Complicações relacionadas ao uso de polimetilmetacrilato na face: Análise de 209 casos / Complications related to the use of polymethyl methacrylate on the face: Analysis of 209 cases

Introdução: O polimetilmetacrilato é um produto de preenchimento permanente. A injeção deste material na face pode levar a complicações. O objetivo deste estudo é determinar em uma série de casos o tempo mediano de ocorrência de complicações, as áreas mais comprometidas, os tipos de complicações e tratamentos mais realizados. Método: Foram estudados 209 casos de pacientes portadores de complicações relacionadas ao uso de polimetilmetacrilato na face que buscaram tratamento entre o período de janeiro de 2000 a junho de 2021. Os dados analisados foram sexo, idade, número de injeções, momento da aplicação, intervalo de tempo até surgir a complicação, tipo de complicação, região comprometida e tratamento realizado. Resultados: A idade média dos pacientes foi de 45 anos (23 a 79 anos). Destes, 172 eram mulheres e 37 homens. O número de aplicações variou de 1 a 5. O tempo mediano de surgimento de complicações foi de 71 meses. As regiões mais comprometidas foram a malar, em 102 pacientes; mandibular, em 100; e zigomática, em 91. Granuloma foi observado em 135 pacientes; edema, em 120; e inflamação, em 78. O tratamento mais realizado foi a injeção de corticoide, em 111 pacientes, seguido de remoção cirúrgica, em 40. Conclusão: Os resultados podem servir como base de conhecimento para uma melhor compreensão das complicações com o uso de polimetilmetacrilato na face.

Introduction: Polymethylmethacrylate is a permanent filler product. Injecting this material into the face can lead to complications. The objective of this study is to determine in a series of cases the median time for complications to occur, the most affected areas, the types of complications, and the treatments most performed. Method: 209 cases of patients with complications related to the use of polymethyl methacrylate on the face who sought treatment between the period of January 2000 and June 2021 were studied. The data analyzed were gender, age, number of injections, moment of application, interval time until the complication arises, type of complication, affected region, and treatment performed. Results: The average age of patients was 45 years (23 to 79 years). Of these, 172 were women and 37 men. The number of applications ranged from 1 to 5. The median time for complications to appear was 71 months. The most affected regions were the malar, in 102 patients; mandibular, in 100; and zygomatic, in 91. Granuloma was observed in 135 patients; edema, in 120; and inflammation, in 78. The most common treatment was corticosteroid injection, in 111 patients, followed by surgical removal, in 40. Conclusion: The results can serve as a knowledge base for a better understanding of complications with the use of polymethylmethacrylate in the face.

Impurities in Hyaluronic Acid Dermal Fillers? A Narrative Review on Nonanimal Cross-Linked Fillers.

Importance: Nonanimal cross-linked hyaluronic acid (HA) dermal fillers are among the most versatile tools in minimal invasive esthetic medicine. Filler injections aim to volumize, provide contour, and reduce wrinkles and skinfolds. In the hand of the experienced user, HA fillers have an excellent safety profile. Nevertheless, adverse events have been reported related to poor injection techniques, infection, and immune reactions. Observations: In this review, the focus is on filler impurities. Impurities can originate from the fermentation process, crosslinking, packaging, and contamination. Impurities consist of particular and nonparticular matter. We discuss possible risks for the patient to be treated with HA fillers. Conclusions and Relevance: Impurities of dermal fillers bear a potential risk for patients, such as delayed autoimmune and inflammatory reactions, biofilm formation, and exposure to leachable Endocrine Disrupting Chemicals. Amount and quality of impurities can be considered as one of the quality parameters of commercially fillers. Considering patient safety, filler impurities should be further reduced.

Cavernous hemangioma of the lip: combined treatment with intralesional laser and surgery.

Infantile cavernous hemangioma is a benign vascular tumor in childhood. Cavernous hemangiomas have a tendency of slow enlargement with subsequent complications such as ulceration and bleeding. We report a case of a large cavernous hemangioma affecting the median upper lip in an 11-year-old girl. The lesion was growing and painful on pressure. The patient felt stigmatized. Treatment was wished for by patient and parents. After careful examination including Doppler ultrasound, we suggested a combined approach. In the first step the lesion was coagulated with an intralesional neodymium-YAG laser using a blunt tip. In the second step, immediately after the action of the laser, the lesion was removed completely by surgery. Defect closure was realized with bilateral tissue-expanding vermillion myocutaneous flaps. The patient was followed-up to 5 months. Disfigurement and functional impairment were eliminated. The result was satisfying for both patient and parents. Vascular lesions of the upper lip-particularly when close to Cupid's bow-can become disfiguring and cause functional impairment. We propose a combined approach with intralesional neodymium-YAG laser photocoagulation to avoid bleeding and to shrink the lesion before complete surgical removal. For defect closure, bilateral tissue-expanding vermillion myocutaneous flaps (Goldstein technique modified by Sawada) were used.

