Do infra implants induce more risk in the long run?

[oganthropologist]

Slotted for saddled infraorbital PEEK implants (~3.4 mm, intraoral approach) next week, but I’m getting some cold feet thinking about:

1. Risk of midface sagging/ptosis: Since the intraoral technique requires tunneling and a subperiosteal dissection, how significant is the risk of midface soft-tissue descent over time? How often do patients later need a facelift to counteract this? I don’t want to be on a hamsterwheel of surgeries
2. If I ever remove the implants: will my face look worse off after suffering all that dissection and soft tissue trauma around the PEEK implant?
   
   
3. Long-term infection risk: When I’m older—say in my 60s—could something like a tooth infection spread to the implant since it was placed via an intraoral incision? I’m asking because I have moderate gum recession.

 

[Foreverbrad]

Bump out of interest

 

[oganthropologist]

Bump out of interest

Have done shit ton of research since asking this question and am now veering towards not pursuing this, sounds like you've got them done based on your bio?

Preliminary findings:

1. Sagging risk with implant I'm still unsure of. The implant being there provides enough strucutre for soft tissue to float, despite soft tissue being ripped apart from bone. So it's more relevant of.a risk to the extent implant is removed.

2. Sagging risk post removal is real. May not always happen, but seems 50/50 (Source 1, 2). This guy on reddit claims to have gotten sunken holes and scars post removal.

3. Long term infection risk - seems low according to data, but can happen. One person on reddit in this thread (username: Addashy) had exactly that happen

Have also been more concerned with nerve damage after seeing it is a frequent side effect.

I don't mean to bash on infras, but rather highlight what seem to be very real risks one should just be aware of.

 

[Foreverbrad]

Have done shit ton of research since asking this question and am now veering towards not pursuing this, sounds like you've got them done based on your bio?

Preliminary findings:

1. Sagging risk with implant I'm still unsure of. The implant being there provides enough strucutre for soft tissue to float, despite soft tissue being ripped apart from bone. So it's more relevant of.a risk to the extent implant is removed.

2. Sagging risk post removal is real. May not always happen, but seems 50/50 (Source 1, 2). This guy on reddit claims to have gotten sunken holes and scars post removal.

3. Long term infection risk - seems low according to data, but can happen. One person on reddit in this thread (username: Addashy) had exactly that happen

Have also been more concerned with nerve damage after seeing it is a frequent side effect.

I don't mean to bash on infras, but rather highlight what seem to be very real risks one should just be aware of.

I have trimax scheduled about three months from now and I need to make a decision on whether to proceed with the infraorbital implants or not.

The sagging risk for me is probably significant due to age but I will be getting a facelift within next five years anyway.

The long term infection risk is bad, especially if you are not satisfied with the implant result and need to inject fillers or fat grafts on top.

Needing a revision surgery either due to infection or a bad aesthetic outcome would be very expensive in comparison to the original “while you are in there doing a Trimax” price. To the point it actually significantly affects the risk-adjusted cost of the whole thing.

If I can cope with a bit of filler for “bone” and fat grafting for volume, I will.

 

[TheEndMogger]

I have trimax scheduled about three months from now and I need to make a decision on whether to proceed with the infraorbital implants or not.

The sagging risk for me is probably significant due to age but I will be getting a facelift within next five years anyway.

The long term infection risk is bad, especially if you are not satisfied with the implant result and need to inject fillers or fat grafts on top.

Needing a revision surgery either due to infection or a bad aesthetic outcome would be very expensive in comparison to the original “while you are in there doing a Trimax” price. To the point it actually significantly affects the risk-adjusted cost of the whole thing.

If I can cope with a bit of filler for “bone” and fat grafting for volume, I

I have trimax scheduled about three months from now and I need to make a decision on whether to proceed with the infraorbital implants or not.

The sagging risk for me is probably significant due to age but I will be getting a facelift within next five years anyway.

The long term infection risk is bad, especially if you are not satisfied with the implant result and need to inject fillers or fat grafts on top.

