Inflammatory Nodules Following Soft Tissue Filler Use
Inflammatory Nodules Following Soft Tissue Filler Use
PMMA fillers, a combination of PMMA crystals, bovine collagen and lidocaine, act by re-volumizing and subsequently serving as a scaffold for new collagen production over time. Skin testing is required prior to use of PMMA because of the presence of bovine collagen, but it is theorized that its decreased electrostatic charge reduces the incidence of foreign-body granulomas. Granulomas secondary to PMMA typically appear white under the skin.
While it has been reported that PMMA granulomas may spontaneously resolve after 2–3 years, corticosteroids, surgical excision, or superficial dermabrasion can augment reduction of these lesions if they are bothersome to the patient. Less invasive techniques such as oral antibiotics or intralesional corticosteroids are recommended prior to surgical excision, with oral antibiotics considered first-line treatment. In contrast to silicone nodules, PMMA nodules have been shown to respond to intralesional corticosteroids; systemic corticosteroids may also lead to some improvement, but lesions may recur with cessation of treatment. Allopurinol has also been reported to be effective for symptomatic treatment of PMMA nodules that developed on the face following scar revision in some cases; however, lesions may remain palpable.
In order to avoid the presence of palpable nodules, PMMA should never be injected into thin skin, such as around the eyes or in very elderly skin. Nodules may also be palpable if using PMMA to correct subcutaneous fat atrophy. Implantation should be made subdermally, taking care not to implant into the papillary dermis. If mistakenly placed superficially, massage may help. Immobility is also beneficial in avoiding nodule formation if using PMMA to inject the lips or perioral region, although injection in this region is not recommended.
8 Polymethylmethacrylate (PMMA)
PMMA fillers, a combination of PMMA crystals, bovine collagen and lidocaine, act by re-volumizing and subsequently serving as a scaffold for new collagen production over time. Skin testing is required prior to use of PMMA because of the presence of bovine collagen, but it is theorized that its decreased electrostatic charge reduces the incidence of foreign-body granulomas. Granulomas secondary to PMMA typically appear white under the skin.
While it has been reported that PMMA granulomas may spontaneously resolve after 2–3 years, corticosteroids, surgical excision, or superficial dermabrasion can augment reduction of these lesions if they are bothersome to the patient. Less invasive techniques such as oral antibiotics or intralesional corticosteroids are recommended prior to surgical excision, with oral antibiotics considered first-line treatment. In contrast to silicone nodules, PMMA nodules have been shown to respond to intralesional corticosteroids; systemic corticosteroids may also lead to some improvement, but lesions may recur with cessation of treatment. Allopurinol has also been reported to be effective for symptomatic treatment of PMMA nodules that developed on the face following scar revision in some cases; however, lesions may remain palpable.
In order to avoid the presence of palpable nodules, PMMA should never be injected into thin skin, such as around the eyes or in very elderly skin. Nodules may also be palpable if using PMMA to correct subcutaneous fat atrophy. Implantation should be made subdermally, taking care not to implant into the papillary dermis. If mistakenly placed superficially, massage may help. Immobility is also beneficial in avoiding nodule formation if using PMMA to inject the lips or perioral region, although injection in this region is not recommended.