Laser in the Treatment of Granulomas on the Nose Produced by Polymethylmethacrylate: A Case Series.

BACKGROUND: The search for aesthetic non-surgical procedures is growing. The use of polymethylmethacrylate (PMMA) as a filling material in the nose represents one of the many options among these aesthetic procedures. Its use, however, can lead to complications. The treatment of these complications is often challenging. METHODS: We performed a retrospective clinical analysis of the medical records of patients undergoing treatment of PMMA granulomas of the nose at a private clinic from January, 2015, to January, 2021. A short-pulsed neodymium-YAG (Nd:YAG) laser was applied intranasally or directly by cutaneous incision in the granulomas. Laser-tissue interaction heats the alloplastic material, fragments the product and creates cleavage paths, thereby facilitating the removal of PMMA, either by intercartilaginous removal or aspiration. RESULTS: Twenty-seven patients were included in the study. All had a history of PMMA injection in the nose. All patients were treated with an intralesional pulsed 1064nm Nd:YAG laser. The material removed after laser-tissue interaction was sent for histopathological examination; this showed the presence of microparticles of exogenous material compatible with PMMA. The partial removal of the alloplastic material was shown to be effective in all cases. One patient developed a small blister in the nasal dorsum. Follow-up ranged from six to 47 months. CONCLUSIONS: The use of intralesional Nd:YAG laser for the treatment of PMMA granulomas on the nose proved to be an effective and safe procedure with improvement of nasal shape, without compromising respiratory function. This technical option represents yet another alternative in the treatment of PMMA granuloma complications. J Drugs Dermatol. 2021;20(11): 1161-1166. doi:10.36849/JDD.6550.

Correction of tear trough deformity by hyaluronic acid soft tissue filler placement inferior to the lateral orbital thickening.

Tear trough deformities can be a sign of facial aging and exert a negative impact in facial attractiveness. Surgical techniques and adipose tissue transfer have been used to improve tear trough deformity. In recent years, minimal invasive procedures such as soft tissue filler injections became more popular. We report a retrospective evaluation of 45 Caucasian female patients ≥40 years (mean age of [58.8 ± 8.9] years). Severity of tear trough was classified according to Hirmand: 3 as grade I, 28 as grade II, and 14 grade III tear trough deformities. We used a monophasic hyaluronic acid, low G prime filler placed inferior to the lateral orbital thickening. On average, 0.4 ml of hyaluronic acid (HA) filler were injected per side. The improvement was I grade 29 patients and II grades in 16 patients. The improvement lasted (10.8 ± 2.3) months. No severe adverse events were noted. Vascular danger zones can be avoided.

Defect closure after successful skin cancer surgery of the nose: a report of 52 cases.

INTRODUCTION: Malignant keratinocyte tumors-that is, basal cell carcinoma (BCC) and squamous cell carcinoma (SCC)-are commonly found on sun-exposed body areas such as the nose. The primary aim of tumor surgery is complete excision. Due to anatomical, functional, and aesthetic issues, reconstruction of such defects remains a challenge. PATIENTS AND METHODS: We report on a series of 52 patients that were treated from 2015 to 2019 at the Goldman Clinic in Porto Alegre, Brazil. The mean age was 63 years (range 28-82 years, standard deviation 14.25 years). Thirty-nine (75%) patients were male and 13 (25%) female. The histological diagnosis was BCC in 49 patients and SCC in three. RESULTS: Nasal defect closures were located on the nasal dorsum, tip, alar nose, and nasion. The nasal dorsal and alar region were the regions most commonly involved. All tumor specimens were 3D histologically investigated. A nasolabial flap was the reconstructive option in 40 subjects (76.9%). A bilobed flap was used in six patients (11.5%). Other flaps used for defect closure were a Rintala flap (n = 2), tunneled island flap (n = 1), and frontal flap (n = 1). Adverse events were rare and manageable. Three relapses were noted during follow-up. CONCLUSIONS: Nasal reconstruction requires an armamentarium of surgical techniques to tailor the procedures based on tumor localization, size, and depth, and patients' needs.

Facial vascular danger zones for filler injections.

