Clinical Experience with Polymethylmethacrylate Microsphere Filler Complications

Abstract

Polymethylmethacrylate (PMMA) filler is widely used for the correction of wrinkles because of its relative long-lasting cosmetic improvements and the rarity of reported complications. However, early and delayed complications, ranging from minor to severe, can occur following PMMA filler injection. We evaluated and treated 13 cases of PMMA filler-related complications that were referred to our institution from July 2005 to June 2010. Of these patients, 92.3% were female and 7.7% were male. Complications were roughly classified as (1) nodular masses, (2) inflammation, (3) allergic reactions, and (4) discoloration. Affected locations were the lips, periocular wrinkles, nasolabial folds, forehead, marionette wrinkles, and cheeks. As there is no standard treatment modality for PMMA filler complications, patients were managed with various treatments aimed at minimizing morbidity. In the cases of lip granuloma, we recommended intralesional steroid injection first, followed by surgical excision, including lip mucosa and orbicularis oris muscle in intractable cases. Additional studies should be conducted to determine the safety of PMMA injection, reduce the occurrence of adverse reactions, and identify risk factors that are associated with higher complication rates.

Polymethylmethacrylate-induced nodules of the lips: Clinical presentation and management by intralesional neodymium:YAG laser therapy

“…In general, PMMA-induced adverse events include (a) nodular masses, (b) inflammation, (c) allergic reactions, and (d) discoloration (Park, Seo, Kim, & Chang, 2012). These events can further lead to lip asymmetry, edema, ulceration, necrosis lymphedema, functional limitation (suck, bite, whistle), chronic bite of the mucosa, and pain.…”

“…While speaking or eating, the orbicularis oris muscle acts as a pump, and causing visible nodule formation and asymmetries (Park et al, 2012). This complication is strongly associated with injection PMMA into the lip.…”

“…In general, PMMA-induced adverse events include (a) nodular masses, (b) inflammation, (c) allergic reactions, and (d) discoloration (Park, Seo, Kim, & Chang, 2012 Ledon et al, 2013). Cutaneous sarcoidal granulomas have been observed after PMMA filler injection in a patient with previously unknown systemic sarcoidosis (Sidwell, McL Johnson, Francis, & Bunker, 2006).…”

“…This complication is strongly associated with injection PMMA into the lip. While speaking or eating, the orbicularis oris muscle acts as a pump, and causing visible nodule formation and asymmetries (Park et al, 2012).…”

Usefulness of Surgical Approach for Granuloma Caused by CaHA Fillers

“…4 However, in some intractable granulomas caused by PMMA fillers, we surgically excised the lesions.…”