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Complications and Management of Polymethylmethacrylate (PMMA) Injections to the Midface
Roberto Murillo Limongi1, Jeremiah Tao1, André Borba1
1Dr Limongi is an Affiliate Professor, Ophthalmology Referral Center at the Hospital das Clínicas, Federal University of Goiás, Goiânia, Goiás, Brazil. Dr Tao is an Affiliate Professor, Gavin Herbert Eye Institute, University of California, Irvine, CA, USA. Dr Borba is an Affiliate Professor, Department of Ophthalmology, University of São Paulo, São Paulo, Brazil. Drs Pereira and Akaishi are Affiliate Professors, and Dr Cruz is Chairman and Professor, Department of Ophthalmology, University of São Paulo - Ribeirão Preto, São Paulo, Brazil. Dr Pimentel is an Affiliate Professor, Department of Ophthalmology, University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
Background:
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 periorbital complications and their treatments.
Objectives:
The purpose of this study is to report a series of complications after periorbital PMMA injections to the midface and to describe their management.
Methods:
Retrospective chart review, including photography and histopathology when available.
Results:
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). Two (18%) were males and 9 (82%) were females. Adverse effects began between 2 to 24 months after injection (mean, 7.2 months; median, 6 months). All patients had edema, erythema, and contour irregularity. Seven (64%) patients had nodules, 4 (36%) had yellow, xanthomatous skin changes, and 2 (18%) had eyelid malposition. 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. Surgical debulking of the implanted material was performed in 9 (82%) cases and was effective in improving edema, erythema, and nodularity.
Conclusions:
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 results. LEVEL OF EVIDENCE 4: Therapeutic.
Insights
Complications from polymethylmethacrylate (PMMA) midface injections include inflammation and nodules. Surgical debulking effectively treated these adverse effects, unlike corticosteroid injections.
Area of Science:
- Dermatology
- Plastic Surgery
- Ophthalmology
Background:
- Polymethylmethacrylate (PMMA) is an injectable filler for facial hollows and wrinkles.
- Periorbital complications from PMMA injections are underreported.
- This study focuses on complications and treatments for PMMA injections in the midface.
Purpose of the Study:
- To report complications following periorbital PMMA injections to the midface.
- To describe the management of these adverse events.
Main Methods:
- Retrospective chart review.
- Inclusion of photographic and histopathological data where available.
Main Results:
- Eleven cases of PMMA midface injection complications were identified.
- Common adverse effects included edema, erythema, contour irregularity, nodules, and eyelid malposition.
- Surgical debulking was effective in 9 patients, while corticosteroid injections showed minimal improvement.
Conclusions:
- PMMA midface injections can lead to chronic inflammation, nodules, skin discoloration, and eyelid malposition.
- Surgical debulking is a favorable treatment for these complications.
- Intralesional corticosteroids are largely ineffective.
