Management of Facial Implant Complications

By Dr. David Sayah Board–Certified Plastic Surgeon (American Board of Plastic Surgery) • Fellow, American College of Surgeons • NYU Medical Center (General Surgery) • UCLA Medical Center (Plastic Surgery) • Hospital Privileges: Cedars-Sinai, Saint John’s, UCLA • 26+ Years Experience • Founder, The Sayah Institute, Beverly Hills

Who would you have tailor your dress—a tailor or a dressmaker? And what about a watch? Would you trust a watch repair technician or a true watchmaker?

There’s a difference.

When something is delicate, precise, and highly visible, you don’t just want someone who can “fix it.” You want someone who understands how it was created, how it functions, and how to rebuild it when things don’t go as planned.

Facial implant surgery—and more importantly, facial implant revision—is exactly that kind of work.

Background and Expertise

With over 26 years of surgical experience and training at two of the country’s most respected institutions—NYU Medical Center and UCLA Medical Center—my path into facial implant revision surgery was anything but accidental.

I’ve been drawing and painting since childhood, and that foundation in visual balance and proportion continues to influence how I approach the face today. During my general surgery training at NYU Medical Center, I operated across multiple specialties—trauma, neurosurgery, cardiac surgery, orthopedics, and pediatric surgery. At the same time, I continued developing my artistic skills through oil painting and sculpting, which I still pursue. That combination of technical surgical training and a lifelong focus on form, structure, and art shapes how I evaluate and correct complex facial problems.

I then completed my plastic and reconstructive surgery training at UCLA, where I focused heavily on complex reconstruction. In cancer and trauma patients, we weren’t just improving appearance—we were rebuilding faces from the ground up using a combination of tissue, structural techniques, and custom-designed or hand-sculpted implants. That experience is directly applicable to revision facial implant surgery, where anatomy is often distorted and solutions need to be individualized.

Following my years at UCLA, I spent an additional year refining endoscopic techniques in plastic surgery, which led to my authoring a chapter on endoscopic facelifts and browlifts in The Art of Aesthetic Surgery—the preeminent plastic surgery textbook—so that other surgeons could learn these approaches. My research on wound healing and scar formation has been published in peer-reviewed journals including the Journal of Surgical Research and Plastic and Reconstructive Surgery.

Today, as the founder of The Sayah Institute in Beverly Hills, a significant part of my practice is devoted to patients dealing with complications from facial implants—whether that’s asymmetry, nerve-related symptoms, or simply results that don’t look or feel right.

Facial Implants in Today’s Practice

Facial implants are not used as frequently as they once were. With the evolution of fillers and fat grafting, we have more options than ever for adding volume to the face.
But implants still have an important role.

When a patient has a truly recessed chin, weak jawline, or underdeveloped cheekbones and wants a permanent, structural solution, implants can be the right choice. They provide definition in a way that injectable treatments often cannot.

At the same time, they are medical devices. And like any implanted device in the body, they can have problems. Some of these problems are straightforward. Others are anything but.

Common Causes of Facial Implant Migration and Asymmetry

One of the most common issues I see is implant movement. Patients will come in saying something just doesn’t feel right—one side looks different, something shifted after a minor injury, or a change occurred without any clear cause.

The reality is that implants can move. It can happen early after surgery or years later. Even when implants are secured with sutures or screws, the face is constantly in motion—talking, chewing, expressing. Add in factors like trauma, inflammation, or even dental work, and over time, that stability can change.

When an implant moves, the first thing patients notice is asymmetry. One side of the face looks higher, fuller, or simply different than the other. In other cases, the implant rotates or settles into a position that looks unnatural.

More concerning is when that movement affects nearby nerves. Patients may develop numbness, tingling, pain, or weakness in certain facial muscles. In more advanced cases, the implant can begin to erode through tissue or become exposed, which often leads to infection.

The key in these situations is timing. The longer a nerve is compressed, the higher the risk that symptoms become permanent. That’s why early evaluation is so important. Sometimes the solution is straightforward—repositioning and securing the implant. Other times, removal is the better option.

When the Problem Originates at the Time of Placement

Not all complications develop over time. Some are present from the moment the implant is placed.

Implants that are slightly off in position, the wrong size, or not properly aligned with the underlying bone can create immediate asymmetry or functional issues. Patients often sense this early—they may not be able to articulate it precisely, but they know something isn’t right.

