Custom Infraorbital-Malar Implants for Aesthetic Augmentation – Silicone vs PEEK

For custom infraorbital–malar augmentation, I’d generally favor PEEK when the goal is true skeletal reconstruction with exact CT-based contour, and silicone when the goal is primarily aesthetic augmentation and you value intraoperative adjustability/reversibility/optimal implant design. There is no literature specifically comparing custom PEEK with custom silicone in this exact anatomic zone so much of the decision comes from material behavior and surgical experience rather than head-to-head trials.

Silicone has decades of facial implant experience and generally favorable complication rates. Its biggest practical advantages are that it is easier to insert, easily carved intraoperatively, and relatively straightforward to remove or revise. There are few tradeoffs in the midface as displacement does not occur due to screw fixation and there is no bony remodeling that occurs in the mdface, A 2025 meta-analysis found relatively low pooled complication rates for silicone facial implants overall, although those data combine different facial regions and implant designs and shouldn’t be interpreted as a direct silicone-versus-PEEK comparison for the infraorbital rim. – malar region

The value of PEEK as an onlay implant in the orbit and cheeks is less compelling that it is for the mandible. While it does have an an elastic modulus closer to cortical bone and excellent fatigue resistance that matters little in a non-load bearing facial bone. What matters most is an acceptable design that will be non-palpable in the thinner tissues of the orbital rim and cheek. Avoiding implant edging here is key and one can debate whether milled implants have as good of edging as molded implants. But the single greatest disadvantage is placement. Just like in the mandible a split or segmentalized design is needed to get the extent of the implant needed properly placed through a lower eyelid incision. I have seen many so called PEEK infraorbital-malar implants placed intraorally. But the reality is they are just cheek implants with no real infraorbital or zygomatic arch coverage. It is apparent due to the rigidity of the material that surgeons are designing PEEK ‘cheek implants’ based on the ability to place them intraorally rather than what the patient aesthetically needs.

Where I’d lean

For a relatively modest cosmetic augmentation — e.g. +2–4 mm malar projection with gentle infraorbital blending — custom silicone or custom PEEK should work equally well.

However for negative-vector orbit, substantial infraorbital rim deficiency, post-traumatic asymmetry, craniofacial asymmetry, or a long implant extending infraorbital ? malar ? zygomatic arch, I would favor custom silicone. While patient-specific PEEK implants have been especially useful for orbital rim and midface reconstruction the aesthetic requirements of onlay augmentation in thin tissues is more unforgiving.

Dr Barry Eppley

Plastic Surgeon