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Alloplastic malar onlays have been used by surgeons to correct or enhance the midfacial skeleton for over 40 years. Case series have shown respectable results using different alloplastic materials in various maxillofacial subsites. However, these articles include small numbers of patients with limited follow up. We present a literature review specifically concentrating on porous polyethylene (Medpor, Stryker) and polyethyl ether ketone (PEEK) malar onlays. We illustrate the technique used by a single oral and maxillofacial surgeon for placement of 119 implants in 61 patients over a 14-year period, and show the results of this work with long-term follow up. A complication rate of 2.5% in this cohort was reported, with follow up of three years, demonstrating that this technique for midfacial correction is successful in both the short and the long term. [ABSTRACT FROM AUTHOR]

A 36-year-old man with Crouzon syndrome was referred post-operatively with unilateral painful limitation of eye movements and proptosis following removal of bilateral malar and orbital rim implants. Further investigation revealed right inferior orbital emphysema, caused by the intra-operative entrance of hydrogen peroxide through a suspected perforation of the orbital septum. The symptoms settled with conservative management. [ABSTRACT FROM AUTHOR]