Chapter

Polymethyl Methacrylate for the Body

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Abstract

Polymethyl methacrylate (PMMA) is a permanent filler used to correct furrows and deep depressions of the body and also for volume replacement. Among all permanent fillers available in the market, PMMA is the most regularly used. PMMA is demonstrated to be safe, effective, and long lasting with few adverse reactions when indicated correctly.

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The number of aesthetic procedures performed worldwide continues to grow together with an increase in the population seeking the restoration or preservation of a youthful appearance. Requests for non-surgical body rejuvenation are increasing. Patients are looking for safe and effective minimally invasive aesthetic procedures. Soft-tissue dermal fillers can meet these expectations. Based on the beneficial outcomes of these treatments in many facial areas, a new trend is developing to target body areas. Different dermal fillers are available and include collagen stimulators initially developed to restore facial volume. Furthermore, they are associated with long-lasting efficiency, a high level of patient satisfaction and a good safety profile, with mainly minor adverse events reported. In appropriate conditions of use, they are now used for body rejuvenation in clinical practice. Their use is expanding and allows addressing various issues including volume loss, skin laxity, cellulite, striae distensae and wrinkles. This review focuses on poly-L-lactic acid (PLLA), used in the first collagen stimulator and one of the most investigated in facial and in off-facial body applications. The available published data, although still limited, are presented by body area, neck and chest, buttocks, abdomen, upper arms, thighs, knees, and hands. Key features of the concerned zones and the main clinical signs affecting the body part as well as the injection modalities are provided along with the aesthetic results. This represents the state of the art on which to base further developments necessary for optimal and safe outcomes of treatment with the PLLA-based collagen stimulators and others in this class for body rejuvenation.
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Progression of lipodystrophy syndrome is a big challenge in HIV treatment. Nowadays, fat loss at the lower part of buttocks has become another problem as patients have started to complain that it is painful to be seated for a long time and/or on hard surfaces. We developed a method for buttock lipoatrophy treatment with PMMA-microspheres, as silicone prostheses and autologous fat transplant were not completely efficient. The treatment consisted of net-crossed injections, in the subcutaneous layer, of a 30% PMMA-microspheres solution on the atrophic areas of the buttock. One hundred and fifty-four patients were included. The amount of PMMA-microspheres used to treat buttock lipoatrophy depended on the degree of atrophy and size of the area to be treated. Patients were satisfied with this treatment and reported to be more comfortable to be seated for longer period of time. We demonstrated that soft tissue augmentation with PMMA-microspheres is safe and efficient for the treatment of buttock lipoatrophy associated with HIV lipodystrophy.
Article
Synthetic permanent fillers for soft-tissue augmentation have acquired an important role in cosmetic improvement of patients with facial aging, facial atrophic scars, or lipoatrophy leading to facial defects. Polymethylmethacrylate (PMMA) is a filler introduced to the market as one option for long-lasting treatment. PMMA microspheres are purified, and the particles are larger than 20 microm. The product used as a filler has proven to be safe, effective, and long lasting. To determine the efficacy and safety of PMMA as a facial filler. Two hundred sixty-six patients (aged 17-72; 154 women) received injections of PMMA to correct facial defects. The number of sessions ranged from one to four, with an interval of 40 to 60 days between applications. Seventy-nine subjects (30%) had facial atrophy related to HIV infection, 159 (60%) had photoaging signs with deep wrinkles and atrophic areas, 25 (9%) had depressive scars from acne process, and three (1%) had residual depressions from lupus profundus. The results were satisfactory and long lasting. Side effects were transient. No late complications were observed. PMMA used for the treatment of atrophy, depressions, and facial wrinkles has been shown to be effective, long lasting, safe, and gratifying to patients and physicians.
Article
Allogenic acellular dermal matrix can be used in single-stage, expander-based immediate and delayed breast reconstructions to provide inferolateral prosthesis coverage and reconstruction of the inframammary fold. Two allogenic dermal matrix products currently available, AlloDerm and DermaMatrix, differ in method of storage, cost, and intraoperative preparation. The purpose of this study was to determine, first, whether there are any significant differences in the rates of postoperative complications, material compliance, or capsule characteristics; and second, if differences are present, whether they had any impact on final outcome. After institutional review board approval, a retrospective analysis of prospectively collected data of 30 patients (50 breasts) who underwent immediate expander-based breast reconstructions using either AlloDerm (n = 25) or DermaMatrix (n = 25) dermal substitutes was performed. Primary endpoints were (1) incidence of seroma, (2) wound infection, (3) number of days requiring drains, (4) rate of tissue expansion, (5) final expanded volume, (6) final implant volume, and (7) neovascularization. The mean follow-up was 6.7 months. During this time, no significant differences in the complication profile were found between the two groups. Both dermal substitutes were found to be well incorporated, with evidence of neovascularization, on histologic examination. This study demonstrated no significant differences in the rate of complications or material compliance. The total complication rate was 4 percent, with seroma and wound infection being the most common complications. The authors' preliminary findings indicate no significant difference between implant/expander-based reconstructions using AlloDerm and those using DermaMatrix.
Facial implants with polymethylmethacrylate for lipodystrophy correction: 30 months follow-up
  • M Serra