Complications after Polymethylmethacrylate Injections: Report of 32 Cases

Salles, Alessandra Grassi; Lotierzo, Priscilla Helena; Gemperli, Rolf; Besteiro, Julio Morais; Ishida, Luis C.; Gimenez, Rodrigo Pinto; Menezes, José Elmo de; Ferreira, Marcus Castro

doi:10.1097/prs.0b013e31816b1385

Cited by 98 publications

(91 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Furthermore, these granulomas may migrate up to 3 cm away from the initial site of injection placement. Patients may not associate an augmentation procedure with development of a nodular mass months or years later [5,6] Most reports in the literature focus on a series of cases limited to one substance; here we present a series of cases that evolved subsequent to lip recontouring by injection with a variety of substances that manifest specific histologic characteristics.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Lip Augmentation Dermal Filler Reactions, Histopathologic Features

Eversole

Tran²,

Hansen³

et al. 2013

Head and Neck Pathol

View full text Add to dashboard Cite

Instances of perioral and labial foreign body reactions to a variety of injectable dermal fillers were selected from the oral and maxillofacial pathology and dermatopathology archives at Pacific Pathology Laboratory of San Diego with the objective being to engender a compilation of histopathologic characteristics that allow the pathologist to identify the inciting materials. All cases of foreign body reactions located in the lips and perioral regions were reviewed by four pathologists, retaining those cases with a history of injection lip augmentation as well as those with histologic features previously documented to represent dermal filler substances. In selected cases, Alcian blue pH 2.5 with and without hyaluronidase pretreatment was performed. Immunohistochemical markers for macrophages (CD 68), adipocytes (S-100) and keratinocytes (AE1/AE2) were undertaken. All instances presented as single or multiple submucosal plaques, nodules or swellings. Natural polymers including collagen, hyaluronate, hydroxyapatite, poly-Llactate and synthetic polymers including carboxymethyl cellulose, dimethylpolysiloxane, and polyethyl methacrylate induce histologically unique features that allow for their identification. Host histopathologic responses included nodule without foreign body reaction, nodule with chronic inflammation, granuloma with epithelioid histiocytic and multinucleated giant cell reaction. Dermal filler foreign body host reactions in conjunction with the morphology of the foreign materials themselves are unique and can be differentiated from one another microscopically.

show abstract

Section: Introductionmentioning

confidence: 99%

“…Natural polymers include human and bovine collagen, [6,7] and the nonsulfated glycosaminoglycan, hyaluronic acid (HA) [8,11,12]. Many of these natural as well as the synthetic polymers serve as gelatinous matrices in which particulate or spherical filler substances, measuring 2-100 lm, are suspended.…”

Section: Introductionmentioning

confidence: 99%

Lip Augmentation Dermal Filler Reactions, Histopathologic Features

Eversole

Tran²,

Hansen³

et al. 2013

Head and Neck Pathol

View full text Add to dashboard Cite

show abstract

“…Therefore, mainly shortor mid-term reactions, like immediate sensitivity reactions, formation of granulomas and swelling, could be picked up in these studies. In a number of case reports, long-term complications occurring after more than 12 months and even more than three years were described [8,16,19,44,[54][55][56][57][58][59][60]. These case reports indicate that more extended follow-up periods are needed to determine long-term effects of permanent fillers.…”

Section: Permanent Tissue Fillersmentioning

confidence: 99%

“…Nodule formation, chronic inflammatory or delayed hypersensitivity reactions, and migration of the injected product are categorized as long-term complications, which occur after several years and can only be removed surgically. Delayed hypersensitivity reactions are related to a triggering event, such as another operation or additional injection [16,18,19]. To gain insight in the safety aspects of injectable tissue fillers, we performed a literature review to collect studies reporting clinical data of injectable tissue fillers.…”

mentioning

confidence: 99%

“…Short-term complications like pain, swelling, fever, immediate hypersensitivity reactions, occur immediately or within several days past treatment and disappear after several weeks. A more severe short-term complication is necrosis [5,16]. Necrosis occurs immediately or within a few days if blood vessels are obstructed by the filler material or if they are injured during the treatment [17].…”