Needing a revision surgery either due to infection or a bad aesthetic outcome would be very expensive in comparison to the original “while you are in there doing a Trimax” price. To the point it actually significantly affects the risk-adjusted cost of the whole thing.

If I can cope with a bit of filler for “bone” and fat grafting for volume, I will.

yo you should get the infras bro fillers are awful

 

[Foreverbrad]

@TheEndMogger

On what basis are fillers awful? The more research I do on them the better option they seem to be. Subperiosteal high-G fillers are equivalent to a silicone implant in their effect and can last for years due to strong cross-linking and lack of tissue movement in that plane.

Being minimally invasive there’s also no dissection required so no risk of tissue sagging . HA is bioidentical so no long term infection risks either.

I can understand the concern with low-G fillers injected in shallow planes being very prone to migration but they are really a different animal and fat grafting is more appropriate there.

 

[TheEndMogger]

@Foreverbrad
They only last a couple years and also a good surgeon will use PEAK instead of silicone no? For me im planning on basically the same thing as you trimax plus orbital implants because after I get it done I just want to be done with it, not have to worry about migration or getting them replaced or whatever

 

[Foreverbrad]

@Foreverbrad
They only last a couple years and also a good surgeon will use PEAK instead of silicone no? For me im planning on basically the same thing as you trimax plus orbital implants because after I get it done I just want to be done with it, not have to worry about migration or getting them replaced or whatever

PEEK or Titanium implants are screwed to the bone whereas silicone I believe are just left to be encapsulated and that’s all that holds them in place. Filler is arguably superior to silicone with the only downside being the need for it to be redone periodically.

What Is The Best Material For Custom Facial Implants? - Plastic Surgeon | Dr. Barry L. Eppley, MD

Q: Dr. Eppley, What materials available for implants? I see he uses a lot of silicone and was wondering why that is. I prefer different material would that be okay? A: There are a variety of materials for custom facial implants including solid silicone, Omnipore/Medpor, PEEK, PEKK and...

www.eppleyplasticsurgery.com

I know it’s appealing to think you’ll “just be done with it” but there seems to be a significant chance that will not be the case, based on my research and also the OP of this thread. Even Eppley there states the overall revision rate is 40% and that’s just revisions - not including infections and complications!

I think PEEK saddled infras sound great in theory but they’re high risk high reward and I’m simply too cost-sensitive at this point to accept that. I’m also old and the “for life” nature of the implants is less appealing. Your situation may differ!

 

[TheEndMogger]

@Foreverbrad
Yeah your bones are probably better than mine if you made it to 30 without killing yourself. I can only do high risk high reward surgeries and I don't care about the money at all. Main thing I heard that I think is true is that surgeries that affect bone/implants have way less risk of looking uncanny than soft tissue surgeries.

 

[oganthropologist]

@Foreverbrad
They only last a couple years and also a good surgeon will use PEAK instead of silicone no? For me im planning on basically the same thing as you trimax plus orbital implants because after I get it done I just want to be done with it, not have to worry about migration or getting them replaced or whatever

Have you had migration of the filler going elsewhere in the face? Or it just dissipated over time?

 

[TheEndMogger]

Have you had migration?

Haven't done any procedures yet but the plan is jaw surgery plus implants so no filler or any of that

 

[oganthropologist]

Haven't done any procedures yet but the plan is jaw surgery plus implants so no filler or any of that

ah i thought you had undereye filler

 

[oganthropologist]

@TheEndMogger

On what basis are fillers awful? The more research I do on them the better option they seem to be. Subperiosteal high-G fillers are equivalent to a silicone implant in their effect and can last for years due to strong cross-linking and lack of tissue movement in that plane.

Being minimally invasive there’s also no dissection required so no risk of tissue sagging . HA is bioidentical so no long term infection risks either.

I can understand the concern with low-G fillers injected in shallow planes being very prone to migration but they are really a different animal and fat grafting is more appropriate there.

hey man - was also heavily looking into undereye filler but reddit posters seem to complain frequently about migration in that area. Fortunately, complications are limited to that, but still not sure if ideal. Unless you've uncovered something different?

