We acknowledge the assistance of Jeffrey K. Smith, Professor and Chairman, Department of Educational Psychology. Rutgers University, for reviewing the questionnaire.

plants is the possibility of adverse systemic effects. Most of the literature regarding this relates to gel-filled breast implants. The possibility of silicone bleed from gel-filled breast implants has been discussed by a number of authors. This has never been reported in gel-filled silicone chin implants. The concern regarding implant bleed is that it may stimulate an immune reaction to extracapsular silicone.' There have been a few reports of auto-immune disease occurring following breast augmentation. Spiera and Kerr reported on scleroderma following silicone implants in 11 cases; two of these involved chin implants.'° This is the only report we have found associating preformed silastic facial implants with the possibility of autoimmune or connective tissue disease. It should be noted that the authors who are rheumatologists have been quoted on this topic and, therefore, receive a disproportionate number of referrals of such problems. They only inferred a possible relationship between scleroderma and silicone implants in their 11 reported cases.' Endo et al. concluded that although there are case reports of systemic rheumatic disease following silicone prostheses, there is no definitive proof of a direct relationship between silicone prostheses and any systemic disease."

In the best epidemiology study to date on the risk of connective tissue disorder after breast implantation. Gabriel et al. conducted a retrospective cohort study, re-viewing the records of 749 women in Olmsted County. Minnesota, receiving breast implants from 1964 to 1991. Only five of these women were later diagnosed with one of the specific connective tissue diseases. Their control was 1498 similar women who had not undergone breast implants, in which 10 cases of connective tissue disorder were diagnosed. The mean follow-up period was 8.8 years. Their study found no association between breast implants and the development of connective tissue disease.'

We feel it is important to have sufficient data regarding the long-term effects of facial implants to make specific recommendations for established policy regarding their use."'" We feel the following questions should be answered regarding the long-term effects of facial implants so that physicians can he secure in recommending these procedures to their patients.

Figure 1. Surgeon's evaluation sheet.

Figure 2. Questionnaire sent out to patients.

1. What are the risks (complications, etc.)?
2. What is the normal host response to implant placement?
3. What are the major causes of implant removal?
4. What are the consequences of implant removal?
5. Are infection and rejection significant problems?
6. Is there a time postoperatively after which rejection and infection will not be expected to occur?
7. What are the reasons for implant rejection?
8. Are rejections related to (a) individual patient response, (b) site of implantation, and/or (c) type of implanT utilized?
9. Are there systemic or life-threatening consequences as a result of facial implant surgery?
10. What is the level of patient satisfaction?
11. Is the gain achieved from surgery sufficient to offset the risk?
12. How should we advise our patients regarding surgical risks?

To answer these questions, we embarked on a retrospective survey of our own patients and hope to be able to expand it in the future, through other surgeons, to a larger patient population. in organizing this survey, we developed an implant data sheet (Figure I). We would like to see a standardized data sheet incorporated into the record of all implant patients to make retrospective and prospective analyses of the information possible.

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