Extensive facial necrosis after infiltration of polymethylmethacrylate

Castro, Anderson Castelo Branco de; Collares, Marcus Vinícius Martins; Portinho, Ciro Paz; Dias, Paulo Cesar; Pinto, R.D.

doi:10.1016/s1808-8694(15)31184-8

Cited by 15 publications

(8 citation statements)

References 6 publications

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“…Such complications have been reported with the use of collagen injections and, in rare cases, have resulted in the sudden and permanent loss of vision. Similar complications have been associated with other injectable preparations, including Brazilian PMMA products [8–11, 33, 34], fat, corticosteroids, local anesthetics, and angiographic agents, but have not been reported after injection of Artecoll or ArteFill. These findings emphasize the importance of avoiding implantation into blood vessels by using blunt cannulas or by moving a sharp needle back and forth during implantation while maintaining constant pressure on the plunger.…”

Section: Complicationsmentioning

confidence: 55%

“…They can often be placed intradermally because of the thickness of the skin in this area. During the 20-year history of Artecoll use in Europe, no case of glabellar skin necrosis [8–10] or vision loss [11] was reported to the manufacturer. Unlike collagen and hyaluronic acid, ArteFill cannot be injected through a resting needle; the needle has to be moved back and forth while avoiding intravascular deposition.…”

Section: Indicationsmentioning

confidence: 99%

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ArteFill® Permanent Injectable for Soft Tissue Augmentation: II. Indications and Applications

Lemperle

Sadick

Knapp³

et al. 2009

Aesth Plast Surg

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Patients ask for procedures with long-lasting effects. ArteFill is the first permanent injectable approved in 2006 by the FDA for nasolabial folds. It consists of cleaned microspheres of polymethylmethacrylate (PMMA) suspended in bovine collagen. Over the development period of 20 years most of its side effects have been eliminated to achieve the same safety standard as today’s hyaluronic acid products. A 5-year follow-up study in U.S. clinical trial patients has shown the same wrinkle improvement as seen at 6 months. Long-term follow-up in European Artecoll patients has shown successful wrinkle correction lasting up to 15 years. A wide variety of off-label indications and applications have been developed that help the physician meet the individual needs of his/her patients. Serious complications after ArteFill injections, such as granuloma formation, have not been reported due to the reduction of PMMA microspheres smaller than 20 μm to less than 1% “by the number.” Minor technique-related side effects, however, may occur during the initial learning curve. Patient and physician satisfaction with ArteFill has been shown to be greater than 90%.

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Section: Complicationsmentioning

confidence: 55%

Section: Indicationsmentioning

confidence: 99%

ArteFill® Permanent Injectable for Soft Tissue Augmentation: II. Indications and Applications

Lemperle

Sadick

Knapp³

et al. 2009

Aesth Plast Surg

View full text Add to dashboard Cite

show abstract

“…There is a higher risk of intravascular injection that can be followed by ischaemia and tissue necrosis when the filler is injected around the lip vermilion and labial mucosa 2 . In the literature, there are five case reports on serious tissue necrosis published between 2007 and 2010, one describes an extensive necrosis of the hemiface that occurred after 24 h from an implantation in the nasolabial fold that presumably damaged the right facial artery 28 , while the other four cases involved necrosis of the nose and lips after injection in the nasolabial folds 21,41 . There are also alarming cases of blindness after PMMA injection in the glabellar region, which was caused by an embolism in the ophthalmic artery 42,43 .…”

Section: Immediate Complicationsmentioning

confidence: 99%

“…Facial fillers can cause adverse reactions such as erythema, swelling, itching, bruising and induration that are very common in the first 72 h after implantation, while late-onset complications that are likely to arise include persistent erythema, itching, depigmentation, induration, lumpiness, persistent granulomatous foreign body reaction, ulceration, vascular complication and tissue necrosis 6,14,17,25,26 . Microspheres phagocytosis and local adverse reactions with granulomatous formation are often related to PMMA injections 6,7,[24][25][26][27][28][29] .…”

Section: Introductionmentioning

confidence: 99%

Complications after polymethylmethacrylate (PMMA) injections in the face: a literature review

et al. 2013

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“…For deep dermal injections in patients with facial lipodystrophy syndrome (LDS), blunt needles of 23G or larger will facilitate nudging venules and arterioles aside and prevent bruising, intravascular deposition of ArteFill, and potential embolism [15, 16]. …”

Section: Injection Techniquementioning

confidence: 99%

ArteFill® Permanent Injectable for Soft Tissue Augmentation: I. Mechanism of Action and Injection Techniques

Knapp²,

et al. 2009

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After more than 25 years of research and development, in October 2006 ArteFill® became the first and only permanent injectable wrinkle filler to receive FDA approval. ArteFill is a third-generation polymeric microsphere-based filler, following its predecessor Artecoll®, which was marketed outside the United States between 1994 and 2006. ArteFill is approved for the correction of nasolabial folds and has been used in over 15,000 patients since its U.S. market introduction in February 2007. No serious side effects have been reported to date according to the FDA’s MAUDE reporting database. ArteFill consists of polymethylmethacrylate (PMMA) microspheres (20% by volume), 30–50 μm in diameter, suspended in 3.5% bovine collagen solution (80% by volume) and 0.3% lidocaine. The collagen carrier is absorbed within 1 month after injection and completely replaced by the patient’s own connective tissue within 3 months. Each cc of ArteFill contains approximately six million microspheres and histological studies have shown that long-term wrinkle correction consists of 80% of the patient’s own connective tissue and 20% microspheres. The standard injection technique is subdermal tunneling that delivers a strand of ArteFill at the dermal–subdermal junction. This strand beneath a wrinkle or fold acts like a support structure that protects against further wrinkling and allows the diminished thickness of the dermis to recover to its original thickness.

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Extensive facial necrosis after infiltration of polymethylmethacrylate

Cited by 15 publications

References 6 publications

ArteFill® Permanent Injectable for Soft Tissue Augmentation: II. Indications and Applications

ArteFill® Permanent Injectable for Soft Tissue Augmentation: II. Indications and Applications

Complications after polymethylmethacrylate (PMMA) injections in the face: a literature review

ArteFill® Permanent Injectable for Soft Tissue Augmentation: I. Mechanism of Action and Injection Techniques

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