Temple Gore-Tex implants placed 18 years ago, followed by filler 1 year ago: how should old implants be removed?
There is more than one way to restore temple volume. Hyaluronic acid fillers and fat grafting are widely used today,
but in the past, solid implants such as Gore-Tex (ePTFE) were sometimes inserted to correct hollow temples.
Difficulties can arise many years later. Patients may no longer remember the precise details of their surgery,
or may undergo another treatment in the same area while the implant remains. The case presented here involved exactly that situation.
"Patient history at a glance"
- 18 years earlier: bilateral temple Gore-Tex (ePTFE) implant insertion
- 1 year earlier:
- Additional hyaluronic acid filler in the same area
- Notable adverse effects: none, including pain or inflammation
- Reason for consultation: dissatisfaction with temple volume appearing excessive over time
- Preoperative assessment: temple ultrasound to identify implant and filler locations and cross-sections
- Procedure: endoscopic removal of both implants
- Notable finding: the cross-section of the removed implant clearly corresponded to the ultrasound findings
Because there were no adverse effects, the decision to remove the implants began with an aesthetic concern rather than a medical problem.
Old implant removal is not considered only when inflammation or infection is present. Patients may also seek removal because of dissatisfaction with facial harmony or the implant's shape or position.
Two volume procedures performed at different times in the same area
The important feature of this case was not simply an old temple implant, but two volume treatments performed at different times coexisting in the same temple region.
A solid implant had been inserted 18 years earlier, followed by hyaluronic acid filler over it 1 year earlier.
Externally, these appeared as a single area of temple volume, but their internal structures differed: the implant was a solid material of defined shape, while the filler was distributed within tissue.
An overly full temple therefore could not be attributed solely to the implant or the filler based on appearance alone.
When surgery was performed long ago or an area has undergone repeated treatment, the first step is to establish what materials are currently present and in what condition.
Before surgery, ultrasound was used to identify the filler
Temple ultrasound was performed before implant removal.
▲ Temple Gore-Tex implant identified on preoperative ultrasound (two views in different cross-sectional planes)
▲ Temple filler identified on preoperative ultrasound
Ultrasound identified the area corresponding to the filler administered 1 year earlier.
The same examination showed a cross-section of the Gore-Tex implant inserted 18 years earlier; this is compared below with its cross-section after removal.
The temple contains multiple layers, including soft tissue, fascia, fat, and muscle. In patients with previous surgery and additional treatments, external contours alone cannot reveal the internal condition.
Ultrasound does more than confirm whether filler is present. Its key purpose is to examine the tissue layers and the relative positions of implant and filler to inform surgical planning.
Because the operation revisits a previously treated area, the current condition needs to be understood as fully as possible before proceeding.
The operation: approaching the implant under endoscopic visualization
Preoperative imaging helped assess the internal condition; during surgery, an endoscope allowed direct examination of the implant and surrounding tissue.
▲ Left: temple Gore-Tex implant seen endoscopically during surgery / Right: both removed temple Gore-Tex implants
Ultrasound and endoscopy serve different roles. Ultrasound images internal structures from outside the skin, while endoscopy allows direct visualization of the implant and surrounding structures during surgery
. Particularly when surgery took place long ago, records may be difficult to obtain and patients often cannot recall the exact implant position or technique.
It is therefore important to assess the current condition with preoperative imaging, then proceed according to the anatomical findings directly observed during surgery.
The length of time an implant has been in place alone also cannot predict adhesion severity or removal difficulty. Its actual location, material condition, and relationship to tissue vary between patients and must be assessed directly during surgery.
The cross-section anticipated on ultrasound and the actual cut surface
The removed implant was cut to examine its cross-section.
A particularly meaningful feature of this case was the opportunity to compare the preoperative ultrasound cross-section directly with the actual cut surface.
The cross-sectional structure seen on ultrasound corresponded to that revealed when the implant was cut in half.
However, the ultrasound image and the directly visible cut surface do not look exactly the same.
Ultrasound reflects the acoustic properties of tissues and materials, so it represents them differently from a photograph of a cut surface.
The purpose of comparing the images is not to show identical pictures, but to understand which actual implant corresponded to the structure identified before surgery.
Even after 18 years, one cannot assume that every old implant will be in a particular condition.
Old implants do not necessarily cause problems, and duration alone does not establish a need for removal.
Does removing the implant also remove the filler?
No. Even when an implant and hyaluronic acid filler occupy the same temple region, as in this case, their properties differ.
The implant is a solid material of defined shape that is removed surgically, whereas filler is injected and distributed within tissue.
Removing an implant does not automatically eliminate surrounding filler, and correcting filler does not remove the implant.
If a patient has had filler or another additional treatment after temple implant surgery and now wants less volume,
the first step is to distinguish how each material contributes to the current contour. This is particularly important when older surgery and a recent treatment coexist, as in this case.
▲ Before temple Gore-Tex and filler removal (preoperative photograph)
With old temple implants, age alone is not the deciding factor
An implant inserted 10, 15, or 20 years ago does not, by itself, establish whether removal is needed.
Nor does its age alone mean removal is impossible. Planning should establish the following.
- What type of implant is present
- Where it is located
- How it relates to surrounding tissue
- Whether the same area has also received filler, fat grafting, or other treatments
- What the patient currently wishes to improve
This was a relatively unusual case involving temple Gore-Tex implants placed 18 years earlier and additional hyaluronic acid filler in the same area 1 year earlier. There were no notable adverse effects, but the patient wanted removal because of dissatisfaction with the current temple volume and shape. Preoperative ultrasound identified the filler and implant locations, and endoscopy guided implant removal. Cutting the removed implant to examine its cross-section allowed comparison with the preoperative images.
The message is more than simply that an 18-year-old implant can be removed. In an area with multiple previous operations or treatments, decisions should not rely on external appearance alone. It is important to establish the treatment history, identify the materials currently present, and integrate imaging with operative findings to determine the necessary extent and method of removal. For old implants, the first priority is their current condition rather than their age.
※ This account is reconstructed from an actual clinical case. Implant type and location, surrounding tissue, and additional treatments vary between individuals, as may the diagnosis and surgical approach.
For questions about temple implant removal, contact 02-545-3700 or "UVOM Plastic Surgery" on KakaoTalk.