Midface polymethylmethacrylate (PMMA) injections can result in chronic inflammation, fibrotic nodules, skin yellowing and eyelid malposition. When managing these complications, a recent study suggests that you may want to put aside the intralesional corticosteroid injections and instead opt for surgical debulking.
Dr. LimongiWhile PMMA injections in the face have been associated with several side effects, the literature on periorbital complications has been scarce, according to the study’s lead author Roberto Limongi, M.D., Ph.D., program director, fellowship-oculoplastic and orbital surgery, Federal University of Goiás, in Goiás, Brazil.
“To our knowledge, this is the first paper that reports the complications of PMMA injection to the midface,” Dr. Limongi tells Cosmetic Surgery Times.
Dr. Limongi and colleagues conducted a retrospective chart review, identifying 11 cases of complications resulting from PMMA injections to the midface. Patients were from 36 to 62 years of age, and two were men.
They found the adverse effects began between two and 24 months post PMMA injection. All patients studied had edema, erythema and contour irregularity.
The most common complication was nodules, which occurred in seven, or 64% of patients; four patients had yellow, xanthomatous skin changes; and two had eyelid malposition.
“Xanthomatous” aspect of the nasojugal groove with important edema and yellowish malar bags in lower eyelid region.
Photo courtesy Dr. Roberto Limongi
Corticosteroid injection, which the researchers tried in six cases, did little to help manage PMMA-related complications. But when the researchers performed surgical debulking of the implanted material, which they did in nine cases, the results were improved edema, erythema and nodularity, according to the study.
See: Clinical photos of surgical debulking of PMMA
“Due to the peculiar features and delicacy of the periorbital region, the use of permanent fillers, such as PMMA, when filling the palpebromalar and nasojugal grooves can cause severe complications and should be avoided. Temporary fillers, such as Restylane [Galderma], must be the first choice,” Dr. Limongi says.
Dr. Limongi offers this tip for PMMA surgical debulking: “The yellowish elastic fibrous tissue is better released from normal structures using a Colorado needle electrocautery (Stryker). Surgical debulking of the material should be performed through a transcutaneous subciliary incision approach.”
This study was published in the February 2016 issue of Aesthetic Surgery Journal.
Surgical Debulking of PMMA
62-Year-old female patient shown above with edema, pain and redness in the lower periorbital region 2 years after PMMA injection to the palpebromalar and nasojugal grooves. Shown below is the same patient undergoing surgical debulking of white material with fibroelastic consistency that infused orbicular muscle.
Photos courtesy Dr. Roberto Limongi.
