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Risk Comparison of Filler Embolism Between Polymethyl Methacrylate (PMMA) and Hyaluronic Acid (HA)

Fangfei Nie1, Hongbin Xie2, Guanhuier Wang1

  • 1Department of Plastic Surgery, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, People's Republic of China.

Aesthetic Plastic Surgery
|March 3, 2019
PubMed
Abstract

Insights

Polymethyl methacrylate (PMMA) fillers pose a lower risk of vascular embolism and necrosis compared to hyaluronic acid (HA) fillers. Increased injection volume for both PMMA and HA significantly elevates risks of embolism and tissue necrosis.

Area of Science:

  • Dermatology
  • Plastic Surgery
  • Vascular Biology

Background:

  • Vascular complications are a known risk associated with dermal fillers.
  • The incidence and severity of these complications vary significantly between different filler materials.
  • Polymethyl methacrylate (PMMA) and hyaluronic acid (HA) are common dermal fillers with distinct properties.

Purpose of the Study:

  • To compare the risk of vascular embolism between PMMA (Artecoll) and HA (Restylane) following arterial injection.
  • To evaluate the incidence of tissue necrosis and histopathological changes associated with each filler type.
  • To assess the impact of injection volume on the safety profile of PMMA and HA fillers.

Main Methods:

  • Rabbit ear central arteries were injected with either 0.1 mL or 0.2 mL of PMMA or HA.
  • Vascular occlusion (embolism) was monitored immediately post-injection.
  • Tissue necrosis and histopathological alterations were analyzed on day 7 post-injection.

Main Results:

  • At 0.1 mL, PMMA showed minimal necrosis (5%) with rapid dispersion, while HA caused significant emboli and necrosis (60%).
  • At 0.2 mL, PMMA resulted in intermediate clotting risk and 30% necrosis, whereas HA led to 100% emboli and necrosis.
  • Necrosis areas were significantly larger with HA compared to PMMA at equal volumes; HA also induced small blood vessel dilation.

Conclusions:

  • PMMA demonstrates a lower risk of embolism compared to HA when injected at equivalent volumes.
  • Increasing the injection volume of both PMMA and HA increases the risk of both vascular embolism and tissue necrosis.
  • These findings highlight differential safety profiles of common dermal fillers, influencing clinical choices.
Keywords:
EmbolismHyaluronic acid (HA)Intra-arterial injectionNecrosisPolymethyl methacrylate (PMMA)

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