Entrapment of soft tissue: a new technique to improve the stability of malar augmentation with hydroxyapatite

Abstract

As far as we know the first reports of the use of hydroxyapatite for malar augmentation were published in 1986.1 Its use in the form of granules has since been shown to produce a more predictable result with fewer complications than implant blocks.2 The granules also permit moulding after implantation, so that the material becomes compacted and approximates closely to the surface of the bone. Moulding is possible because the hydroxyapatite is packed under the periosteum and can be reshaped by pressure on the soft tissues. However, postoperative moulding can result in displacement of the granules through the subperiosteal pocket into the surrounding tissues, and this increases the risk of infection. Implanted granules can also be displaced spontaneously after washout by large haematomas, or under the natural pressure of the muscles during the first postoperative weeks.