title: Novel use of polymethyl methacrylate (PMMA) microspheres in the treatment of infraorbital rhytids.
abstract: OBJECTIVE
  To demonstrate safely with the use of polymethyl methacrylate (PMMA) microspheres in the infraorbital eyelid area using a deliberate conservative injection in the treatment of rhytids.
  
  
  METHODS
  A retrospective case series of 289 patients in an outpatient cosmetic dermatology clinic evaluated and treated by one senior provider (NM) of infraorbital rhytids with PMMA from December 2010 to March 2011. Statistical analysis was performed for race, skin type, history of hypertrophic scar, autoimmunity, history of "sensitive skin" and history of prior procedures such as prior facelift, rhinoplasty, and blepharoplasty.
  
  
  RESULTS
  Two hundred ninety-one patients underwent at least 1-6 injections of PMMA microspheres into bilateral under eye area. Early complications were edema and ecchymosis. Late complications were identified in 4 of 289 patients who developed small granulomas. All patients who developed granulomas had had a previous lower blepharoplasty (P = 0.00). A history of "sensitive skin" was approaching statistical significance (P = 0.15).
  
  
  CONCLUSIONS
  This study has shown that PMMA microsphere injection is a safe subdermal technique in the correction of infraorbital rhytids. Safety was demonstrated in 289 patients with only 4 minor complications of small lateral granuloma which all resolved within 4 weeks after intralesion triamcinolone injection. However, this is an off-label use of a permanent filler not approved for use in the infraorbits and significant caution must be taken with full disclosure to the patient leading to informed consent. Caution in PMMA microsphere injection should be given in the patient with prior blepharoplasty. The advantage of PMMA microsphere is that the result seems to be predictable and natural.
authors.affiliation: La Jolla Cosmetic Laser Clinic, La Jolla, CA, USA; California Retina Associates, Chula Vista, CA, USA.
authors.forename: Nasrin
authors.initials: N
authors.lastname: Mani
authors.forename: Jasmine
authors.initials: J
authors.lastname: McLeod
authors.forename: Maxwell B
authors.initials: MB
authors.lastname: Sauder
authors.forename: Daniel N
authors.initials: DN
authors.lastname: Sauder
authors.forename: Marcella R
authors.initials: MR
authors.lastname: Bothwell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001672:Biocompatible Materials / Q000008:administration & dosage* / Q000009:adverse effects; D005145:Face; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D010045:Outpatients; D017060:Patient Satisfaction; D019904:Polymethyl Methacrylate / Q000008:administration & dosage* / Q000009:adverse effects; D012060:Rejuvenation; D012189:Retrospective Studies; D015595:Skin Aging / Q000187:drug effects*; D016896:Treatment Outcome
chemical_list: D001672:Biocompatible Materials; D019904:Polymethyl Methacrylate
keywords: filler; infraorbital; polymethyl methacrylate (PMMA) microsphere; rejuvenation; rhytids