A facial implant is a solid piece placed directly on the bone to add projection where the structure does not have it: the cheekbone, the angle of the jaw or the lower rim of the eye socket.
This is structural surgery, not volume surgery. When what is missing is bone — a flat cheekbone, a jaw with no angle — no amount of filler replaces it: filler rests on soft tissue and spreads, while an implant rests on bone and projects. That difference is what decides the indication.
The trade-off is its nature: an implant is permanent for as long as it is in place, it goes in a deep plane, and removing it, though possible, is a second operation. That is why, when the problem is lost volume rather than absent structure, the right answer is usually a graft of your own fat or filler, not an implant.
It usually helps when there is
- A flat or dropped cheekbone, with the middle third of the face lacking projection.
- A poorly defined jaw angle, with a blurred lower contour of the face.
- Structural facial asymmetry, congenital or after trauma.
- A hollow under the lower rim of the eye from lack of bony support.
- Wanting a stable structural change rather than a treatment to be renewed every year.
Worth discussing first if
- What is missing is soft volume and not bone: your own fat solves it better and is reversible.
- Current smoking, which multiplies the risk of the implant becoming infected.
- Active dental or gum infection, because of the intraoral approach.
- Expecting a very angular face: large implants give themselves away.
- A history of radiotherapy to the area.
None of these rules the procedure out on its own; all of them change the conversation.
Where they are placed
Each area has its own implant, its own route of access and its own recovery. Two are often combined.
Malar (cheekbone)
Projects the middle third of the face. It is placed from inside the mouth, on the cheekbone, and supports an area that loses volume over the years.
Mandibular
Defines the angle of the jaw and widens the lower third. Also through an intraoral route, in a deep plane close to nerve branches.
Infraorbital
Supports the lower rim of the eye when the hollow of the under-eye is structural. It is the least frequent and the most delicate to indicate.
On the bone and properly fixed
The implant is placed in direct contact with the bone, in a pocket cut to its measure — not large, because it would move, and not tight, because it would buckle — and fixed with a screw. An implant that shifts produces asymmetry and can be felt, and it is the most frequent late complication when it is not fixed.
The size is chosen by measuring, with photographs and sometimes with imaging, and with a conservative eye: in the face, the difference between structure and excess is a few millimetres. Symmetry is also checked with the person sitting up before closing, because the face is not symmetrical to begin with and the implant should not simply copy one side onto the other.
When the consultation shows that what is missing is filling and not structure, that is said plainly: a graft of your own fat gives a softer result, with no foreign material and with the advantage that it can be repeated or left alone. Not every flat middle third needs an implant.
What the process is like
From the first consultation to discharge, with the usual timings for this procedure.
Consultation and planning
Photographs, measurement of the projections and a decision on whether the problem is bony or one of soft volume. Area, size and route of access are defined.
Before surgery
Laboratory tests, anaesthetic assessment and a dental check-up. Strict stopping of smoking. The informed consent is signed.
Surgery
In theatre, with prophylactic antibiotics. Cutting of the pocket, placement of the implant and fixation with a screw. Closure in layers.
Follow-up
Reviews at one week, one month and three months, with oral hygiene instructions if the approach was intraoral.
Week by week
The recovery is uneventful, but the swelling lasts longer than people expect.
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Days 1 to 5
Marked swelling of the face, a soft diet, mouthwashes and antibiotics. Sleeping with the head raised.
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Days 6 to 14
The swelling subsides enough for social life at around the second week. Numbness of the lip, gum or cheek may persist.
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Weeks 3 to 8
Exercise built back up. Sensation gradually returns to normal. Any blow to the area is avoided.
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Months 3 to 6
Final shape, with the implant settled in its pocket and the residual swelling resolved.
Risks, and what is not promised
The general risks of any surgery, and those specific to carrying an implant: infection — which in many cases makes it necessary to remove it — displacement, asymmetry, a palpable or visible edge, and extrusion. Also altered sensation in the area from involvement of nerve branches, usually temporary.
Over the years there may be resorption of the bone under the implant from sustained pressure. It does not always have clinical consequences, but it is one more reason not to oversize the piece.
No particular face is promised, nor is the implant promised to last indefinitely: it may need replacing or removing. These risks are reduced by a sound indication, strict asepsis and a correct technique. They are not eliminated. The ones that apply to your case are explained to you in the consultation and are set down in writing in the informed consent.
The information on this page is for guidance and does not replace an in-person medical consultation. Medical practice is an obligation of means, not of result.
The questions we are asked most about facial implants
It depends on what is missing. If bone is missing — a cheekbone with no projection, a jaw with no angle — the implant gives a definition that fat does not reach. If what is missing is soft volume, your own fat looks more natural, carries no foreign material and can be repeated.
In quite a few cases the best answer is a combination: implant where structure is missing and fat where filling is missing.
Yes. That is one of the advantages of an implant over an osteotomy: the piece comes out. But it is a second operation, with its anaesthetic and its recovery, not a formality.
That is why the size is decided conservatively from the start.
An implant of the right size, well placed on the bone, cannot be told apart by touch under normal conditions. What can be felt is the edge of an implant that is too big, badly seated or displaced.
In areas with very thin skin, such as the lower rim of the eye, the margin is smaller, and that is why the indication there is more restrictive.
They have no replacement date as such: they can stay in place for many years without causing problems. What does happen is that the face goes on ageing around them, and an implant can become too visible when the soft tissue covering it thins.
It is a reason for long-term review, not a scheduled expiry.
Question not answered here? There are more answers in the frequently asked questions.
