title: Adverse results with PMMA fillers.
abstract: BACKGROUND
  Various alloplastic materials have been used for filling depressions and for body contouring. Among them, polymethylmethacrylate (PMMA) has provoked many clinical compilations in both the acute and chronic phases. This study shows the correlation between the clinical application of PMMA and the physiopathology of the acute and late complications.
  
  
  METHODS
  Histological studies were performed on biopsy samples from patients who presented with side effects and acute and late complications after PMMA injections given at other health-care centers or aesthetic services.
  
  
  RESULTS
  The histological findings of the samples that were harvested from patients who developed clinical complications or side effects caused by injection of PMMA disclosed not only normal tissues from the implanted areas but also development of capsules that involved individual microspheres of PMMA, and when the capsules were close together they formed concentric capsular groups involving various sets of microspheres and their capsules.
  
  
  CONCLUSIONS
  The injection of PMMA within the tissues can cause severe complications and side effects in both acute and chronic phases. Initially, the complications are related to vascular compromise, but at the late phase they are a consequence of capsular contracture that involves particles of PMMA. The contracture causes local tissue hardening and clinical nodulation of the implanted areas, ending with extrusion of the filler material.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266.
authors.affiliation: Instituto de Cirurgia do Lago Ltda., SHIS QI 09 Cj. E Bl. 1, Salas 1 a 6, Lago Sul, Brasília/DF, 71625-009, Brazil. carpaneda@carpaneda.com.br
authors.forename: Erick
authors.initials: E
authors.lastname: de Melo Carpaneda
authors.forename: Carlos Augusto
authors.initials: CA
authors.lastname: Carpaneda
mesh_terms: D000328:Adult; D000368:Aged; D001672:Biocompatible Materials / Q000008:administration & dosage / Q000009:adverse effects*; D005145:Face / Q000601:surgery; D005260:Female; D005548:Foreign-Body Migration / Q000139:chemically induced* / Q000473:pathology*; D005549:Foreign-Body Reaction / Q000139:chemically induced* / Q000473:pathology*; D006801:Humans; D007279:Injections, Subcutaneous / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D019904:Polymethyl Methacrylate / Q000008:administration & dosage / Q000009:adverse effects*; D011183:Postoperative Complications / Q000139:chemically induced / Q000473:pathology; D015361:Rhytidoplasty / Q000009:adverse effects*
chemical_list: D001672:Biocompatible Materials; D019904:Polymethyl Methacrylate