criticism. A Comprehensive Review of the Current Literature. Plastic and reconstructive surgery. 2018 Oct:142(4):991-999. doi: 10.1097/PRS.0000000000004765.
- Childers CP, Maggard-Gibbons M. Understanding Costs of Care in the Operating Room. JAMA surgery. 2018 Apr 18:153(4):e176233. doi: 10.1001/jamasurg.2017.6233.
- Vijayalakshmi P, Geetha CS, Mohanan PV. Assessment of oxidative stress and chromosomal aberration inducing potential of three medical grade silicone polymer materials. Journal of biomaterials applications. 2013 Feb:27(6):763-72. doi: 10.1177/0885328211426353.
References
Binder WJ, Azizzadeh B. Malar and submalar augmentation. Facial plastic surgery clinics of North America. 2008 Feb:16(1):11-32, v
Abdulaziz MKB, Kamal M, Kolaityte V, Aziz H. Complications of alloplastic facial skeletal implants in aesthetic surgery: A systematic review and meta-analysis. Journal of plastic, reconstructive & aesthetic surgery : JPRAS. 2025 Aug:107():5-18. doi: 10.1016/j.bjps.2025.04.042.
Cuzalina LA, Hlavacek MR. Complications of facial implants. Oral and maxillofacial surgery clinics of North America. 2009 Feb:21(1):91-104, vi-vii. doi: 10.1016/j.coms.2008.10.009.
Lutz JC, Assouline Vitale LS, Graillon N, Foletti JM, Schouman T. Standard and Customized Alloplastic Facial Implants Refining Orthognathic Surgery: Outcome Evaluation. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 2020 Oct:78(10):1832.e1-1832.e12. doi: 10.1016/j.joms.2020.05.009.
Niamtu J 3rd. Essentials of cheek and midface implants. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 2010 Jun:68(6):1420-9. doi: 10.1016/j.joms.2009.12.004.
Romano N, Federici M, Castaldi A. Imaging of cranial nerves: a pictorial overview. Insights into imaging. 2019 Mar 15:10(1):33. doi: 10.1186/s13244-019-0719-5.
Hazani R, Rao A, Ford R, Yaremchuk MJ, Wilhelmi BJ. The safe zone for placement of chin implants. Plastic and reconstructive surgery. 2013 Apr:131(4):869-872. doi: 10.1097/PRS.0b013e3182818e6c.
Hu KS, Yun HS, Hur MS, Kwon HJ, Abe S, Kim HJ. Branching patterns and intraosseous course of the mental nerve. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 2007 Nov:65(11):2288-94
Azizzadeh B, Mashkevich G. Nerve injuries and treatment in facial cosmetic surgery. Oral and maxillofacial surgery clinics of North America. 2009 Feb:21(1):23-9, v. doi: 10.1016/j.coms.2008.10.003.
Mendelson B, Wong CH. Changes in the facial skeleton with aging: implications and clinical applications in facial rejuvenation. Aesthetic plastic surgery. 2012 Aug:36(4):753-60. doi: 10.1007/s00266-012-9904-3.
Fattahi T. The prejowl sulcus: an important consideration in lower face rejuvenation. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 2008 Feb:66(2):355-8. doi: 10.1016/j.joms.2006.11.032.
Cronin RJ Jr, Oesterle LJ, Ranly DM. Mandibular implants and the growing patient. The International journal of oral & maxillofacial implants. 1994 Jan-Feb:9(1):55-62
Op Heij DG, Opdebeeck H, van Steenberghe D, Quirynen M. Age as compromising factor for implant insertion. Periodontology 2000. 2003:33():172
Yaremchuk MJ. Mandibular augmentation. Plastic and reconstructive surgery. 2000 Sep:106(3):697-706
Birgfeld C, Heike C. Craniofacial Microsomia. Clinics in plastic surgery. 2019 Apr:46(2):207-221. doi: 10.1016/j.cps.2018.12.001.
Schwaiger M, Echlin K, Atherton D, Haers P. The use of Medpor implants for midface contouring in cleft patients. International journal of oral and maxillofacial surgery. 2019 Sep:48(9):1177-1184. doi: 10.1016/j.ijom.2019.02.008.
Aarts BE, Convens J, Bronkhorst EM, Kuijpers-Jagtman AM, Fudalej PS. Cessation of facial growth in subjects with short, average, and long facial types - Implications for the timing of implant placement. Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery. 2015 Dec:43(10):2106-11. doi: 10.1016/j.jcms.2015.10.013.
Hardin AM, Knigge RP, Oh HS, Valiathan M, Duren DL, McNulty KP, Middleton KM, Sherwood RJ. Estimating Craniofacial Growth Cessation: Comparison of Asymptote- and Rate-Based Methods. The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association. 2022 Feb:59(2):230-238. doi: 10.1177/10556656211002675.
Stringer D, Brown B. Correction of mandibular asymmetry using angled titanium mesh. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 2009 Aug:67(8):1619-27. doi: 10.1016/j.joms.2008.12.068.
