Complications after polymethylmethacrylate injections: report of 32 cases.
BACKGROUND
During the past 15 years, polymethylmethacrylate has been used as a synthetic permanent filler for soft-tissue augmentation.


METHODS
This article reports 32 cases of complications seen at Hospital das Clínicas, Faculty of Medicine, University of São Paulo, for procedures performed elsewhere.


RESULTS
The average age of the patients was 43.6 years (range, 22 to 70 years). Twenty-five patients were women. Sixteen injection procedures were performed by certified plastic surgeons, nine by dermatologists, two by urologists, and one by a nonphysician. Complications were classified into five groups according to main presentation as follows: tissue necrosis (five cases), an acute complication that can be related to technical mistakes but that can also be dependent on patient factors or caused by local infection; granuloma (10 cases), which usually presents as a subacute complication 6 to 12 months after the procedure; chronic inflammatory reactions (10 cases), which usually occur years later and can be related to a triggering event, such as another operation or infection in the area that was injected (these reactions are immunogenic in origin and may have cyclic periods of activation and remission); chronic inflammatory reaction in the lips (six cases), which may be present with severe symptoms, especially with lymphedema, because of mobility of the lip; and infections (one case), which are rare but possible complications after filling procedures.


CONCLUSIONS
Polymethylmethacrylate filler complications, despite being rare, are often permanent and difficult or even impossible to treat. Safety guidelines should be observed when considering use of polymethylmethacrylate for augmentation.
Salles
Alessandra Grassi
AG
São Paulo and Belo Horizonte, Brazil From the Division of Plastic Surgery, Faculty of Medicine, University of São Paulo.
Lotierzo
Priscilla Helena
PH
Gemperli
Rolf
R
Besteiro
Júlio Morais
JM
Ishida
Luís Carlos
LC
Gimenez
Rodrigo Pinto
RP
Menezes
Jorge
J
Ferreira
Marcus Castro
MC
D000328:Adult; D000368:Aged; D001672:Biocompatible Materials / Q000008:administration & dosage / Q000009:adverse effects*; D001938:Brazil; D002613:Cheilitis / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005260:Female; D005549:Foreign-Body Reaction / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D015745:Granuloma, Foreign-Body / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007271:Injections, Intradermal; D008297:Male; D008875:Middle Aged; D019904:Polymethyl Methacrylate / Q000008:administration & dosage / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D019736:Prostheses and Implants / Q000009:adverse effects*; D012086:Reoperation; D015361:Rhytidoplasty; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery
D001672:Biocompatible Materials; D019904:Polymethyl Methacrylate