Why PEEK is the Gold Standard for Custom Facial Implants

PEEK: The Next Revolution in Facial Contouring and Reconstruction

In the dynamic field of facial aesthetic and reconstructive surgery, the quest for the ideal implant material is ongoing. While standardized implants revolutionized the field in the mid-20th century, beginning with silicone elastomer in the 1950s for standardized chin and malar implants. The materials continued to advance with porous polyethylene (Medpor), PMMA, and Teflon entering the market by the 1970s and 1980s. These improved fixation reliability and introduced early CT-based stereolithography and CAD/CAM for custom models.

However, the 2000s ushered in a new era with the arrival of Polyether Ether Ketone (PEEK) in craniomaxillofacial reconstruction. This material is strong, radiolucent, and bone-like. As a custom facial implant specialist, Dr. Zelken finds PEEK to be his favorite medium for custom facial implants.

The Unmatched Benefits of PEEK Implants

PEEK offers a superior combination of characteristics that surpass many older implant materials. Its properties are uniquely suited for the intricate anatomy of the face:

• Mimics Natural Bone
• PEEK boasts a high strength-to-weight ratio.
• Crucially, its elastic modulus is closer to cortical bone when compared to titanium. This biomechanical similarity means the implant interacts with the surrounding skeletal structure in a more favorable, "bone-like" manner.
• Radiologic Compatibility
• PEEK is radiolucent and CT/MRI-friendly. This is a massive advantage, as it ensures the implant won't interfere with future diagnostic imaging.
• Durability and Biologic Inertness
• The material is inert and has polishable surfaces.
• It exhibits minimal cold flow (creep), meaning the implant retains its precisely engineered shape over time under the body's stresses.
• It is FDA approved for cranial applications and has a track record of success for facial onlay.
• Precision Engineering
• The implant is highly modifiable, allowing for the creation of intricate features like fenestrations, countersinks, and suture/tether paths. This allows for a "keying" effect with the bone and secure fixation.

Comprehensive Applications: Where and When PEEK Excels

PEEK's customizability and robust properties make it indispensable for a broad spectrum of procedures, from purely cosmetic enhancement to complex reconstruction and revision surgery.

Aesthetic and Reconstructive Indications

PEEK is used across the maxillofacial skeleton for both enhancing appearance and restoring form:

• Aesthetic Contouring: Correcting features such as malar/zygoma deficiencies, enhancing the paranasal area, defining the mandibular angle, and resolving chin asymmetry.
• Reconstruction: Addressing significant structural issues, including post-traumatic defects and correcting bony irregularities or "residuals" left after complex orthognathic (jaw) surgeries.

PEEK for Revision and Complex Cases

PEEK is often the best solution when older materials have failed to deliver satisfactory results.

• Revision Surgery: It is ideally suited for the revision of legacy silicone or porous implants.
• Symmetry Optimization: The ability to precisely design PEEK implants makes them the ultimate tool for achieving high-level symmetry optimization.
• Addressing Failures: We often transition to PEEK when silicone implants fail to achieve goals or if they have required revision more than twice.
• Specific Complex Areas: It is particularly valuable for challenging areas like the jaw angles and the malar region.
• Patient Preference: PEEK is increasingly used simply at the patient's request, who may be drawn to its durability and custom precision.

In summary, PEEK represents the frontier of custom facial skeletal surgery, providing a rigid, easily revisable implant that allows surgeons to offer a truly unique and premium product to their patients.