Maas CS, Merwin GE, Wilson J, Frey MD, Maves MD. Comparison of biomaterials for facial bone augmentation. Archives of otolaryngology--head & neck surgery. 1990 May:116(5):551-6
Oliveira RV, de Souza Nunes LS, Filho HN, de Andrade Holgado L, Ribeiro DA, Matsumoto MA. Fibrovascularization and osteogenesis in high-density porous polyethylene implants. The Journal of craniofacial surgery. 2009 Jul:20(4):1120-4. doi: 10.1097/SCS.0b013e3181abb4ab.
Romo T 3rd, Lanson BG. Chin augmentation. Facial plastic surgery clinics of North America. 2008 Feb:16(1):69-77, vi
Danieletto-Zanna CF, Ferreira GZ, Ferreira O, Pavan AJ, Camarini ET. Infected Silicone Chin Implant After Implant-Supported Jaw Rehabilitation: Case Report and Literature Review. The Journal of oral implantology. 2022 Aug 1:48(4):307-311. doi: 10.1563/aaid-joi-D-20-00112.
Gafar Ahmed M, AlHammad ZA, Al-Jandan B, Almohammadi T, Khursheed Alam M, Bagde H. Silicone Facial Implants, to Fixate or Not to Fixate: A Narrative Review. Cureus. 2023 Feb:15(2):e34524. doi: 10.7759/cureus.34524.
Rowe P, Koller A, Sharma S. Physiology, Bone Remodeling. StatPearls. 2025 Jan
Frodel JL, Lee S. The use of high-density polyethylene implants in facial deformities. Archives of otolaryngology--head & neck surgery. 1998 Nov:124(11):1219-23
Kattimani V, Sreeram RR, Panga GSK, Vasamsetti DB, Tiwari R. Patient-Specific Implants in Maxillo-Facial Reconstruction: Current Practices and Way Forward-An Overview of Systematic Reviews. Journal of maxillofacial and oral surgery. 2025 Aug:24(4):1075-1089. doi: 10.1007/s12663-025-02440-4.
Velarde K, Cafino R, Isla A Jr, Ty KM, Palmer XL, Potter L, Nadorra L, Pueblos LV, Velasco LC. Virtual surgical planning in craniomaxillofacial surgery: a structured review. Computer assisted surgery (Abingdon, England). 2023 Dec:28(1):2271160. doi: 10.1080/24699322.2023.2271160.
Naini FB, Donaldson AN, McDonald F, Cobourne MT. Assessing the influence of chin prominence on perceived attractiveness in the orthognathic patient, clinician and layperson. International journal of oral and maxillofacial surgery. 2012 Jul:41(7):839-46. doi: 10.1016/j.ijom.2012.01.012.
Fanous N, Yoskovitch A. Estimating implant size in chin augmentation: A simplified approach. The Canadian journal of plastic surgery = Journal canadien de chirurgie plastique. 2003 Fall:11(3):161-5
Doddamani GM, Swathi PV, Tan KFH. Assessment of anterior malar projection using visual photographs and lateral cephalograms: A comparative study. Journal of orthodontic science. 2018:7():15. doi: 10.4103/jos.JOS_30_18.
Hinderer UT. Malar implants for improvement of the facial appearance. Plastic and reconstructive surgery. 1975 Aug:56(2):157-65
Caruso SR, Yamaguchi E, Portnof JE. Update on Antimicrobial Therapy in Management of Acute Odontogenic Infection in Oral and Maxillofacial Surgery. Oral and maxillofacial surgery clinics of North America. 2022 Feb:34(1):169-177. doi: 10.1016/j.coms.2021.08.005.
Khorasani M, Janbaz P, Rayati F. Maxillofacial reconstruction with Medpor porous polyethylene implant: a case series study. Journal of the Korean Association of Oral and Maxillofacial Surgeons. 2018 Jun:44(3):128-135. doi: 10.5125/jkaoms.2018.44.3.128.
Oranges CM, Grufman V, di Summa PG, Fritsche E, Kalbermatten DF. Chin Augmentation Techniques: A Systematic Review. Plastic and reconstructive surgery. 2023 May 1:151(5):758e-771e. doi: 10.1097/PRS.0000000000010079.
Wang MW, Rodman RE. Gender Facial Affirmation Surgery; Techniques for Feminizing the Chin. Facial plastic surgery clinics of North America. 2023 Aug:31(3):419-431. doi: 10.1016/j.fsc.2023.04.006.
Al-Jandan B, Marei HF. Mandibular angle augmentation using solid silicone implants. Dental and medical problems. 2018 Oct-Dec:55(4):367-370. doi: 10.17219/dmp/99531.
Rojas YA, Sinnott C, Colasante C, Samas J, Reish RG. Facial Implants: Controversies and Criticism. A Comprehensive Review of the Current Literature. Plastic and reconstructive surgery. 2018 Oct:142(4):991-999. doi: 10.1097/PRS.0000000000004765.
Childers CP, Maggard-Gibbons M. Understanding Costs of Care in the Operating Room. JAMA surgery. 2018 Apr 18:153(4):e176233. doi: 10.1001/jamasurg.2017.6233.
Vijayalakshmi P, Geetha CS, Mohanan PV. Assessment of oxidative stress and chromosomal aberration inducing potential of three medical grade silicone polymer materials. Journal of biomaterials applications. 2013 Feb:27(6):763-72. doi: 10.1177/0885328211426353.