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Buttock augmentation injections are filled with volumizing substances, such as silicone.

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Try out PMC Labs and tell us what you think. Learn More. We present a case of a year-old woman who developed heart failure and severe inflammatory reaction after the illicit cosmetic injections of polymethyl-methacrylate or polyacrylamide hydrogel from a primary care provider.

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Polymethylmethacrylate PMMA has been used as an injectable filler to treat hollows and reduce rhytids. PMMA injections have been associated with several side effects, however, the literature is scarce on Pmma or hydrogel injections complications and their treatments. The purpose of this study is to report a series of complications after periorbital PMMA injections to the midface and to describe their management. Retrospective chart review, including photography and histopathology when available. The authors identified 11 cases of complications of PMMA injections to the midface.

Patient ages ranged from 36 to 62 years mean, 47 years; median, 44 years. Adverse effects began between 2 to 24 months after injection mean, 7.

All patients had edema, erythema, and contour irregularity. Histopathology demonstrated a giant cell inflammation in 5 of 6 cases. Corticosteroid injection was tried in 6 cases but was associated with minimal clinical improvement. PMMA injection to the midface may be associated with chronic inflammation, fibrotic nodules, yellowing of the skin, and eyelid malposition. Intralesional corticosteroid injections yielded minimal or no improvement; surgical debulking achieved favorable .

Injectable fillers are increasingly popular alternatives to incisional aesthetic surgery to reduce facial rhytids. Alloplastic fillers may be classified as temporary or permanent. Hyaluronic acid HA is commonly administered as a temporary filler that slowly disappears through enzymatic degradation. PMMA is a rigid, transparent and colorless, thermoplastic material. Complications of fillers may be seen early after injection or late. Weeks to months after injection, massage may be effective for contour irregularity.

Inflammation may respond to corticosteroids or other anti-inflammatory treatment. HA can be reversed with enzymatic agents eg, hyaluronidase or managed expectantly. Treatment options may be fewer and more complex for the adverse effects of permanent fillers. Contour irregularities, color changes, and nodularity after injection may be more evident in the periocular region due to thin skin and intricate orbitofacial contours.

Inflammation and edema are other sequelae that may be difficult to manage in this highly visible zone. PMMA injections have been associated with several side effects, however the literature is scarce on periorbital complications and their treatment. The purpose of this paper is to report complications of PMMA injection to the midface and to describe the treatment.

Retrospective chart Pmma or hydrogel injections, including photographs and histopathology when available, of consecutive patients with PMMA injection complications presenting between January and October Subjective and objective findings on presentation, and after treatment, were extracted from the charts. The patient and treating surgeon in each case reported the subjective measures.

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Detailed information about each of the 11 cases Pmma or hydrogel injections available online as Supplementary Material Figure 1 and Supplementary Figures An intraoperative video of one case may also be viewed as Supplementary Material at www. A A year-old man presented with malar bags and persistent edema 18 months after PMMA injection to the nasojugal and palpebromalar grooves. B Postoperative appearance 3 months after debulking of the material and a midface lift.

Dermal fillers are increasingly popular and many synthetic polymers have emerged. However, there exist serious risks with injection to the periocular region. Vascular occlusions after facial fillers have been well described and even blindness is a risk. This series demonstrates other sequelae including edema, erythema, fibrosis, eyelid malposition, nodular irregularity, skin discoloration, and granulomatous inflammation.

Many of these adverse effects have been ly described and may relate to the type of injectable. Hyaluronic acid HA has been used extensively in the midface.

Given in small amounts to the supraperiosteal space, HA has been associated with high patient satisfaction and a low incidence of serious complications. The duration of action averages 6 months with a residual effect lasting up to 2 to 3 years therefore the primary limitation of HA is short longevity.

Resolution of cosmetic buttock injection-induced inflammatory reaction and heart failure after excision of filler material

For the potentially longer lastingmany have tried non-biodegradable alloplastic fillers. PMMA has been described as a permanent, biocompatible, non-toxic, non-sensitizing, and non-migratory material. This case series demonstrates that pure PMMA microsphere injection in the periorbital tissues may be associated with various complications and side effects. Chiefly, a granulomatous inflammatory, giant cell reaction with phagocytosis of PMMA particles may occur.

Grossly, there was commonly a hardening of the local tissues, edema, erythema, and formation of nodules. The authors describe for the first time, to their knowledge, yellow, xanthomatous discoloration of the skin as an additional side effect of PMMA injection in 4 cases Supplementary Figures The other side effects of PMMA injection have been ly described. Park et al reported 13 cases of complications following facial filling with PMMA. Further research is necessary to clarify the frequency of adverse effects and overall safety and efficacy of PMMA as a Pmma or hydrogel injections filler, especially compared to other materials.

The histopathology data herein may provide some insights to the behavior of PMMA injected to the midface.

Five of six specimens revealed a foreign body type chronic granulomatous reaction with giant cells encasing the injected PMMA Supplementary Figure 1C. These findings corroborate Carpaneda et al, who describe 58 of 63 patients developing a late type inflammatory reaction, 6 months after injection of PMMA throughout the body.

PMMA microsphere size may be an important variable in the pathophysiology. However, a confounding variable in the latter study is the actual microsphere size correlated poorly to the manufacturer-specified size. The behavior of PMMA injected to the face and the factors that lead to complications may be incompletely understood.

However, the above cases and literature suggest PMMA may have some undesirable effects in the eyelids and periocular region. The study has several limitations. First, it is retrospective in nature and includes a small of heterogeneous patients and no control. In addition, the data was incomplete in Pmma or hydrogel injections cases, including one lost to follow-up, and the aesthetic outcome measures were largely subjective.

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PMMA injection to the periocular region may be associated with giant cell inflammation, fibrotic nodules, yellowing of the skin, and eyelid malposition. The best treatment for these PMMA injection complications remains uncertain. Corticosteroid injection may have limited efficacy while surgical debulking may be beneficial. Further investigation may clarify the best treatment protocols for side effects of PMMA injections to the midface. The authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article.

The authors received no financial support for the research, authorship, and publication of this article. An overview of permanent and semipermanent Pmma or hydrogel injections. Plast Reconstr Surg. Google Scholar. Dermatol Surg. Smith KC. Reversible vs.

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Dermatol Online J. Duffy DM. Complications of fillers: overview. Avoiding and treating dermal filler complications. Goldberg RA. The three periorbital hollows: a paradigm for periorbital rejuvenation. Adverse with PMMA fillers.

Aesthetic Plast Surg. The natural history of polymethylmethacrylate microspheres granulomas.

Complications after polymethylmethacrylate PMMA injections in the face: a literature review. Clinical experience with polymethylmethacrylate microsphere filler complications. Complications after polymethylmethacrylate injections: report of 32 cases.