Strategies for Malar Implant Placement: A Review of Access, Planning, and Outcomes

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.