Accurate 3D bone reconstruction is one of the most difficult tasks to achieve in maxillo-facial surgery. In the present study, a zygomatic bone defect was reconstructed with a custom made implant fabricated by selective laser melting (SLM) processing from titanium particles. 2 years follow-up revealed diplopia (double vision) resolution, as well as esthetic and functional stabile reconstruction. Technical queries regarding the fabrication process and medical reconstruction are discussed.