title: Delayed granulomatous reactions to facial cosmetic injections of polymethylmethacrylate microspheres and liquid injectable silicone: A case series.
abstract: Polymethylmethacrylate microsphere (PMMA) and liquid injectable silicone (LIS) fillers are non-biodegradable, synthetic polymers utilized for long-term soft-tissue augmentation. Delayed granulomatous reactions to permanent fillers are a rare yet significant event that can occur months to years post procedure and are often refractory to treatment and associated with significant cosmetic morbidity. We report a case series of 4 patients who developed granulomatous reactions to PMMA or LIS, 15 months to 5 years post injection. The etiology of granulomatous reactions to permanent fillers is still poorly understood, with foreign-body reactions and/or biofilms purported to play a role. Real-time biochemical analysis with polymerase chain reaction should be performed when the index of suspicion for the presence of a biofilm is high.
authors.affiliation: a Westlake Dermatology Clinical Research Center, Westlake Dermatology & Cosmetic Surgery , Austin , TX , USA.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Friedmann
authors.affiliation: b PGY-4 Dermatology Resident, University of Alberta , Edmonton, Alberta , Canada.
authors.forename: Anil
authors.initials: A
authors.lastname: Kurian
authors.affiliation: c Cosmetic Laser Dermatology , San Diego , CA , USA.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Fitzpatrick
mesh_terms: D000328:Adult; D003357:Cosmetic Techniques / Q000009:adverse effects; D000067548:Dermal Fillers / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D015745:Granuloma, Foreign-Body / Q000139:chemically induced* / Q000175:diagnosis; D006801:Humans; D008875:Middle Aged; D019904:Polymethyl Methacrylate / Q000008:administration & dosage / Q000009:adverse effects*; D020034:Silicone Gels / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000067548:Dermal Fillers; D020034:Silicone Gels; D019904:Polymethyl Methacrylate
keywords: Fillers; granulomas; polymethylmethacrylate microspheres; silicone