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Strategies for Malar Implant Placement: A Review of Access, Planning, and Outcomes
Martin Kauke-Navarro1, Leonard Knoedler2, Felix J Klimitz1
1From the Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine; New Haven, CT.
Background:
The absence of standardized planning and placement strategies for malar implants contributes to variable aesthetic outcomes.
Methods:
A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines searched PubMed/MEDLINE, Cochrane CENTRAL, and Google Scholar for clinical studies on aesthetic malar implantation. Surgical access, implant positioning, planning methods, and complications were extracted.
Results:
Fifteen studies including 796 patients were analyzed. Intraoral (n = 370) and preauricular (n = 350) approaches were most common, followed by subciliary (n = 54) and endonasal (n = 20). Intraoral access showed higher infection rates (2.0%), revisions (4.3%), removals (2.0%), and malposition (1.3%). Preauricular access was associated with asymmetry (20.3%) and contour irregularities. Subciliary and endonasal approaches showed few reported complications. Most implants were placed over the anterolateral zygoma to enhance malar projection. Only 3 studies used patient-specific implants, and 6 incorporated computed tomography or 3-dimensional planning.
Conclusions:
Intraoral access carries a higher infection risk. Targeting the central malar eminence may optimize projection while avoiding lateral overcorrection. Broader use of patient-specific implants and image-guided planning may improve precision and aesthetic outcomes.
