Augmentation mentoplasty using a custom-design wire cage

Facial balance is a central concern in rhinoplasty, with at least 25% of patients potentially requiring chin augmentation. Alloplastic implants have been widely used in augmentation mentoplasty, but availability and cost remain barriers in certain regions. Prior research has shown that silicone and rubber implants are effective but may not be accessible in low-resource settings. This gap motivated the development of an alternative implant material that could be locally produced and customized. No prior work had resolved the issue of implant displacement in chin augmentation using wire-based prostheses. The need for a cost-effective, globally accessible solution led to the exploration of wire cage implants. However, early versions of this approach faced challenges with prosthesis displacement. That uncertainty drove the refinement of radiographic techniques to better match implant shape to patient anatomy. The goal was to improve implant stability while maintaining aesthetic outcomes.

The aim of this study was to evaluate a custom-design wire cage for augmentation mentoplasty as an alternative to traditional alloplastic implants. The specific problem addressed was the lack of affordable and accessible chin implants in certain regions. The motivation stemmed from the high prevalence of hypoplastic chins requiring augmentation in rhinoplasty patients. The authors sought to develop a globally available implant that could be tailored to individual anatomy. The procedure was tested in 125 patients over 20 years to assess long-term outcomes. The initial series revealed implant displacement, prompting modifications to the design and surgical technique. The study aimed to determine whether a wire-based implant could provide consistent and safe results. The focus was on improving implant stability and reducing complications through radiographic-guided customization.

The study involved 125 patients who underwent augmentation mentoplasty with a custom wire cage over a 20-year period. A cephalometric evaluation was conducted to determine the shape of the mentum before surgery. An orthodontist constructed the wire cage based on these measurements. A buccal approach was used to create a subperiosteal pocket for implant placement. A new radiographic technique was developed to assess mentum shape preoperatively and monitor bone formation postoperatively. In the final 20 cases, diced cartilage wrapped in Surgicel was used to fill the wire cage. Histological analysis was performed on three removed prostheses to examine tissue formation. The procedure was modified to improve the fit of the wire cage to the underlying bone structure.

The wire cage implant was used in 125 patients, with the majority reporting satisfactory aesthetic outcomes. Early in the study, eight patients experienced prosthesis displacement, with two requiring removal. After modifying the implant design to better conform to bone shape, no further displacement occurred. In three patients, the prosthesis was removed due to tissue formation filling the cage. Histological examination revealed connective tissue with a thin layer of bone formation. The radiographic technique successfully identified four mentum types before surgery. The use of diced cartilage wrapped in Surgicel in the last 20 cases improved implant stability. Follow-up ranged from 3 to 12 years, with consistent and safe results reported across all patients.

The authors propose that the custom wire cage implant provides a viable alternative to traditional alloplastic implants in augmentation mentoplasty. The procedure was found to be safe and effective, with no further prosthesis displacement after design modifications. The use of a radiographic technique allowed for precise customization of the implant to individual anatomy. The histological findings suggest that tissue regeneration occurred within the cage, contributing to long-term stability. The procedure’s consistency and safety were confirmed in a follow-up period of up to 12 years. The authors suggest that the wire cage implant is particularly useful in regions where traditional implants are unavailable or costly. The study supports the continued use of this technique with the modified design and radiographic guidance. The results indicate that the wire cage can achieve satisfactory aesthetic outcomes when properly customized.