Abstract
Injectable fillers have long been used for cosmetic purposes and in HIV induced lipodystrophy patients. A foreign body granuloma may be a side effect of the application of absorbable products/temporary and most often the nonabsorbable/permanent fillers. It is not possible to predict the formation of these granulomas, and it may occur regardless of the application technique. In this article we describe the surgical treatment of a patient with multiple granulomas caused by intradermal injection of PMMA in the face, with poor response to conservative treatments, and severe psychosocial impairment due to this unsightly and disfiguring complication.
Highlights
In the few last years, filling substances have been widely used in aesthetic procedures and for the correction of lipodystrophy in HIV-positive patients
Products containing hyaluronic acid in different densities, bovine collagen, autologous fat, liquid silicone, poly-l-lactic acid and polymethyl methacrylate (PMMA), among others are widely used for this purpose
Polymethyl methacrylate (PMMA) is a polymer composed of synthetic microspheres of 30μm to 40μm, with homogenous surface, conveyed suspended in a 1:3 solution (3.5% bovine collagen and lidocaine) or in carboxymethylcellulose colloid solution
Summary
In the few last years, filling substances have been widely used in aesthetic procedures and for the correction of lipodystrophy in HIV-positive patients. The application of PMMA might be related to some adverse effects, such as nodules, inflammation, allergic reactions, dyschromias, necrosis, infection and foreign body granuloma formation. 9. The present paper describes the surgical treatment of a patient bearing multiple granulomas caused by a previous PMMA based intradermal filling in the face, with a poor response to conservative treatments and severe psychosocial compromise due to this unsightly and deforming complication. Magnetic resonance imaging of the face (performed with contrast) showed multiple heterogeneous nodular formations, with lobular borders and isointense signal at t1 and predominantly intense in t2 and stir, showing slight contrast uptake, with confluent appearance in the subcutaneous of the malar and mandibular regions, nasogenian sulcus, bilaterally periorbicular, possibly corresponding to foreign bodies. Surgeries with the same characteristics were performed in four surgical times, with intervals of approximately 1 month, progressing with good cicatrization, without infectious complications and satisfactory aesthetic outcome, according to the patient’s report (Figures 2 and 3)
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