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Complications after Polymethylmethacrylate Injections: Report of 32 Cases

Salles, Alessandra Grassi M.D.; Lotierzo, Priscilla Helena M.D.; Gemperli, Rolf M.D.; Besteiro, Júlio Morais M.D.; Ishida, Luís Carlos M.D.; Gimenez, Rodrigo Pinto M.D.; Menezes, Jorge M.D.; Ferreira, Marcus Castro M.D.

Plastic and Reconstructive Surgery: May 2008 - Volume 121 - Issue 5 - p 1811-1820
doi: 10.1097/PRS.0b013e31816b1385

Background: During the past 15 years, polymethylmethacrylate has been used as a synthetic permanent filler for soft-tissue augmentation.

Methods: This article reports 32 cases of complications seen at Hospital das Clínicas, Faculty of Medicine, University of São Paulo, for procedures performed elsewhere.

Results: The average age of the patients was 43.6 years (range, 22 to 70 years). Twenty-five patients were women. Sixteen injection procedures were performed by certified plastic surgeons, nine by dermatologists, two by urologists, and one by a nonphysician. Complications were classified into five groups according to main presentation as follows: tissue necrosis (five cases), an acute complication that can be related to technical mistakes but that can also be dependent on patient factors or caused by local infection; granuloma (10 cases), which usually presents as a subacute complication 6 to 12 months after the procedure; chronic inflammatory reactions (10 cases), which usually occur years later and can be related to a triggering event, such as another operation or infection in the area that was injected (these reactions are immunogenic in origin and may have cyclic periods of activation and remission); chronic inflammatory reaction in the lips (six cases), which may be present with severe symptoms, especially with lymphedema, because of mobility of the lip; and infections (one case), which are rare but possible complications after filling procedures.

Conclusions: 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.

São Paulo and Belo Horizonte, Brazil

From the Division of Plastic Surgery, Faculty of Medicine, University of São Paulo.

Received for publication October 30, 2006; accepted April 27, 2007.

Disclosure:The authors have no financial interest or commercial association with any of the products or drugs mentioned in this article.

Alessandra Grassi Salles, M.D., Rua Joaquim Floriano 466, cj. 2102, 04534-002, São Paulo, Brazil,

©2008American Society of Plastic Surgeons