FACIAL IMPLANTS - (Cheeks, Chin, Lips and Nasolabial Folds) Facial implants can dramatically improve facial proportion and beauty. Implants can also be useful as part of a total rejuvenation program. Facial implants may be temporary or permanent. Both solid and injectable implants are used for different purposes. There are several types of solid, permanent facial implants. Cheek (malar) and chin implants come in a variety of sizes, shapes and materials. These are used to improve the underlying bony structure to create better facial proportion. For example, a weak chin will make the nose appear more prominent. By augmenting the chin, the nose appears more in proportion with the rest of the face. Cheek or malar implants may be used to create more defined cheekbones or may be used to fill out soft tissue deficiency, which is common with facial aging. Solid soft tissue implants may be used for underdeveloped lips or deep grooves, such as the grooves between the nose and the corner of the mouth, the nasolabial groove. There is also a wide and ever changing variety of injectable soft tissue fillers. These include a variety of collagen products, as well as other temporary and permanent filling materials. Even in your own fat (removed from any area of excess) can be used effectively in facial augmentation. IMPLANT MATERIAL Several different materials are available for augmentation. Solid Silastic is most widely used and has been used successfully for many years. Other available materials include ePTFE (Gore-Tex or Softform), which is a porous material that has been used in heart and blood vessel surgery for over twenty years. The body's own tissue tends to grow into this implant. Other available implants include acellular human dermis (Alloderm) and, at times, your own body's tissues that are removed from another procedure. Each implant material has advantages and disadvantages and the details of these should be discussed with Dr. Finn. All implants do carry some risks. Infection, asymmetry, and need for removal or re-positioning are a few of these. There may be a risk of autoimmune disease. Your surgeon will discuss these risks with you in detail before proceeding with any type of implant. At Aesthetic Solutions, it is very important to us that you are extremely well informed and all of your questions are answered before proceeding with any type of surgery. MALAR AUGMENTATION High, well-defined cheekbones create a triangular shape to the face. The increased definition created with cheek implants may be very pleasing. Facial asymmetry in the midface may be improved with cheek implants. In addition, loss of facial soft tissues and bone may be camouflaged with implants to rejuvenate the face. For cheek implants, a light sedation is usually used. Local anesthetics are injected into the area and a small incision is made underneath the upper lip. A pocket is made and the appropriate size and shape implant is placed. This is usually secured with a small suture underneath the skin. Supporting tape is sometimes placed on the cheek. Bruising is usually minimal, although significant swelling sometimes occurs and takes four to seven days to start going down. Sutures are all dissolvable and one may return to work and exercise at four to seven days after surgery. Contact sports are best avoided for at least six weeks. CHIN IMPLANT For the chin implant, a small incision is made in the crease below the chin or inside the lower lip. A pocket is created and the appropriate size and shape implant is used. The implants may be used either to increase the projection of the chin or to fill out the hollows created in between the jowl and the chin. Skin sutures are removed at five to seven days and bruising is usually moderate. Chin implants are often combined with liposuction of the area underneath the chin in order to create the best profile possible. Computer imaging may be extremely revealing in determining if a chin implant is for you. LIP ENLARGEMENT Lip enhancement remains a very popular procedure. Several materials have been used for lip augmentation, each with their own pluses and minuses. At times, your own tissue, such as fat from a liposuction procedure or tissue removed at the time of a face-lift may be used to augment the lip. This type of augmentation may sometimes last from six to twelve months or longer. Injectable fillers are the simplest way to both enlarge the lip volume and sometimes to fill in the small wrinkles around the mouth. This procedure causes minimal bruising and swelling. Different injectables each have their advantages. Discuss your options with your physician at consultation. ePTFE (Gore-Tex or Soft-Form) implants are often used in the lip. This material is incorporated into your own body's tissues and never reabsorbs. At times, the implant may be felt but this tends to soften up over the first three to four months. ePTFE implants may be removed. With aging, the lip not only loses volume, but droops as well. A lip lift or roll is a surgical procedure to raise the red portion of the lip. These procedures may be combined with implants. Please discuss with Drs. Finn or Cox the different materials and procedures available to determine which will give you your best result. OTHER AREAS At times, implant material will be used in the nasolabial fold or the groove between the nose and the corner of the mouth. Other areas may have custom-made implants as well. Oftentimes, defects from a previous surgery, scarring or trauma may be improved using specialized implants. PREPARING FOR SURGERY Once you decide to proceed with facial implants, you will be given a detailed explanation as to what to do to prepare for surgery. In order to minimize bruising and swelling, we ask that you avoid any aspirin or aspirin-containing products as well as any anti-inflammatories such as ibuprofen or naproxen (including Motrin, Aleve and Advil) for at least two weeks before surgery. It is fine to go ahead and take Tylenol (Acetaminophen) before surgery. In addition, we ask you to avoid taking vitamin E supplements as this may also result in more bruising. We have found using a vitamin K cream and using a homeopathic herb called "Arnica Montana" tends to reduce bruising. We have both of these available in our clinic and will be happy to discuss this with you further. It is important to be well rested for surgery, and if you are anxious, a mild sedative may be given for the night before surgery. Surgery may be done with a local anesthetic, but at times intravenous sedation will be desired as well. If you are undergoing sedation, it is important to avoid anything to eat or drink after midnight the night before surgery. If you have high blood pressure or take other medications, these medications may be taken with a sip of water the morning of surgery. If you have any questions, please feel free to call our staff for details. DR. FINN Dr. Finn has extensive training and experience with all aspects of both cosmetic and reconstructive facial plastic surgery. He holds a Bachelor of Science degree from Yale University and while at medical school at Case Western Reserve University, was elected to the Alpha Omega Alpha Honor Society. He completed a six-year residency at the University of Texas Southwestern Medical Center in Dallas where he received the American Academy of Facial Plastic and Reconstructive Surgery Residency Research Award for his study in wound healing. He is board-certified by the American Academy of Facial Plastic Surgery and has been awarded the Jack Anderson Award for Academic Excellence by that academy in 1998. Dr. Finn is also board-certified in Otolaryngology and Head and Neck Surgery. Dr. Finn presents at many national medical lectures and authored the chapter “Broad Nasal Tip” in the eMedicine online surgery textbook, Otolaryngology and Facial Plastic Surgery. In addition to private practice, Dr. Finn is an Assistant Consulting Professor of Surgery at Duke University. Dr. Finn donates one day a month to help teach Duke physicians facial plastic surgery at the Durham Veterans Hospital. He holds admitting privileges at several hospitals including North Carolina Specialty Hospital, Durham Regional Hospital, UNC Hospitals and the Durham Veterans Hospital. Academic achievements, however, only tell part of the story. With patience and understanding, Dr. Finn will carefully explain and teach you about your anticipated procedures. Only with discretion, trust and compassion may optimal results be achieved. At Aesthetic Solutions you may be assured that our physicians and staff will try to provide the best available treatment in a most warm and friendly atmosphere. Aesthetic Solutions 5821 Farrington Road Suite 101 Chapel Hill, NC 27517 Tel: 919-403-6200 Fax: 919-403-6242 info@aesthetic-solutions.com