Although he has offered custom implants for years, the process is constrained by the expense and logistical challenges of designing, ordering, and receiving a custom-made implant. The implants typically used in the custom arena are made of silicone, the same material used in prefabricated, off-the-shelf devices. Because off-the-shelf devices can be far less expensive, are readily available, and generally arrive at our doorstep a day or 2 after they are ordered, these have been (and remain) the preferred solution for the majority of patients treated by Dr. Zelken. Chin and paranasal implants seldom require screw fixation and can be placed under near direct visualization. Because they are made from malleable silicone, incisions are generally shorter than what is required for plastic devices, such as those made with Medpor or polyether ether ketone (PEEK). Although these prefabricated devices have smooth surfaces, they can easily conform to the complex topography of the underlying bone