Complications related to the use of polymethyl methacrylate on the face: Analysis of 209 cases

▪ ABSTRACT

Introduction:

Polymethylmethacrylate is a permanent filler product. Injecting this material into the face can lead to complications. The objective of this study is to determine in a series of cases the median time for complications to occur, the most affected areas, the types of complications, and the treatments most performed.

Method:

209 cases of patients with complications related to the use of polymethyl methacrylate on the face who sought treatment between the period of January 2000 and June 2021 were studied. The data analyzed were gender, age, number of injections, moment of application, interval time until the complication arises, type of complication, affected region, and treatment performed.

Results:

The average age of patients was 45 years (23 to 79 years). Of these, 172 were women and 37 men. The number of applications ranged from 1 to 5. The median time for complications to appear was 71 months. The most affected regions were the malar, in 102 patients; mandibular, in 100; and zygomatic, in 91. Granuloma was observed in 135 patients; edema, in 120; and inflammation, in 78. The most common treatment was corticosteroid injection, in 111 patients, followed by surgical removal, in 40.

Conclusion:

The results can serve as a knowledge base for a better understanding of complications with the use of polymethylmethacrylate in the face.

Keywords:

Polymethyl methacrylate - Foreign-body reaction - Long term adverse effects - Dermal fillers - Granuloma, foreign-body

Institution: Hospital São Lucas da PUCRS; Clínica Goldman Cirurgia Plástica, Porto Alegre, RS, Brazil.

Publication History

Received: 11 November 2023

Accepted: 30 April 2024

Article published online:
20 May 2025

• REFERÊNCIAS

• 1 Urdiales-Gálvez F, De cabo-Francés FM, Bovéa I. Ultrasound patterns of different dermal filler materials used in aesthetics. J Cosmet Dermatol 2021; 20 (05) 1541-1548
• 2 Urdiales-Gálvez F, Delgado NE, Figueiredo V, Lajo-Plaza JV, Mira M, Moreno A. et al. Treatment of Soft Tissue Filler Complications: Expert Consensus Recommendations. Aesthetic Plast Surg 2018; 42 (02) 498-510
• 3 Trinh LN, McGuigan KC, Gupta A. Delayed Complications following Dermal Filler for Tear Trough Augmentation: A Systematic Review. Facial Plast Surg 2022; 38 (03) 250-259
• 4 Mundada P, Kohler R, Boudabbous S, Toutous Trellu L, Platon A, Becker M. Injectable facial fillers: imaging features, complications, and diagnostic pitfalls at MRI and PET CT. Insights Imaging 2017; 8 (06) 557-572
• 5 Lemperle G, Gauthier-Hazan N, Wolters M, Eisemann-Klein M, Zimmermann U, Duffy DM. Foreign body granulomas after all injectable dermal fillers: part 1. Possible causes. Plast Reconstr Surg 2009; 123 (06) 1842-1863
• 6 Paulucci BP. PMMA Safety for Facial Filling: Review of Rates of Granuloma Occurrence and Treatment Methods. Aesthetic Plast Surg 2020; 44 (01) 148-159
• 7 Machado RA, Oliveira LQ, Martelli-Júnior H, Pires FR, Carvas JB, Rogerio VE. et al. Adverse reactions to the injection of face and neck aesthetic filling materials: a systematic review. Med Oral Patol Oral Cir Bucal 2023; 28 (03) e278-e284
• 8 Blanco Souza TA, Colomé LM, Bender EA, Lemperle G. Brazilian Consensus Recommendation on the Use of Polymethylmethacrylate Filler in Facial and Corporal Aesthetics. Aesthetic Plast Surg 2018; 42 (05) 1244-1251
• 9 Souza RN, Mendoça SG, Alencar EC, França ALA, Araújo ÊG, Leite LAS. Late complication of cutaneous filling after a facelift: a case report. Rev Bras Cir Plást 2016; 31 (02) 269-272
• 10 Singh K, Nooreyezdan S. Nonvascular Complications of Injectable Fillers-Prevention and Management. Indian J Plast Surg 2020; 53 (03) 335-343
• 11 Pompeu M, Lima V, Magalhaes HL, Regattieri N, Costa IMC. Foreign body granuloma treatment with 22-MHz ultrasound-guided corticoid infiltration. J Cosmet Dermatol 2019; 18 (03) 908-909
• 12 Durkin AJ, Catena D, Woltjen N, Boyle K, Polling M, Weng J. et al. Surgical Management of Polymethylmethacrylate-Collagen Gel Complications in the Lower Eyelid: A Case Series. Ann Plast Surg 2023; 90 (01) 12-18
• 13 Goldman A, Wollina U. Intralesional Neodymium YAG laser to Treat Complications of Polymethylmethacrylate. Open Access Maced J Med Sci 2018; 6 (09) 1636-1641
• 14 Goldman A, Wollina U. Polymethylmethacrylate-induced nodules of the lips: Clinical presentation and management by intralesional neodymium: YAG laser therapy. Dermatol Ther 2019; 32 (01) e12755
• 15 Goldman A, Wollina U, Machado D, Marionwic D. Laser in the Treatment of Granulomas on the Nose Produced by Polymethylmethacrylate: A Case Series. J Drugs Dermatol 2021; 20 (11) 1161-1166
• 16 Piccolo D, Mutlag MH, Pieri L, Pennati BM, Conforti C, Bonan P. Novel Management of Granuloma Formation Secondary to Dermal Filler with Intralesional 1444 nm Nd:YAG Laser Technique. Medicina (Kaunas) 2023; 59 (08) 1406-1406
• 17 Schelke LW, Decates TS, van der Lugt CIM, Pelzer L, de Mey G, Velthuis PJ. Intralesional Laser Treatment for Dermal Filler Complications. Plast Reconstr Surg 2018; 141 (06) 1361-1369
• 18 Freire de Carvalho J. Polyautoimmunity (Psoriasis, Sjogren’s syndrome, and autoimmune uveitis) following polymethylmethacrylate injection. Eur Rev Med Pharmacol Sci 2021; 25 (06) 2478-2480
• 19 Vengalil N, Council LM, Michalski BM. Foreign body granulomas to polymethylmethacrylate soft tissue filler following COVID-19 infection. JAAD Case Rep 2023; 41: 1-3