Filler injections are widely used for facial rejuvenation. The technique is safe as long as some precautions are respected. In this review we will focus on vascular anatomy in the upper, middle and lower face. We performed a PUBMED research on "facial danger zones" and "filler injections" and "hyaluronic acid" and "vascular compromise" with a focus on the last decade. This is of particular importance since vascular compromise is one of the most severe adverse events possibly leading to tissue necrosis and in rare cases to loss of vision. We describe the danger zones in these esthetic units and provide recommendations how to avoid severe adverse events. We report on temporal region, glabella and nose, infraorbital region, nasolabial folds and nasal triangle, lips, and chin. Although we focus on hyaluronic acid fillers, our recommendations will also scope other filler types and autologous adipose tissue transfer. We also take a closer look on innovations to improve the safety of facial filler injections. Facial rejuvenation with hyaluronic acid fillers is a popular method. It is safe if the facial danger zones are recognized and proper injection techniques and fillers are used.

Lip enhancement and mouth corner lift with fillers and botulinum toxin A.

Beautiful lips are responsible for facial attractiveness and a youthful appearance. During aging process, lips become thinner and the red lips borders get poor defined. Downturn of the corners of the mouth suggests negative emotions. Lip surgery and underlying pathology may result in asymmetries and lip incontinence. Minor invasive procedures with hyaluronic acid fillers and botulinum toxin A are versatile tools to improve appearance of the lips, restore function and improve psycho-social well-being. In this review, we discuss anatomy, safety concerns, injections techniques as well as esthetic and medical indications.

Long lasting facial rejuvenation by repeated placement of calcium hydroxylapatite in elderly women.

Calcium hydroxylapatite (CaHA) is a biostimulatory filler with long lasting efficacy after a single injection. Data con the effect of repeated injections, however, are sparse. This is a single-center observational study. Forty Caucasian females of Fitzpatrick skin type I to III, aged between 50 and 95 years (mean age 63 ± 13.4 years), and seeking nonsurgical improvement of facial aging were included. Patients with previous face lifts, threads or other surgical treatments were excluded. Only women ≥50 years of age were included. Midface and lower face were treated, that is, cheeks, tear troughs, jawline, and Marionette lines. The usual time for a repetition of filler injection was 12 to 14 months. Mean follow-up was 36 ± 10.8 months after first injection of Radiesse. Outcome was measured using the Global Aesthetic Improvement Scale (GAIS). Mean patient's GAIS was 2.7 ± 0.7, while physicians GAIS was 2.6 ± 0.6 suggesting a remarkable improvement 12 months after the first procedure. Mean patient's GAIS at 3 and 5 years after first procedure was 2.4 ± 0.8, while physicians GAIS was 2.5 ± 0.7. Repeated injection of CaHA leads to a significant and long-lasting improvement of facial appearance.

The dual 980-nm and 1470-nm diode laser for vascular lesions.

Transcutaneous use of dual diode lasers is a new option in dermatology. The aim of the study was to demonstrate the transcutaneous application of a dual laser in dermatologic outpatients. We used a laser system that combines 980 nm and 1470 nm wavelengths for treatment of vascular lesions. Fifty-six adult Caucasian patients of Fitzpatrick skin type I-III, 32 females and 24 males with mean age of (41 ± 3.7) years were included. We treated 497 vascular lesions of skin and lips. Complete clearance was achieved in cherry angiomas, venous lakes, lip hemangioma, and spider nevi in 100% after a single treatment. Patients with couperose and/or facial telangiectasia needed several treatment sessions. Mild to moderate pain during the laser shots was noted in all patients. No adverse events were recorded. The dual 980-nm/1470-nm diode laser is a safe and effective tool for common vascular lesions.

Polymethylmethacrylate-induced nodules of the lips: Clinical presentation and management by intralesional neodymium:YAG laser therapy.

The lips are essential part of the beauty and attractiveness of the human face. Lip augmentation has become an increasingly used method to improve appearance. Soft tissue fillers are the most commonly used tools. Permanent fillers, however, have been associated with unwanted side effects after lip augmentation. In the present article the present authors will focus on permanent fillers based on polymethylmethacrylate (PMMA). The present authors provide a short review on PMMA fillers and known associated adverse events. The present authors provide a critical review of treatment options. Illustrated by clinical cases The present authors report our preferred treatment of PMMA nodules on lips by intralesional neodymium:YAG laser and blunt suction cannula with or without minor surgery.

Adipose tissue, fillers, and skin tightening.

The role of adipose tissue has long been underestimated in esthetic dermatology. With the development of liposculpture and lipolysis, subcutaneous adipose tissue has gained an increasing interest. Harvested tissue has been used for lipofilling. In recent years, a better understanding of adipocyte physiology and its role in aging opened a new road for targeted treatments. Subcutaneous adipose tissue is no longer an innocent bystander in the combat of aging and the correction in esthetics. Adipose tissue is of importance for metabolic function and thermoregulation. Adipose tissue is involved in inflammation. Adipose tissue is heterogeneous in sense of function, color and size of adipocytes. The tissue is an important source of somatic stem cells.

