Intralesional Neodymium YAG laser to Treat Complications of Polymethylmethacrylate

Abstract

BACKGROUND:Dermal fillers are widely used for facial and body contouring. Polymethylmethacrylate (PMMA) is a permanent biphasic filler for soft tissue augmentation. In case of unwanted side effects, drug therapy and surgical excision have been commonly used with mixed results.AIM:We report on a series of patients with adverse events to PMMA and an innovative minor invasive procedure to reduce disfigurement by nodules and lumps.METHODS:We employed a subdermal, intralesional 1,064 nm neodymium-doped yttrium aluminium garnet (Nd: YAG) laser in combination with suction using a blunt liposuction cannula of 2.0-2.5 mm of diameter.RESULTS:For 12 years, a total of 81 consecutive subjects (79 females and 2 males) were treated. The average age of the patients was 43.7 years (range 26 to 76 years). Granulomas and lumps could be removed in a minor invasive procedure with tumescent anaesthesia. In a minority of cases, the procedure had to be repeated. The results were impressive and not adverse events related to intralesional laser therapy were observed, 86.4% of patients were satisfied.CONCLUSION:The procedure should be used before or in combination with classical surgery to remove PMMA in case of adverse tissue reactions to PMMA.

Aesthetic Surgical Pathway in Permanent Facial Filler Removal

“…Surgical excision may remove the material but it is considered a challenging surgery, often with tissue damage and scarring as a cosmetically undesirable result 28,29 .During last years, Intra-lesional Laser Treatment (ILT) 11 , has been proposed in medical literature as an alternative to surgical approach in order to treat permanent filler complications. Nevertheless, as shown by Schelke et al in 2018, resolution of the complication was achieved only in 9percent of the cases over two hundred forty-two patients treated with ILT: in most patients (83percent) just an improvement was recorded 30 .In the present case series, almost 40percent of lips operated on already received one or more laser treatments,performed by other physicians, with no improvements.Outcomes published in medical literature regarding laser treatments for permeant lip filler removal has not shown satisfactory results 11,15,16 .Moreover, in our experience we noticed that patients who already performed laser treatment in the lip area before surgery showed hardening of the tissues and the persistence of the permanent filler.Quite often patients claimed depressions and irregularities developed following lip laser treatments(Figure7).…”

“…complications, as systemic antibiotic therapy, intra-lesional injections of corticosteroid and/or 5fluorouracil, needle aspiration, surgical drainage and laser therapy [7][8][9][10][11] ,although none of those techniques is able to totally remove previously injected permanent fillers. he mainstay for a proper preoperative filler-removal evaluation is represented by the Magnetic Resonance Imaging (MRI) 13 .Ultrasonographic evaluation may give infos related to the facial location of the filler and regarding the type of filler injected, although only the MRI let the surgeon to clearly evaluate the relationship between the fillers and the surrounding tissues such as muscles, fat compartments and fascia layers 13,14 .A careful preoperative evaluation is mandatory to reduce the risk of facial nerve damaging, a main issue why surgeons usually refuse to perform these surgical procedures.Although non-surgical procedures may solve and/or mitigate permanent fillers complications, the only way to remove the filler previously injected is represented by surgical excision [15][16][17][18][19][20] . A very poor literature is present about this topic, only some reports of permanent filler surgical removal have been published, especially focusing on lips area 3,5,19,20 .Permanent filler removal with direct excision induce visible and unpleasant scar.We present a pathway of facial surgical accesses to be performed in order to remove permanent fillers previously injected with hidden access achieving two goals: permanent filler removal and facial aesthetic balance restoration.…”

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

“…We employed a subdermal, intralesional 1,064 nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser in combination with suction using a blunt liposuction cannula of 2.0-2.5 mm of diameter. The present authors obtained good results with the intralesional Nd:YAG laser either as a single treatment or in combination with surgery (Goldman & Wollina, 2018). In both patients, we employed a subdermal, intralesional 1,064 nm Nd:YAG laser in combination with suction using a blunt liposuction cannula of 2.0-2.5 mm of diameter successfully either alone or combined with surgery ( Figure 3).…”

“…They used fiber diameters between 200 μm and 600 μm for intralesional treatment of nodules and granulomas in 242 patients. The present authors obtained good results with the intralesional Nd:YAG laser either as a single treatment or in combination with surgery(Goldman & Wollina, 2018).2 | CASE REPORTSCase #1: A 55-year-old female patient(Figure 1). We employed a subdermal, intralesional 1,064 nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser in combination with suction using a blunt liposuction cannula of 2.0-2.5 mm of diameter.…”

Delayed Granulomas as a Complication Secondary to Lip Augmentation with Dermal Fillers: A Systematic Review

“…The procedure was well tolerated and 86.4% of the patients were satisfied. 25 In our subset of patients, many ultimately required surgical removal of the granuloma, particularly if there was a single nodule. For those with multiple nodules, more aggressive treatments were pursued, including intralesional 5-FU.…”