title: Complications and Management of Polymethylmethacrylate (PMMA) Injections to the Midface.
abstract: BACKGROUND
  Polymethylmethacrylate (PMMA) has been used as an injectable filler to treat hollows and reduce rhytids. PMMA injections have been associated with several side effects, however, the literature is scarce on periorbital complications and their treatments.
  
  
  OBJECTIVE
  The purpose of this study is to report a series of complications after periorbital PMMA injections to the midface and to describe their management.
  
  
  METHODS
  Retrospective chart review, including photography and histopathology when available.
  
  
  RESULTS
  The authors identified 11 cases of complications of PMMA injections to the midface. Patient ages ranged from 36 to 62 years (mean, 47 years; median, 44 years). Two (18%) were males and 9 (82%) were females. Adverse effects began between 2 to 24 months after injection (mean, 7.2 months; median, 6 months). All patients had edema, erythema, and contour irregularity. Seven (64%) patients had nodules, 4 (36%) had yellow, xanthomatous skin changes, and 2 (18%) had eyelid malposition. Histopathology demonstrated a giant cell inflammation in 5 of 6 cases. Corticosteroid injection was tried in 6 cases but was associated with minimal clinical improvement. Surgical debulking of the implanted material was performed in 9 (82%) cases and was effective in improving edema, erythema, and nodularity.
  
