This study has shown that PMMA microsphere injection is a safe subdermal technique in the correction of infraorbital rhytids. Safety was demonstrated in 289 patients with only 4 minor complications of small lateral granuloma which all resolved within 4 weeks after intralesion triamcinolone injection. However, this is an off-label use of a permanent filler not approved for use in the infraorbits and significant caution must be taken with full disclosure to the patient leading to informed consent. Caution in PMMA microsphere injection should be given in the patient with prior blepharoplasty. The advantage of PMMA microsphere is that the result seems to be predictable and natural.
Acne vulgaris is one of the most common skin diseases; it will affect one out of two people in their lifetimes and about 80% of people aged between 11 and 30 years. [1][2][3] Acne scarring, a common complication, develops to some degree in the majority of acne sufferers. 4 Scars are divided into three general categories: ice-pick scars, rolling scars, and boxcar scars 5 and are a result of excessive inflammation, acne severity, physical manipulation of the skin, and a delay in seeking adequate treatment. 3 It affects people both physically and emotionally worldwide, regardless of sex, age, and ethnicity. 2,6 There is also a negative societal perception of acne scars. 7 Unfortunately, many cases of acne remain untreated or are treated sub-optimally, and patients that later develop acne scarring often need acne scarring treatment. None of the currently available treatments achieve a complete resolution of scars, and thus, prevention of scarring by early and aggressive acne treatment is the best option. 8 There are many different treatment modalities for acne scarring, such as chemical peeling, retinoids, dermabrasion, microneedling, subcision, surgical excision, dermal fillers, platelet-rich plasma (PRP), and different energy-based devices. Evidently, a combination of various treatment modalities gives better results than monotherapy. 8,9 Energy-based devices, such as intense pulsed light (IPL), radiofrequency, and lasers, have gained popularity as part of the scar treatment arsenal in recent years. The ablative 2940 nm Er:YAG and 10 600 nm CO 2 lasers have been used in treating various types of scars. However, due to adverse effects such as edema, erythema, dyspigmentation,
Laser skin resurfacing with ablative lasers, such as the 10 600 nm CO 2 laser, the 2940 nm Er:YAG laser and the 2790 nm Er:YSGG laser, has been used for facial rejuvenation for the last 20 years. 1 Despite many alternative methods for skin rejuvenation, full-field ablative laser therapy remains popular due to maximum improvement in a single treatment. 2 However, it is associated with disadvantages such as pain, prolonged erythema, swelling, crusting, infections, pigmentary changes, and scarring. 2 Patients are increasingly seeking less invasive options with comparable effect. Fractional lasers ablate only columns of the treated area, leaving intervening areas of unharmed skin that help in rapid re-epithelization, reducing the chances of adverse effects. Fractional laser skin
Study Background: Soft tissue temporary and semi-permanent fillers continue to increase in popularity worldwide for facial rejuvenation. The study aims to review the cosmetic use and complication rate in large retrospective case series of Polymethyl Methacrylate (PMMA) microspheres in facial rejuvenation. Methods:The study is a retrospective case series of 779 patients that underwent PMMA filler by one senior provider (NM) for facial rejuvenation to 7 consistent and reproducible areas of the face determined from chart review in order of preference: Peri-oral (589), Infra-orbital (395), Nasolabial folds (379), Temporal (212), Cheek (161), Glabella (99), and Scar area (8) from February 2009 to September 2015 and the chart review was completed in May 2016. Results:The average age at first injection was 51.4 years old with standard deviation of 12.2 years. Sevenhundred and six patients were female and 73 were male. Forty-three (5.4%) patients injected with PMMA had nodular complications. The average time to first sign of complication was 1.2 years with a range of .02 to 4.61 years. Prior blepharoplasty, rhytidectomy, rhinoplasty, Fitzpatrick skin classification, or history of autoimmunity was not significant to nodular complication. Thirty-four patients resolved with multiple steroid injections averaging 3.7 injections to resolution. Five were lost to follow up. Four have had ongoing injections with one undergoing surgical resection for multiple infra-orbital and peri-oral nodules.Conclusions: Injection of permanent PMMA filler using a subdermal technique in the context of facial rejuvenation is possible with clinically significant cosmetic benefit. Since this is an off-label use of PMMA filler, caution must be taken with full disclosure to the patient leading to informed consent.
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