What Can I Do About Lumps from a PMMA Product Like Artefill or Artecoll?

Hello,     Thank you for your excellent question regarding the treatment options for removal of a nodule in the tear trough of the lower eyelid caused by PMMA particles. You did not indicate the size of the nodules but in my opinion, the precise and complete surgical removal of the nodule in total, will be a better option then Micro-needle aspiration or curettage, both of which may very well not remove the entire nodule and more than likely, needle aspiration will cause more extensive bruising and swelling and more tissue damage that precise surgical excision.  I also believe that surgical excision will leave less scar tissue because this is a controlled and precise dissection of the nodule out of the tissues.  Using a needle will only break up the product to a degree and you will continue to have PMMA in the region.  This opinion is based on my previous experience regarding this issue and my opinion may change based on your physical exam. I make this opinion without seeing or feeling the nodules you are experiencing. I wish you the best of luck and I feel certain you will get this resolved.Best regards,Dr. Ryan Mitchell

This is a very difficult problem and is probably due to the variability in particle size of precise.  Anything less than 80 microns can be gobbled up (phagocytized) by macrophages in your immune system.  So in this case, your body is attempting to attack and wall off the particles.  If it were my choice I would carefully use very dilute amounts of steroid injections over many months gradually with massage and hold off on procedures that can trade one problem for another.

Dr. Malouf

First of all, to everyone reading this, don't have a permanent filler placed under the eyes. They have never been recommended for this area, for good reason!Unfortunately, most people do far less self-education on cosmetic treatments before they get them than after.
Second, stay at home for your cosmetic treatments and choose Board Certified Dermatologists or Board Certified Plastic Surgeons for cosmetic treatments. The FDA assures that rigorous testing is done in clinical studies with dermal fillers before they are approved. This is not a certainty in other countries which have a different (or no) system of physician qualification, training or product safety rules and testing.
ArteFill is not the same as Precise (Percise) or Artecoll or other permanent fillers found outside the U.S. ArteFill was re-engineered from Artecoll (used in Europe) to lessen the problem potential of granulomas. ArteFill contains a low percentage of polymethylmethacrylate beads -- 20% PMMA. The rest is collagen which breaks down and is removed by the body. ArteFill requires an allergy test (another safety factor).
I will not use ArteFill (Artefill is the only FDA approved noresorbable filler at this time) in any area other than that indicated in the FDA approval. Nor will I inject ArteFill before a patient has used a temporary filler first to gauge satisfaction with the correction they receive.
Any filler product can produce late stage reactions, but the chances are extremely low with temporary fillers like Juvederm, Restylane or a low concentration HA like Prevelle Silk. The more permanent the product, the more potential to small lumps or bumps.
Regarding the filler you received in Mexico:
There was no specific component information that I could find on Percise other than it is PMMA suspended in a saline hydrogel...and there was no information on percentages indicating the ratio of the PMMA to the carrier.
Now, to answer your question about removing a granuloma under your eye.
PMMA is a permanent particulate implant. It is meant for deeper injection in the nasolabial folds, not under the eyes, not in the lips and not in other areas of the face. Your problem will likely be most acceptably addressed with surgery - and I'd recommend you only go to a reconstructive plastic surgeon or an oculoplastic surgeon who will have the skills to minimize any scarring.