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.

 

[RealSurgerymax]

There is no difference in the look of PEEK vs Silicone implants. It is all down to design and placement. I have designed and assisted placement of over 100 PEEk or Titanium infra implants.

About 15% of the time, the outline of the new orbital rim is visible under the thin skin. Using the same design, a silicone implant would be just as visible. These silicone implants are the consistency of a pencil eraser, pretty firm, not soft gel like feel. Extremely soft fat pads create under eye contour deformities known as "Bags." So the softness/hardness of the implant material is irrelevant.

When the orbital rim is visible from IO implants either it needs to be changed for a less projected design or fat grafting needs to be done over it to smooth it out.

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.

You are correct and you can put 2 and 2 together to see which Italian surgeon did those original implants (the renders always look like that) - and they weren't designed by me/Giant (the best) they were designed by the Italian company.

All non-Giant designed Italian implants look like that.