Before I write this blog, I want to include a quick note. I do NOT do PMMA injections. When I do facial fillers, I like ones which degrade and are natural. This is primarily the class known as Hyaluronic Acid fillers, “HA” fillers for short. (Juvederm, Restylane, Perlane, Voluma). The HA fillers are known as temporary fillers, as they slowly disappear because of enzymatic degradation. This is not to confused with “permanent fillers” like Hydroxyapatite (Radiesse) or Polymethyl-methacrylate (PMMA), both of which I do not use.
Journal time. This is out of the February Aesthetic Surgery Journal “Complications and Management of PMMA Injections to the Midface.”
What is PMMA?
- It is transparent, rigid, and colorless plastic material.
- Polymerized PMMA microspheres are used as a facial filler because of low cost, accessibility, and longer lasting results.
- Complications can be seen early or late. These include contour irregularities, color changes, nodularity, eyelid malposition, inflammation, swelling.
- Weeks to months after injection, massage may help with contour irregularity.
- Inflammation may respond to steroids
This study was done looking at injections into the midface, area around the eye. This is a common place for us to inject. It is difficult because of the thin skin and vascularity in the area.
Study:
- Retrospective chart review. Photos and histology when available.
- 11 complications were found
- They started 2-24 months after injection (mean 7 months)
- All had edema, redness, irregularity. 64% had nodules. 36% had yellow skin changes. 18% had eyelid malposition.
- Histology: giant cell inflammation
- Treatment: 82% had surgical debulking to remove the material, with improvement in swelling, redness, and nodularity.
My thoughts?
This one is preaching to the choir. I do not like anything artificial in the face. When in residency, I took out silicone nodules from people’s skin. It had been a popular treatment for acne pitting years before- they would inject free silicone into the skin. The silicone worked well for a while, but your body does not like foreign objects. It encapsulates them, it can infect them, and it can reject them by spitting them out through the skin. All of these known processes can lead to redness, swelling, pain, nodules, irregularities, and discoloration. From this study, it also indicates the PMMA causes scarring which actually distorted the eyelid position.
Natural substances are best. In of the office I love HA fillers (Juvederm, Restylane, Voluma, Perlane). In the operating room I use fat transfer.