Expanded Median Forehead Flap and Abbé Flap for Nasal and Upper Lip Reconstruction After Complications of Polymethylmethacrylate

Abstract

Despite the benefits from the minimally invasive technique, complications may occur, raising doubts about the safety of polymethylmethacrylate as an injectable filler material. The authors report their treatment of a patient from another institution with necrosis involving full-thickness nasal skin and upper lip after injection of polymethylmethacrylate in the nasolabial folds and nose for augmentation. An expanded median forehead flap was used to reconstruct the nose, and an Abbé flap was used for the upper lip. The flaps and the skin expander allowed reconstruction with correct texture, color, and dimensions, producing a good aesthetic and functional outcome.

Complications after polymethylmethacrylate (PMMA) injections in the face: a literature review

“…There is a higher risk of intravascular injection that can be followed by ischaemia and tissue necrosis when the filler is injected around the lip vermilion and labial mucosa. In the literature, there are five case reports on serious tissue necrosis published between 2007 and 2010, one describes an extensive necrosis of the hemiface that occurred after 24 h from an implantation in the nasolabial fold that presumably damaged the right facial artery, while the other four cases involved necrosis of the nose and lips after injection in the nasolabial folds. There are also alarming cases of blindness after PMMA injection in the glabellar region, which was caused by an embolism in the ophthalmic artery.…”

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

“…Initially, the complications are often related to vascular compromise such as blanching or necrosis, but at the late phase they are a consequence of fibrosis and capsular contracture that involves particles of PMMA. In case of extended necrosis an Abbé flap had been used to reconstruct the upper lip (de Figueiredo, Naufal, Zampar, & Mélega, 2010). Either extrusion of the material after incision or defect closure after tissue necrosis by skin grafts or by flaps may be necessary (Kim, Ahn, Jeong, & Suh, 2014).…”

“…Either extrusion of the material after incision or defect closure after tissue necrosis by skin grafts or by flaps may be necessary (Kim, Ahn, Jeong, & Suh, 2014). In case of extended necrosis an Abbé flap had been used to reconstruct the upper lip (de Figueiredo, Naufal, Zampar, & Mélega, 2010).…”

Prevention and Treatment of Complications after Polymethylmethacrylate-Microspheres Injections

“…A series of publications on the advantages and disadvantages of PMMA fillers has been published recently, [8][9][10][11][12][13] and their possible complications have been mentioned in detail [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] and reported to the FDA. Most of the published and presented granulomas have been caused by the impure Brazilian PMMA and Artecoll injected before 2006.…”

“…Some superficial necrotic areas healed surprisingly well, others needed reconstruction with local skin grafts and mucosal flaps or even a forehead flap/Indian flap. 23,28…”