mentioning

confidence: 99%

See 1 more Smart Citation

Clinical data on injectable tissue fillers: a review

Vries

Geertsma

2013

Expert Review of Medical Devices

View full text Add to dashboard Cite

Treatment with injectable tissue fillers for aesthetic purposes is increasingly popular. In parallel with this success, questions related to the safety of these treatments and the products involved are being raised more prominently. To gain insight in the safety aspects of injectable tissue fillers, we performed a literature review to collect studies reporting clinical data of injectable tissue fillers. We found several case reports where serious complications after more than three years are described. However, there are only a limited number of well-defined prospective clinical studies available with follow-up periods longer than three years. Furthermore, causes of complications, that is, treatment or product related, are often not specified in literature. Considering the intended functional period of fillers in combination with the known occurrence of long-term complications, there is a need for well-defined prospective clinical studies. In order to be able to discriminate between product failure (a product safety issue) or application methodology (a physician expertise or training issue), better identification of observed complications and whether they are product or treatment related, is needed. For the safe use of the fillers it is important that treatment with injectable tissue fillers is performed by a trained physician, who knows the product specifications and its applications. . Moreover, it is expected that due to increase in life expectancy, the demand for anti-aging treatments, like tissue augmentation with injectable tissue fillers, will grow [2]. Their success has been attributed to the fact that treatments with injectable tissue fillers are fast and appear to be relatively easy [2]. Only a relatively 'simple' subcutaneous injection is needed. Today, various injectable tissue fillers with different characteristics are available, for example, duration of the effect, material type and intended anatomical location.Although the application of an injectable tissue filler seems to be relatively simple and safe, reports of serious adverse effects have appeared in the literature [2][3][4][5][6][7][8]. Estimates of the occurrence of severe complications after treatment with various types of injectable tissue fillers range between 1:80 and 1:50,000 patients [9,10]. Adverse side effects can be caused by incorrect injection techniques (treatment related) or by the characteristics of the products (product related) [11,12]. Short-, mid-and long-term complications can be discerned (TABLE 1) [2,13-15]. Short-term complications like pain, swelling, fever, immediate hypersensitivity reactions, occur immediately or within several days past treatment and disappear after several weeks. A more severe short-term complication is necrosis [5,16]. Necrosis occurs immediately or within a few days if blood vessels are obstructed by the filler material or if they are injured during the treatment [17]. Mid-term complications such as delayed inflammatory reactions, ulceration and granuloma reaction may occur after 2-12 months. I...

show abstract

Disorders of the Lymphatic Vessels

Mortimer

Gordon

2016

Rook's Textbook of Dermatology, Ninth Edition

View full text Add to dashboard Cite

Lymphatic dysfunction interferes with fluid homeostasis, tissue immunity and peripheral fat mobilization. Any chronic oedema represents lymphatic failure. If impaired lymph drainage is solely responsible, then lymphoedema results. This produces characteristic skin changes known as elephantiasis as well as increased fat deposition in the subcutaneous tissues. Impaired immune cell trafficking results in an increased risk of infection, particularly cellulitis/erysipelas, which often becomes recurrent. This chapter describes the clinical consequences of lymphatic dysfunction and in particular the impact on the skin and subcutaneous tissues. The sections are divided according to common clinical presentations.

show abstract

Complications after Polymethylmethacrylate Injections: Report of 32 Cases

Abstract: Polymethylmethacrylate filler complications, despite being rare, are often permanent and difficult or even impossible to treat. Safety guidelines should be observed when considering use of polymethylmethacrylate for augmentation.

Cited by 98 publications

References 27 publications

Lip Augmentation Dermal Filler Reactions, Histopathologic Features

Lip Augmentation Dermal Filler Reactions, Histopathologic Features

Clinical data on injectable tissue fillers: a review

Disorders of the Lymphatic Vessels

Contact Info

Product

Resources

About