Solid Midfacial Implants: When Fillers Are Not Enough.

The aging process results in volumetric changes on multiple levels of the face including the skin, soft tissue, and underlying facial skeleton. Malar and mandibular augmentation with facial fillers and alloplastic implants are two treatment options used to achieve the goal of volume enhancement. Noninvasive modalities have become increasingly popular due to the availability of office-based options that require a limited understanding of facial aesthetics, a basic grasp of the mechanisms behind the aging process, and no level of surgical expertise or training. It is important, however, to understand the limitations and appropriate use of each technique, surgical and nonsurgical, either as a sole modality or in conjunction with each other to attain optimal aesthetic results. Although minimally invasive soft-tissue augmentation procedures such as fillers offer midface treatment options, alloplastic implants provide a stable support platform or scaffolding for skeletal and soft-tissue augmentation that fillers alone cannot often provide. A multilevel understanding of facial aesthetics must include the facial skeletal architecture and foundation that it provides for proper soft-tissue draping and contour. Alloplastic implants remain the standard for skeletal augmentation and remain the mainstay when fillers are not sufficient for midface augmentation.