In those cases, the goal is not just to “fix” the implant but to understand why it looks or feels off. Sometimes that means repositioning. Sometimes it means exchanging the implant. And in some cases, it means removing it altogether and choosing a different approach.

Understanding Facial Asymmetry After Implant Surgery

One of the most important conversations I have with patients is about asymmetry.

No face is perfectly symmetric. That’s normal. But implants can sometimes exaggerate those differences rather than correct them. Even with careful planning, standard implants don’t always account for the subtle variations that exist from one side of the face to the other.

This is where experience matters. In many cases, I combine techniques—adjusting or removing implants while using fat grafting to fine-tune contour and balance. Fat grafting allows for precise, layered correction, almost like sculpting in real time. For more complex cases, custom-designed implants based on 3D imaging can provide a level of precision that standard implants simply can’t achieve.

Nerve-Related Symptoms: When to Act Quickly

When a patient tells me they have numbness, pain, or weakness after an implant, I take that seriously.

Nerves in the face are delicate, and they don’t tolerate prolonged pressure well. Sometimes the symptoms are temporary and improve with time. But sometimes they’re a sign that the implant is in the wrong position or has shifted.

This is one of those situations where waiting too long can make things worse. If intervention is needed—whether that’s adjusting the implant or removing it—doing it sooner rather than later can make the difference between full recovery and permanent change.

Infection Around Facial Implants: A Different Kind of Problem

Infections behave differently when an implant is involved.

Unlike your natural tissue, implants don’t have blood flow. That means antibiotics have a hard time reaching bacteria that attach to the implant surface. Those bacteria form what’s called a biofilm—a protective layer that makes them even harder to eliminate.

In some cases, antibiotics can help temporarily. But more often than not, the implant needs to be removed to fully resolve the infection. Then comes the next decision: what to do about the other side. If only one implant is infected, removing it can leave the face noticeably asymmetric. So we have to decide whether to remove both implants and reconstruct later, or address things in stages. These are nuanced decisions that depend on the patient’s priorities and anatomy.

Long-Term Bone Changes Beneath Facial Implants

One of the less discussed—but very real—issues with facial implants is how they affect the bone underneath.

Bone is constantly remodeling. When an implant sits on bone for years, the pressure can gradually change the shape of that bone. In chin implants, for example, that can mean erosion toward the dental roots.

This becomes especially important when removing implants. The anatomy you’re left with is not the same as it was before the implant was placed. In some cases, the bone has reshaped in a way that makes removal more complex and reconstruction more involved. That’s why imaging—particularly 3D CT scans—is so important. It allows me to see exactly what’s happening beneath the surface and plan the safest and most effective approach.

Considering Facial Implant Revision? Here’s What to Know

Facial implant complications are not all the same. Some are subtle. Others are complex. But in every case, the goal is the same: restore balance, preserve function, and achieve a result that looks natural.

This is not assembly-line surgery. It’s problem-solving, reconstruction, and refinement—often all at once. And just as with a dress or a watch, when something this visible and this intricate needs to be corrected, who you choose matters.

With over 26 years of experience, advanced fellowship training in endoscopic techniques, published research in facial reconstruction, and a practice dedicated to complex revision cases at The Sayah Institute in Beverly Hills, I bring both the surgical foundation and the artistic perspective this work demands.

If you’re experiencing complications from a facial implant—or simply have concerns about a previous result—I encourage you to schedule a consultation at The Sayah Institute. A thorough evaluation, including 3D imaging when appropriate, will give us a clear picture of what’s happening and the options available to you.

About Dr. David Sayah

Dr. David Sayah is a board-certified plastic surgeon and Fellow of the American College of Surgeons with over 26 years of experience. He completed his general surgery training at NYU Medical Center and his plastic surgery residency at UCLA Medical Center, followed by an endoscopic surgery fellowship. He has authored chapters in The Art of Aesthetic Surgery and published research in the Journal of Surgical Research and Plastic and Reconstructive Surgery. He maintains hospital privileges at Cedars-Sinai Medical Center, Saint John’s Hospital, and UCLA Medical Center. Dr. Sayah is the founder of The Sayah Institute, located at 436 North Bedford Drive, Suite 202, Beverly Hills, CA 90210. He can be reached at (310) 385-0000.