By Plastic Surgeon Dr Dirk Kremer. 

The cosmetic surgery industry is constantly changing to provide people with new procedures that, when administered by a registered plastic surgeon, are safer and more effective than ever. This week, I'm taking a look at the different aesthetic procedures that use implants. I don't believe that implants are the solution for everything and I sometimes prefer other options such as dermal fillers, but I think it is very interesting to see all the different types of implants that exist.

Silicone and saline implants

There are two main types of implants in plastic surgery: silicone and saline. When used in respect of health regulations with medically-authorised products (unlike PIP which used silicone that wasn’t allowed for medical use), both type of implants are safe. Both saline and silicone implants are surrounded by an elastic silicone shell which prevents rupture and both have a textured surface that prevents the implants from moving, and reduces the risk of a capsula contracture. However, saline implants are more likely to rupture and/or deflate after their insertion than silicone ones, and silicone implants are less likely to wrinkle and/or fold than saline ones.

While it may appear that silicone is better, the advantage of saline implants shouldn't be forgotten. Indeed, the sterile salt water that is inserted into the saline implant is similar to the body’s natural fluids, therefore if the saline implant were to rupture the contents would be easily absorbed and excreted causing minimum harm to the body. On the other hand, the silicone gel used in silicone implants is cohesive which means it won't spread through the tissue, should the silicone shell rupture.

Breast implants

There are many reasons why a woman may wish to have breast augmentation surgery. Pregnancy and weight gain/loss can change the shape, size and firmness of a woman’s breasts, which can leave her feeling unsure, self-conscious or generally unhappy with their appearance. If this is the case, you may opt for breast implants which can help you achieve your desired size and shape. Breast enhancement was the most popular cosmetic procedure in the UK during 2013 with 11,123 women going under the knife to change the shape or size of their breasts. Although pear-shaped implants exist, I personally prefer round implants, which with gravity will somewhat become slightly pear shaped, and for a natural result I believe all plastic surgeons should use the split-muscle technique.

Buttock implants

Buttock augmentation may be chosen for similar reasons to breast augmentation. Factors such as pregnancy and weight loss/gain can change the body’s shape, leaving you unsatisfied with your body, and you can be naturally thin and think that your shapes are too soft or flat for your tastes. Silicone implants can lift and firm your buttocks to reduce the look of sagging or to give shape to a flat bottom. I personally am not a fan of this procedure since the risk of losing the implant - and having undergone surgery for nothing - due to infection and seroma is quite high. Furthermore, after this procedure patients should be immobilized for quite a while for a good recovery which makes a return to a normal/public life difficult.

Facial implants

Cheek implants

Having a strong cheek bone is quite popular nowadays as it helps to frame the face. For people with less prominent cheek bones, cheek implants can help to project cheek bones forward to create the preferred look. Personally I prefer using dermal fillers than implants, I think the result is more natural, and it is less permanent so if you don’t like high cheekbones anymore you just have to wait and the effect will pass, instead of having to have surgery to take the implants out. When using hyaluronic acid surgeons can inject an enzyme, hylase, which allows them to correct, reduce or even completely remove the filler.

Chin and jaw implants

“Mentoplasty” or the insertion of chin implants is normally undergone when a patient wants a more prominent chin. This is the same with jaw implants where the width of the jaw is increased to create a more prominent jaw or a more symmetrical face. These procedures can be done individually or can often be an accompaniment to another procedure such as ear or nose surgery to achieve more natural looking results. The jaw implant can be inserted through an incision under the chin or through an incision in the mucosa in the mouth. This is the best way to hide a scar but it raises the risk of an infection in which case the implant has to be removed again. A chin implant can be simply inserted, positioned and fixed in place by placing it under the skin of the bone or can be fixed with screws drilled into the bone of the chin. Chin implants exist in a big variety of shape, length and projection and for each patient the right implant has to be meticulously chosen. The surgery can be done even under local anesthesia even though most patients prefer a sedation.

Lip implants

Generally lip augmentation is performed with dermal fillers, but silicone lip implants do exist, and in order to avoid the unnatural looking “trout pout” it is important to use a lower lip implant 1.5 times the size of your upper lip. Surgeons in favour of lip implants will say that the effect is permanent, whereas dermal fillers are not permanent. This is true indeed, as to keep fuller lips you need to have dermal fillers every 3 to 6 months. Since I am in favour of dermal fillers, I would say that they work perfectly to give plumper lips, and it is temporary so if you change your mind you just have to wait or you can get the enzyme hylase injected to dissolve it immediately and you will be back to the way you looked before. The main problem I see with lip implants is that if you change your mind, removing the implants is difficult and there are strong risks of scarring. This is why lip implants are almost never recommended unless for treatment of a lip deformity. Also, kissing lips that have been enhanced with a silicone implant can feel a bit odd.

It is important to note that when thinking about any cosmetic procedure you should be sure of what goals you would like to achieve from the surgery, and you should find a registered and experienced aesthetic surgeon such as myself whom you can trust. Finally, you should only look into cosmetic surgery with realistic expectations and a positive attitude. If you know you want to have plastic surgery, and know which procedure you desire or wish to have some help and advice to find the right option, please feel free to book a consultation with me by calling my office.