title: Complications after polymethylmethacrylate injections: report of 32 cases.
abstract: 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.
authors.affiliation: São Paulo and Belo Horizonte, Brazil From the Division of Plastic Surgery, Faculty of Medicine, University of São Paulo.
authors.forename: Alessandra Grassi
authors.initials: AG
authors.lastname: Salles
authors.forename: Priscilla Helena
authors.initials: PH
authors.lastname: Lotierzo
authors.forename: Rolf
authors.initials: R
authors.lastname: Gemperli
authors.forename: Júlio Morais
authors.initials: JM
authors.lastname: Besteiro
authors.forename: Luís Carlos
authors.initials: LC
authors.lastname: Ishida
authors.forename: Rodrigo Pinto
authors.initials: RP
authors.lastname: Gimenez
authors.forename: Jorge
authors.initials: J
authors.lastname: Menezes
authors.forename: Marcus Castro
authors.initials: MC
authors.lastname: Ferreira
mesh_terms: 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
chemical_list: D001672:Biocompatible Materials; D019904:Polymethyl Methacrylate