PEEK vs Silicone for saddled infraorbital implants

[kingofkings]

I came across this comment from Eppley's blog, what do you think?

"Dr. Eppley, I am interested in replacing my PEEK infraorbital-malar implants as they don’t saddle the rim and as a result they stick put unnaturally. These implants were placed intraorally at the time of double jaw surgery.

Answer: Be aware of two very relevant aesthetic issues. 1) when have to saddle the infraorbital rim you have to use a lower eyelid incision to do the dissection needed as well as to ensure proper placement and 2) PEEK is not a good implant material for thin tissues like the lower eyelid and orbital rims as it can not be made withj feather edging as it is machined in its fabrication. You will likely end up with visible edging even if it saddles the rim. …less than what you have now just at a different level and degree

There is a reason your current PEEK implants don’t haver a feathered edge design and look bulky…which is very obvious in bot the design and after actual placement. This is a design limitation of all very rigid materials that have to be machined in manufacturing. There is always going to be at least a 1mm edge. This is not an aesthetic issue in thicker tissues like the jawline and lower cheeks. But it will be one around the orbital rim which is an unforgiving implant placement site."

I've read a couple of different reports of infra implant visibility, is this why?

I'm well aware of the popular consensus that PEEK mogs silicone for facial implants

 

[chrishell]

His first point is not entirely true. Many surgeons are able to place saddled implants with just an intraoral incision. Whether that's still the best incision to use is debatable but it can be and is done. The second point is a good one. Needing fat grafts to smooth edges after PEEK infras is very common. But design is much more often the bottleneck than material with regards to implant show. The person that asked that question is very likely the person described here who had his implants replaced by Eppley. From the pic provided I can tell the design alone is unnatural and that the lack of feathered edges would be the least of his worries. Given the limitations of silicone I personally would take the risk with peek implants and plan on needing multiple rounds of fat grafts.

 

[kingofkings]

His first point is not entirely true. Many surgeons are able to place saddled implants with just an intraoral incision. Whether that's still the best incision to use is debatable but it can be and is done. The second point is a good one. Needing fat grafts to smooth edges after PEEK infras is very common. But design is much more often the bottleneck than material with regards to implant show. The person that asked that question is very likely the person described here who had his implants replaced by Eppley. From the pic provided I can tell the design alone is unnatural and that the lack of feathered edges would be the least of his worries. Given the limitations of silicone I personally would take the risk with peek implants and plan on needing multiple rounds of fat grafts.

Thanks. Appreciate the input.

What are the limitations of silicone you're referring to?

Reading Eppley's post got me wondering if it's a coincidence that the best infraorbital-malar implant result I've seen is that Saiyan one which was silicone

 

[chrishell]

Lower risk of extrusion, displacement, infection.

Saiyan is just one guy.