  
  CONCLUSIONS
  PMMA injection to the midface may be associated with chronic inflammation, fibrotic nodules, yellowing of the skin, and eyelid malposition. Intralesional corticosteroid injections yielded minimal or no improvement; surgical debulking achieved favorable results. LEVEL OF EVIDENCE 4: Therapeutic.
authors.affiliation: Dr Limongi is an Affiliate Professor, Ophthalmology Referral Center at the Hospital das Clínicas, Federal University of Goiás, Goiânia, Goiás, Brazil. Dr Tao is an Affiliate Professor, Gavin Herbert Eye Institute, University of California, Irvine, CA, USA. Dr Borba is an Affiliate Professor, Department of Ophthalmology, University of São Paulo, São Paulo, Brazil. Drs Pereira and Akaishi are Affiliate Professors, and Dr Cruz is Chairman and Professor, Department of Ophthalmology, University of São Paulo - Ribeirão Preto, São Paulo, Brazil. Dr Pimentel is an Affiliate Professor, Department of Ophthalmology, University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Roberto Murillo
authors.initials: RM
authors.lastname: Limongi
authors.affiliation: Dr Limongi is an Affiliate Professor, Ophthalmology Referral Center at the Hospital das Clínicas, Federal University of Goiás, Goiânia, Goiás, Brazil. Dr Tao is an Affiliate Professor, Gavin Herbert Eye Institute, University of California, Irvine, CA, USA. Dr Borba is an Affiliate Professor, Department of Ophthalmology, University of São Paulo, São Paulo, Brazil. Drs Pereira and Akaishi are Affiliate Professors, and Dr Cruz is Chairman and Professor, Department of Ophthalmology, University of São Paulo - Ribeirão Preto, São Paulo, Brazil. Dr Pimentel is an Affiliate Professor, Department of Ophthalmology, University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Jeremiah
authors.initials: J
authors.lastname: Tao
authors.affiliation: Dr Limongi is an Affiliate Professor, Ophthalmology Referral Center at the Hospital das Clínicas, Federal University of Goiás, Goiânia, Goiás, Brazil. Dr Tao is an Affiliate Professor, Gavin Herbert Eye Institute, University of California, Irvine, CA, USA. Dr Borba is an Affiliate Professor, Department of Ophthalmology, University of São Paulo, São Paulo, Brazil. Drs Pereira and Akaishi are Affiliate Professors, and Dr Cruz is Chairman and Professor, Department of Ophthalmology, University of São Paulo - Ribeirão Preto, São Paulo, Brazil. Dr Pimentel is an Affiliate Professor, Department of Ophthalmology, University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: André
authors.initials: A
authors.lastname: Borba
authors.affiliation: Dr Limongi is an Affiliate Professor, Ophthalmology Referral Center at the Hospital das Clínicas, Federal University of Goiás, Goiânia, Goiás, Brazil. Dr Tao is an Affiliate Professor, Gavin Herbert Eye Institute, University of California, Irvine, CA, USA. Dr Borba is an Affiliate Professor, Department of Ophthalmology, University of São Paulo, São Paulo, Brazil. Drs Pereira and Akaishi are Affiliate Professors, and Dr Cruz is Chairman and Professor, Department of Ophthalmology, University of São Paulo - Ribeirão Preto, São Paulo, Brazil. Dr Pimentel is an Affiliate Professor, Department of Ophthalmology, University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Filipe
authors.initials: F
authors.lastname: Pereira
authors.affiliation: Dr Limongi is an Affiliate Professor, Ophthalmology Referral Center at the Hospital das Clínicas, Federal University of Goiás, Goiânia, Goiás, Brazil. Dr Tao is an Affiliate Professor, Gavin Herbert Eye Institute, University of California, Irvine, CA, USA. Dr Borba is an Affiliate Professor, Department of Ophthalmology, University of São Paulo, São Paulo, Brazil. Drs Pereira and Akaishi are Affiliate Professors, and Dr Cruz is Chairman and Professor, Department of Ophthalmology, University of São Paulo - Ribeirão Preto, São Paulo, Brazil. Dr Pimentel is an Affiliate Professor, Department of Ophthalmology, University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Ana Rosa
authors.initials: AR
authors.lastname: Pimentel
authors.affiliation: Dr Limongi is an Affiliate Professor, Ophthalmology Referral Center at the Hospital das Clínicas, Federal University of Goiás, Goiânia, Goiás, Brazil. Dr Tao is an Affiliate Professor, Gavin Herbert Eye Institute, University of California, Irvine, CA, USA. Dr Borba is an Affiliate Professor, Department of Ophthalmology, University of São Paulo, São Paulo, Brazil. Drs Pereira and Akaishi are Affiliate Professors, and Dr Cruz is Chairman and Professor, Department of Ophthalmology, University of São Paulo - Ribeirão Preto, São Paulo, Brazil. Dr Pimentel is an Affiliate Professor, Department of Ophthalmology, University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Patrícia
authors.initials: P
authors.lastname: Akaishi
authors.affiliation: Dr Limongi is an Affiliate Professor, Ophthalmology Referral Center at the Hospital das Clínicas, Federal University of Goiás, Goiânia, Goiás, Brazil. Dr Tao is an Affiliate Professor, Gavin Herbert Eye Institute, University of California, Irvine, CA, USA. Dr Borba is an Affiliate Professor, Department of Ophthalmology, University of São Paulo, São Paulo, Brazil. Drs Pereira and Akaishi are Affiliate Professors, and Dr Cruz is Chairman and Professor, Department of Ophthalmology, University of São Paulo - Ribeirão Preto, São Paulo, Brazil. Dr Pimentel is an Affiliate Professor, Department of Ophthalmology, University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Antônio Augusto
authors.initials: AA
authors.lastname: Velasco e Cruz
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D003357:Cosmetic Techniques / Q000009:adverse effects*; D000067548:Dermal Fillers / Q000008:administration & dosage / Q000009:adverse effects*; D005141:Eyelid Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D005145:Face; D005260:Female; D006801:Humans; D007249:Inflammation / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D015552:Injections, Intralesional; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D010859:Pigmentation Disorders / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D019904:Polymethyl Methacrylate / Q000008:administration & dosage / Q000009:adverse effects*; D012060:Rejuvenation; D012189:Retrospective Studies; D015595:Skin Aging; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000067548:Dermal Fillers; D019904:Polymethyl Methacrylate