Surgical Management of Polymethylmethacrylate-Collagen Gel Complications in the Lower Eyelid: A Case Series.

BACKGROUND: As nonsurgical rejuvenation with fillers continues to grow in popularity, patients are increasingly interested in more durable results. Polymethylmethacrylate (PMMA)-collagen gel is unique among fillers in that the PMMA microspheres are not completely absorbed and phagocytosed by the body. This durability coupled with the biophysical properties of PMMA makes it a poor choice for periorbital rejuvenation, an unforgiving and highly complex anatomic area. METHODS: Between 2011 and 2018, 14 patients with PMMA granulomas in various facial areas self-referred to the senior author's practice. Of these patients, 11 were managed nonsurgically; however, all 3 patients who presented with granulomas in the infraorbital area required surgery to remove the filler and restore a natural aesthetic. RESULTS: The 3 patients with significant swelling and PMMA filler nodules in the infraorbital area with unacceptable cosmetic appearance were females between the ages of 50 and 55 years. Nonsurgical protocols were unsuccessful, and surgical removal was required. All subjects have been followed for a minimum of 2 years with no immediate- or long-term postoperative complications secondary to PMMA removal. Patients remain satisfied with the outcome of the surgery. CONCLUSIONS: Despite the evidence that the periorbital area is prone to adverse events when injected with particulate fillers, misguided enthusiasm for PMMA-collagen gel as a durable treatment continues to lead to unnecessary and severe complications in patients. The case studies presented here highlight that this product should not be introduced into the periorbital area. We also describe a surgical treatment approach for its removal if complications arise.

Single-center, prospective comparison of calcium hydroxylapatite and Vycross-20L in midface rejuvenation: Efficacy and patient-perceived value.

BACKGROUND: Numerous fillers can be used for midface revolumization. While rheological data, physiochemical properties, and durability measured in clinical studies can inform selection, direct comparisons between equal volumes of different fillers are lacking. AIMS: To compare aesthetic improvement achieved with 3 cc of either calcium hydroxyapatite with integral lidocaine CaHA(+) or VYC-20L in the midface. PATIENTS/METHODS: In this prospective, single-center study, 17 patients with midface volume loss received 3 cc of either CaHA(+) or VYC-20L. Outcomes at post-treatment days 1, 7, 30, 90, 180, and 365 were measured by Subject and blinded Physician using the Global Aesthetic Improvement Scale (SGAIS and PGAIS). Cost per point improvement on SGAIS over time was determined. RESULTS: Outcomes were globally positive, with a large majority of subjects at least improved at all time points. A higher proportion of subjects were at least "very improved" in the CaHA(+) treatment group at each time point, a difference that reached significance at day 90 (100% vs 50%, P = .02), day 180 (89% vs 37.5%, P = .03), and day 360 (89% vs 37.5%, P = .03). For both SGAIS and PGAIS, only subjects within the VYC-20L cohort had "unaltered" appearance within 1 year. At 1 year, the average cost per point of SGAIS improvement for VYC-20 was approximately twice that of CaHA-20L. CONCLUSION: The results of this study indicate that CaHA(+) supports better, more durable outcomes than an equal volume of VYC-20L in the midface, providing a higher value to the patient.