Augmentation malarplasty is a cosmetic procedure rarely associated with complications; however, some reported complications are severe. The authors describe a case of missed diagnosis in a patient with chronic sinusitis secondary to erosion of malar implants into the maxillary sinuses. A review of the literature demonstrates that all severe complications of implant-based malar augmentation involve bone erosion and occur many years after initial placement. Silicone implants may have a higher risk for bone erosion and severe complications; however, it is not clear whether this risk is only associated with implants that have not been adequately fixed to the underlying bone. Surgeons should ensure that implants will not move from their original location, and screw fixation is the most reliable method for this purpose. Patients undergoing augmentation malarplasty should be informed of this potential complication so that lengthy workups and unnecessary treatments can be avoided.
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