While the available materials for custom facial implants, silicone, PEEK, porous polyethylene and titanium, have been around for years I find few patients and even many surgeons don’t think about them properly. Misconceptions about their properties abound and the following are a few of the most common.
Common Misconceptions
“Rigiduty Means A Superior Aesthetic Result”
While absolute rigidity offers a superior result in spanning bone gaps and in the reconstruction of bone defects it does not offer similar benefits in onlay bone augmentation where the goal is a soft tissue push to create an external aesthetic effect. All of the facial implant materials provide similar aesthetic effects, as none of them are compressible or soft,.Differences in the amount of rigidity between them are not relevant to how well they achieve overlying soft tissue displacement.
“Newer Materials Are Better”
Silicone has been used in facial implant surgery for more than fifty years and is the grandfather of facial implant materials but it remains omnipresent because it continues to perform exceptionally well. Newer materials must demonstrate superior clinical results in terms of aesthetic outcomes or lower risks of complications to truly be better. To date no one material has separated itself from the others. Newer materials offer some advantages but also come with their own disadvantages.
“The Most Expensive Material Must Be the Best”
Patients often assume that PEEK or titanium must be superior simply because they cost more. In reality, price reflects manufacturing complexity rather than clinical performance. A more expensive material does not produce a more attractive jawline, cheekbone, or forehead if the implant design is incorrect.
“Tissue Ingrowth Means a Better Implant”
Porous polyethylene is frequently promoted because tissue grows into the implant. While this provides biological attachment, it also makes later revision or removal considerably more difficult. Tissue ingrowth should be viewed as a characteristic of the material—not automatically as an advantage or disadvantage.
“Titanium Is Stronger, So It Must Be Better”
Titanium is unquestionably stronger than silicone or PEEK, but cosmetic facial implants rarely require that level of strength. An implant sitting on a healthy facial skeleton is intended to improve contour, not support body weight or repair a fractured bone. Choosing titanium simply because it is the strongest material is like using structural steel to build a garden fence—it works, but it is often unnecessary.
“Custom Means Perfect”
A custom implant is manufactured specifically for one patient, but custom manufacturing does not guarantee a beautiful result. The implant still has to be designed correctly. Computer software can precisely produce almost any shape, including one that is aesthetically incorrect. Successful custom implants depend on thoughtful design as much as precise manufacturing.
Frequently Asked Questions
What is the best material for a custom facial implant?
There is no universally best material. The ideal choice depends on the anatomy being treated, the purpose of the implant, and the possibility of future revision. For most cosmetic facial implants, I prefer solid silicone because of its versatility, flexibility, and ease of revision.
Why do you use silicone for most cosmetic implants?
Silicone combines several advantages that are particularly valuable in aesthetic surgery. It can be manufactured into complex one-piece designs, inserted through relatively small incisions, securely fixed with titanium screws, and revised or exchanged if needed in the future. Those characteristics make it especially well suited for cosmetic facial augmentation.
Can silicone implants leak?
No. Solid facial implants are not filled with silicone gel. They are made from a solid medical-grade silicone elastomer and cannot leak like a gel-filled breast implant.
Are facial implants permanent?
Yes. Silicone, PEEK, porous polyethylene, and titanium are all intended to be permanent materials. They do not wear out or require routine replacement. Revision surgery is usually performed because a patient desires a different aesthetic result or develops a complication—not because the material has failed.
Can facial implants become infected?
Yes. Every implant material can become infected. Infection risk depends more on surgical technique, implant location, tissue quality, and healing than on the material itself.
Which material is easiest to remove?
In general, solid silicone is the easiest material to revise or remove because it does not become firmly incorporated into surrounding tissues. This is one of its greatest advantages in cosmetic surgery, where future aesthetic refinement is sometimes requested.
Does tissue grow into silicone implants?
No. The body forms a thin fibrous capsule around silicone rather than growing deeply into the implant. This makes revision surgery considerably easier than with porous materials.
Will my implant set off airport metal detectors?
No. Silicone, PEEK, and porous polyethylene are nonmetallic. The small titanium screws commonly used for fixation almost never trigger airport security systems.
Will my implant look natural?
Natural results depend far more on implant design, proper sizing, smooth contour transitions, and surgical placement than on the material itself. Even the best material cannot compensate for an implant that is poorly designed or incorrectly positioned.
Can different materials be used in the same patient?
Absolutely. A patient may have a silicone jawline implant, titanium fixation screws, and a PEEK cranial implant if each material best serves its particular purpose. Material selection should always be individualized rather than based on a single preference.
The Bottom Line
Patients often spend considerable time comparing silicone, PEEK, porous polyethylene, and titanium in hopes of finding the “best” facial implant material. In my experience, that is the wrong place to begin.
The first priority is defining the exact skeletal change needed to achieve the desired facial appearance. Once that goal has been established, the implant can be designed to create the appropriate contour, projection, width, and symmetry. Only then should the material be selected.
Every major implant material has a legitimate role in craniofacial surgery. PEEK and titanium excel when structural reconstruction and rigidity are required. Porous polyethylene provides tissue incorporation that may be beneficial in selected situations. But for most cosmetic custom facial implants, I believe solid silicone offers the best overall balance of precision, flexibility, long-term stability, and revision potential.
After performing custom facial implant surgery for many years, I have found that patients achieve their best results not because a particular material was used, but because the implant was thoughtfully designed to fit their unique anatomy and aesthetic goals. The material supports that design—it does not define it.
Ultimately, the success of a custom facial implant is determined by four principles:
- Accurate diagnosis of the underlying skeletal deficiency.
- A well-designed patient-specific implant based on a high-quality CT scan.
- Precise surgical placement with stable fixation.
- Selection of the implant material that best complements the design and surgical objectives.
When these principles are followed, each of the available materials can perform exceptionally well. The question is not, “Which material is the best?” It is, “Which material is best for this patient, this implant, and this operation?”
Dr. Barry Eppley
Plastic Surgeon