Background The absence of standardized planning and placement strategies for malar implants contributes to variable aesthetic outcomes. Methods A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines searched PubMed/MEDLINE, Cochrane CENTRAL, and Google Scholar for clinical studies on aesthetic malar implantation. Surgical access, implant positioning, planning methods, and complications were extracted. Results Fifteen studies including 796 patients were analyzed. Intraoral (n = 370) and preauricular (n = 350) approaches were most common, followed by subciliary (n = 54) and endonasal (n = 20). Intraoral access showed higher infection rates (2.0%), revisions (4.3%), removals (2.0%), and malposition (1.3%). Preauricular access was associated with asymmetry (20.3%) and contour irregularities. Subciliary and endonasal approaches showed few reported complications. Most implants were placed over the anterolateral zygoma to enhance malar projection. Only 3 studies used patient-specific implants, and 6 incorporated computed tomography or 3-dimensional planning. Conclusions Intraoral access carries a higher infection risk. Targeting the central malar eminence may optimize projection while avoiding lateral overcorrection. Broader use of patient-specific implants and image-guided planning may improve precision and aesthetic outcomes.
Kauke-Navarro et al. (Thu,) studied this question.