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Issues with PMMA longterm

Aug 25, 2014

I have been reading as much as I can regarding PMMA and adverse side effects. When doing a search it seems like results from around 2006 are the most numerous to show up and there is no discussion of negative effects let alone long term effects. I did read about one person who after 6 years started to get swollen under her eyes, an area where she did not have PMMA injections. The swelling was increasing and the skin was warm to touch. Doctors on the forum for the most part suggested that she start oral antibiotics and one called for prednisone. It occurred to me when reading their responses that there did not seem to be any widely acceptable approach, it was kind of all over the place. Some suggested surgical removal and others said surgerical removal is very difficult. Before I do anything to my face I would like to have an idea of what can go wrong and what procedure can be used to handle the situation, hopefully something that can be considered standard procedure in response to a problem. I have seen Dr. Casavantes name from Tijuana a lot. I have had very successful cosmetic dentistry done there so I am not nervous about going to Mexico after doing my research. Are their any doctors on the West Coast using PMMA for facial filler other than Arte-Fill? Any information is greatly appreciated.

Response from Dr. Pierone

Hello and thanks for posting.

Complications from facial fillers may be separated into immediate and late events. Immediate complications would include pain, bruising, swelling, infection, and suboptimal aesthetic results. These are generic issues since they are common to all facial fillers.

In the United States, there are really only two permanent facial fillers in use.

Silicone has been used off-label for many years as a facial filler using a micro-droplet technique methodology. Not many doctors have much experience with micro-droplet silicone, but in skilled hands the results may be quite good.

Artefill was approved by the FDA in 2007 and consists of PMMA in combination with lidocaine and bovine collagen. This is a hybrid product since the PMMA is permanent and bovine collagen is temporary. After injection, the PMMA stays and the collagen is reabsorbed. The PMMA becomes surrounded by multi-nucleated giant cells, a type of macrophage that becomes specialized to surround foreign elements that the body cannot dissolve. This multi-nucleated giant cells lock the PMMA into place so that it cannot migrate from the injection site.

Late complications may occur as well, and they are particularly relevant to permanent fillers like Artefill and silicone. Both are rare, but the two late complications that may develop are infection and granuloma formation. Late or persistent infection may occur with permanent fillers, sometimes in association with biofilm formation. Granuloma formation is characterized by inflammation that develops around the injection site of fillers. The process seems to be related to an immunological response to the filler, in many cases it seems to be triggered by an unrelated infection. There may also be an increased risk of granuloma formation in people with a history of autoimmune conditions like lupus or rheumatoid arthritis.

I have seen a few cases of granuloma formation and prednisone has been an effective response to reduce the inflammation. Because of the swelling and nodularity of the reaction, sometimes smoothing in the region with fillers may be necessary as well. Surgical removal is generally not needed since the surrounding inflammation is really the culprit.

I hope that this information helps and good luck!

More lasting facial filler
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