[Skip to Content]
[Skip to Content Landing]
Views 418
Citations 0
Original Investigation
May/Jun 2018

Adverse Events in Facial Implant Surgery and Associated Malpractice Litigation

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan
  • 2Facial Plastic Surgery Associates, Houston, Texas
  • 3Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan
JAMA Facial Plast Surg. 2018;20(3):244-248. doi:10.1001/jamafacial.2017.2242
Key Points

Question  What are the most common complications of facial implants, locations associated with complications, and factors raised in litigation related to facial implants?

Findings  Thirty-nine adverse events reported to the US Food and Drug Administration were included in this cross-sectional study, with infection the most common complication reported and 32 patients requiring removal of their implants. Half of malpractice cases involved allegedly inadequate informed consent.

Meaning  Prior to facial implant surgery, it is critical to have a thorough discussion of possible complications and techniques to treat them.


Importance  Facial implants represent an important strategy for providing instant and long-lasting volume enhancement to address both aging and posttraumatic defects.

Objective  To better understand risks of facial implants by examining national resources encompassing adverse events and considerations facilitating associated litigation.

Design, Setting, and Participants  A cross-sectional study reviewed complications following facial implants. The procedures reviewed were performed on patients at locations throughout the United States from January 2006 to December 2016. Data collection was completed in March 2017. The Manufacturer and User Facility Device Experience database, which contains medical device reports submitted to the US Food and Drug Administration (FDA), was searched for complications that occurred from January 2006 to December 2016 involving facial implants made by Implantech, MEDPOR, Stryker, KLS Martin, and Synthes. Furthermore, the Thomson Reuters Westlaw legal database was searched for relevant litigation.

Main Outcomes and Measures  The complications of facial implants were analyzed in relation to the location of implant and severity of complication. Litigation was analyzed to determine which factors determine outcome.

Results  Thirty-nine instances of adverse events reported to the FDA were identified. Sixteen (41%) involved malar implants, followed by 12 chin implants (31%). The most common complications included infection (18 [46%]), implant migration (9 [23%]), swelling (7 [18%]), and extrusion (4 [10%]). Thirty-two patients (83%) had to have their implants removed. Infection occurred at a mean (SD) of 83.3 (68.8) days following the surgery. One-third of complications involved either migration or extrusion. The mean (range) time to migration or extrusion was 381.1 (10-2400) days. In 12 malpractice cases identified in publicly available court proceedings, alleged inadequate informed consent and requiring additional surgical intervention (ie, removal) were the most commonly cited factors.

Conclusions and Relevance  Infection and implant migration or extrusion are the most common complications of facial implants. Most of these complications necessitate removal. These considerations need to be discussed with patients preoperatively as part of the informed consent process, as allegedly inadequate informed consent was cited in a significant proportion of resultant litigation, and there were overlapping considerations among adverse events reported to the FDA and factors brought up in relevant litigation. Cases resolved with settlements and jury-awarded damages encompassed considerable award totals.

Level of Evidence  NA.