Mondor's Disease after Aesthetic Breast Surgery: A Case Series and Literature Review.

BACKGROUND: Mondor's disease of the subcutaneous veins of the breast is an uncommon disorder. The etiology of Mondor's disease remains unclear. Usually, it is a self-limited disease. This condition has been associated with trauma, surgical biopsies, breast surgery (including silicone breast implant), physical activity, and a manifestation of breast cancer. MATERIALS AND METHODS: This is a retrospective analysis of 652 female patients who underwent aesthetic breast surgery in the last 10 years. RESULTS: We found three cases of Mondor's disease after plastic surgery of the breast (0.46%) and performed an analysis of the clinical aspects and therapeutic measures. The disease onset was a couple of weeks to 2 years after surgery, never within the first 2 weeks after surgery. We did not observe ulceration or breast cancer. Treatment was unnecessary in two patients, whereas hot compresses and nonsteroidal medical drugs were prescribed in one patient. All lesions healed within 2-3 weeks. CONCLUSION: Mondor's disease is a possible complication after aesthetic breast surgery but often runs a self-limiting course with spontaneous remission. It is important to exclude breast cancer. The patient should be informed that the disease runs a benign and self-limiting course.

Intralesional Neodymium YAG laser to Treat Complications of Polymethylmethacrylate.

BACKGROUND: Dermal fillers are widely used for facial and body contouring. Polymethylmethacrylate (PMMA) is a permanent biphasic filler for soft tissue augmentation. In case of unwanted side effects, drug therapy and surgical excision have been commonly used with mixed results. AIM: We report on a series of patients with adverse events to PMMA and an innovative minor invasive procedure to reduce disfigurement by nodules and lumps. METHODS: We employed a subdermal, intralesional 1,064 nm neodymium-doped yttrium aluminium garnet (Nd: YAG) laser in combination with suction using a blunt liposuction cannula of 2.0-2.5 mm of diameter. RESULTS: For 12 years, a total of 81 consecutive subjects (79 females and 2 males) were treated. The average age of the patients was 43.7 years (range 26 to 76 years). Granulomas and lumps could be removed in a minor invasive procedure with tumescent anaesthesia. In a minority of cases, the procedure had to be repeated. The results were impressive and not adverse events related to intralesional laser therapy were observed, 86.4% of patients were satisfied. CONCLUSION: The procedure should be used before or in combination with classical surgery to remove PMMA in case of adverse tissue reactions to PMMA.

Surgical Treatment for Extramammary Paget's Disease.

OPINION STATEMENT: Extramammary Paget's disease (EMPD) is a rare, slow growing non-melanoma skin cancer.Diagnosis is often significantly delayed, since clinical presentation may resemble common benign dermatoses. Treatment is characterized by high recurrence rates. This is in part due to ill-defined margins and by frequent development of satellites. Improvement of outcome needs a better preoperative planning with fluorescence diagnostics or scouting biopsies. Mohs micrographic surgery has some advantages for patients, such as reduced relapse rates and prolonged relapse-free survival. Improved identification of Paget cells in cryosections by immunostainings or alternatively the use of delayed Mohs with formalin-fixed material reduces the rate of false-negative results. Surgery remains the cornerstone of treatment.

Simultaneous Occurrence of Balanoposthitis Circumscripta Plasmacellularis Zoon, Phimosis and in Situ Carcinoma of the Penis: Case Report with An Unusual Ulcerated Polypoid Variant of Zoon's Disease and a Carcinoma in Situ of Reserve Cell Type.

BACKGROUND: Zoon's balanitis is a benign disease characterized by an asymptomatic, chronic, solitary, shiny, red-orange plaque of the glans and/ or prepuce. In rare cases of Zoon's disease, penile squamous cell carcinoma developed in the chronic inflammatory lesions. CASE REPORT: We report on a 68-year-old male patient presenting with phimosis and coexistent Zoon's disease and penile carcinoma in situ treated successfully by circumcision. CONCLUSION: Coexistence of both lesions in contrast to the development of cancerous lesions within pre-existent Zoon's disease is a very rare observation.

Successful Treatment of Reticular Blue Veins of the Lower Eyelid by Long-Pulse Nd: YAG - Case Report with 8-Year Follow-Up.

BACKGROUND: Facial reticular blue veins are of esthetic concern. Most often these veins develop on the lower lids. The safest and most effective way of treatment is by vascular lasers. CASE REPORT: We report on a successful reticular vein treatment using a long-pulsed 1064 nm Nd: YAG laser. We present a follow-up of 8 years with constant esthetic improvement without unwanted adverse events. CONCLUSION: There was no relapse demonstrating the efficacy of Nd: YAG laser.