 

[Foreverbrad]

hey man - was also heavily looking into undereye filler but reddit posters seem to complain frequently about migration in that area. Fortunately, complications are limited to that, but still not sure if ideal. Unless you've uncovered something different?

I think there is a distinction needs to be made between tear trough filler (low-G filler injected quite superficially) and cheekbone filler (high-G filler injected on the bone) - the former will migrate badly whereas the latter will mostly stay put.

Fat grafting seems to be the best solution for under eye as this will stay put even if injected superficially. It has its own risks but to me it seems the most natural solution and there are some very good before and afters.

I will only be using filler on the bone for zygo and gonion augmentation and only in small quantity.

Yeah your bones are probably better than mine if you made it to 30 without killing yourself. I can only do high risk high reward surgeries and I don't care about the money at all. Main thing I heard that I think is true is that surgeries that affect bone/implants have way less risk of looking uncanny than soft tissue surgeries.

Not necessarily - it’s just back in my day you didn’t need to be chadlite to get LTBs. You guys have it hard. So do I now, but at least remember a time when it was different.

Implants are good if you are massively lacking in bone mass. Personally I don’t even have a negative orbital vector so it makes little sense.

 

[oganthropologist]

I think there is a distinction needs to be made between tear trough filler (low-G filler injected quite superficially) and cheekbone filler (high-G filler injected on the bone) - the former will migrate badly whereas the latter will mostly stay put.

Fat grafting seems to be the best solution for under eye as this will stay put even if injected superficially. It has its own risks but to me it seems the most natural solution and there are some very good before and afters.

I will only be using filler on the bone for zygo and gonion augmentation and only in small quantity.




Not necessarily - it’s just back in my day you didn’t need to be chadlite to get LTBs. You guys have it hard. So do I now, but at least remember a time when it was different.

Implants are good if you are massively lacking in bone mass. Personally I don’t even have a negative orbital vector so it makes little sense.

Ah ok, so you’re not planning filler in your infraorbitals, rather on your cheek / zygo?

Fat grafting seems promising as well, but also runs the risk (albeit small) of lumps and bulging, which are not reversible and would require surgery.

 

[Don12456]

Did u ask Pagnoni all these questions?

 

[moltisantichincel]

what conclusion did you come to? yes or no on implants?

 

[oganthropologist]

what conclusion did you come to? yes or no on implants?

Currently leaning 70% no. Will be speaking with Pags again this week.

He is a pretty transparent guy and genuinely seems competent. From previous convos, he has already admitted:

- temporary nerve loss of sensation/mild damage is likely, lasting ~2-3 months. Permanent nerve damage less likely but possible.
^ transparently, I glossed over this as I thought to myself "who the fuck cares if I can't feel my upper lip" but people posting here make it sound terrible....

 

[monecel]

For point 1 wouldn't the consistent under-eye support of the implants that would naturally degrade with age for normal bone counteract the other supposed soft-tissue downsides? Also for infection risk most cases of that occur within a postoperative period, infections in a longer timespan are usually caused by issues

 

[oganthropologist]

For point 1 wouldn't the consistent under-eye support of the implants that would naturally degrade with age for normal bone counteract the other supposed soft-tissue downsides? Also for infection risk most cases of that occur within a postoperative period, infections in a longer timespan are usually caused by issues

Yes, Eppley calls this "implant float" whereby the natural soft tissue is degraded, but the implant holds it up. It seems like in only severe cases of malpositioning can the implant not "float" and induce sagging.

That being said, for risk #2, you can see why sagging is sometimes the case.

 

[monecel]

Yes, Eppley calls this "implant float" whereby the natural soft tissue is degraded, but the implant holds it up. It seems like in only severe cases of malpositioning can the implant not "float" and induce sagging.

That being said, for risk #2, you can see why sagging is sometimes the case.

just get repeat plasma fibroblasts and spam peptides after surgery