Complications and Management of Polymethylmethacrylate (PMMA) Injections to the Midface

• Published in: Aesthetic surgery journal Vol. 36; no. 2; p. 132
• Main Authors: Limongi, Roberto Murillo, Tao, Jeremiah, Borba, André, Pereira, Filipe, Pimentel, Ana Rosa, Akaishi, Patrícia, Velasco e Cruz, Antônio Augusto
• Format: Journal Article
• Language: English
• Published: England 01.02.2016
• Subjects: Adrenal Cortex Hormones - administration & dosage; Adult; Cosmetic Techniques - adverse effects; Dermal Fillers - administration & dosage; Dermal Fillers - adverse effects; Eyelid Diseases - chemically induced; Eyelid Diseases - diagnosis; Eyelid Diseases - therapy; Face; Female; Humans; Inflammation - chemically induced; Inflammation - diagnosis; Inflammation - therapy; Injections, Intralesional; Injections, Subcutaneous; Male; Middle Aged; Pigmentation Disorders - chemically induced; Pigmentation Disorders - diagnosis; Pigmentation Disorders - therapy; Polymethyl Methacrylate - administration & dosage; Polymethyl Methacrylate - adverse effects; Rejuvenation; Retrospective Studies; Skin Aging; Treatment Outcome
• ISSN: 1527-330X
• DOI: 10.1093/asj/sjv195

Polymethylmethacrylate (PMMA) has been used as an injectable filler to treat hollows and reduce rhytids. PMMA injections have been associated with several side effects, however, the literature is scarce on periorbital complications and their treatments. The purpose of this study is to report a series of complications after periorbital PMMA injections to the midface and to describe their management. Retrospective chart review, including photography and histopathology when available. The authors identified 11 cases of complications of PMMA injections to the midface. Patient ages ranged from 36 to 62 years (mean, 47 years; median, 44 years). Two (18%) were males and 9 (82%) were females. Adverse effects began between 2 to 24 months after injection (mean, 7.2 months; median, 6 months). All patients had edema, erythema, and contour irregularity. Seven (64%) patients had nodules, 4 (36%) had yellow, xanthomatous skin changes, and 2 (18%) had eyelid malposition. Histopathology demonstrated a giant cell inflammation in 5 of 6 cases. Corticosteroid injection was tried in 6 cases but was associated with minimal clinical improvement. Surgical debulking of the implanted material was performed in 9 (82%) cases and was effective in improving edema, erythema, and nodularity. PMMA injection to the midface may be associated with chronic inflammation, fibrotic nodules, yellowing of the skin, and eyelid malposition. Intralesional corticosteroid injections yielded minimal or no improvement; surgical debulking achieved favorable results. LEVEL OF EVIDENCE 4: Therapeutic.