Controversial answers regard lipo to removal of PMMA

Hi RaneideWilkins!

That's a really important and complicated question, and it's completely understandable why you'd feel confused — there's a lot of mixed information out there, especially when it comes to PMMA and biopolymer removal. Let’s break this down clearly so it makes more sense. PMMA (polymethyl methacrylate) is a permanent filler. Once injected into tissue, it becomes surrounded by fibrous tissue and can harden over time. Biopolymers vary in composition but behave similarly, often causing chronic inflammation, migration, or even hard lumps. Therefore, liposuction is very limited in what it can do for PMMA/biopolymer removal, especially when the material has hardened or become encapsulated in fibrous tissue. Liposuction MAY help if the material was recently injected and is still soft or mixed with fat; it hasn’t migrated deeply or formed solid nodules. However, most of the time, PMMA becomes firm or nodular, making it impossible to remove with liposuction alone. The best, most effective way to remove PMMA, silicone or biopolymer would be open excision. Especially when there are visible lumps or contour deformities, pain, infection, systemic responses or the material is hard, nodular, or inflamed. Open excision allows the surgeon to see the material directly, remove it from deep planes, and reconstruct the area afterward.

Finding a UK-based surgeon who specializes in PMMA, biopolymer or silicone removal can be tough, because most complex removals are done in the U.S. There are a few reconstructive or cosmetic plastic surgeons who may offer open excision for biopolymers, but you’ll want to verify their experience with PMMA specifically, as it's not a standard cosmetic procedure in the UK. I recommend searching for reconstructive plastic surgeons with experience in foreign body removal, cosmetic surgeons with international training or practice history in the U.S., or you can contact the British Association of Aesthetic Plastic Surgeons (BAAPS) for leads.

I am a board-certified plastic and reconstructive surgeon in the United States (New York based) with a specialized focus on silicone and biopolymer removal. Over the years, I have dedicated my practice to safely addressing complications arising from these materials. Recognizing the unique challenges they pose, I developed a two-stage surgical excision process and a third stage of reconstruction (often referred to as a reconstructive BBL). This approach is designed to ensure the most complete removal possible while minimizing risks and optimizing patient outcomes. I'd be happy to see you for a complimentary virtual evaluation to discuss your options. My Silicone Coordinator has undergone silicone removal and reconstruction and would be happy to share her silicone journey with you and help you along the way with yours. Please give us a call (516) 279-2616

Silicone biopolymers are commonly used in the face and body. They may sometimes cause noticeable symptoms that we gauge using the Karamanoukian Soft Tissue Reaction Grading Scale from I to V. The severity of your complications dictates the interventions needed, ranging from itching and burning to severe necrosis of the soft tissue. Nerve pain and symptomatic swelling is also possible. Insurance may cover your surgery, but that is a discussion that requires you to contact and appeal to your insurance carrier. Options for removal are complex and depend on whether you have the material in your face or body. We reverse BBL with silicone commonly and remove silicone from the lips very commonly. Diffuse silicone in the face is not likely to respond to removal. Filler migration, swelling, and granulomas can cause significant discomfort and cosmetic ramifications. Our office specializes in the use of enzymes and filler reversal techniques without hyaluronidase to help improve the results of botched cosmetic fillers, whether caused by Juvederm, Restylane, or foreign fillers. We can also test for the material to determine the likelihood of silicone granulomas and silicone reaction.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Hi raneidewilkins,

Thank you for your question regarding the removal of PMMA and biopolymers through liposuction versus open surgery. It's understandable to feel confused given the varying opinions on this matter. As a plastic surgeon specializing in the removal of silicone, PMMA, and other biopolymers, I want to share my experience and insights with you.

While it's true that achieving 100% removal of these substances can be challenging, significant removal is indeed possible, and I have witnessed firsthand the positive impact this can have on patients' health and well-being. Over the years, handling hundreds, if not thousands, of cases involving silicone injections and biopolymer removal, I've seen a vast improvement in symptoms following the removal procedures.

The approach to removal largely depends on the location of the substance, its volume, and the associated symptoms. For substances injected into the lips or other areas where precision is crucial, an open technique often yields the best results. This method allows for a more thorough removal of the material. Liposuction can be beneficial in areas with larger volumes of biopolymer, but it's important to note that not all liposuction techniques are equally effective for this purpose. The choice between liposuction and open surgery depends on several factors, including the characteristics of the filler used and its location.

In terms of PMMA removal specifically, the decision between liposuction and open surgery should be made after a detailed consultation. Open surgery allows for a more direct and comprehensive removal, especially when dealing with substances that have migrated or formed complex granulomas.

While I cannot speak to the availability of specific doctors in the UK performing PMMA removal, I can tell you that we welcome a significant number of international patients seeking removal of silicone, PMMA, and other biopolymers. These patients often come to us after experiencing various symptoms and are seeking experienced specialists in this field.

If you have products in your lips, I strongly recommend considering the open technique for the most effective cleanup. It's crucial to consult with a surgeon who has extensive experience in biopolymer removal to discuss the best approach for your situation.

In conclusion, although complete removal may not always be possible, substantial improvement and symptom relief can be achieved. The key is to work with a specialist who understands the complexities of biopolymer removal and can offer a personalized treatment plan based on your specific needs.

Sincerely,

Dr. J. Timothy Katzen, MD, FASMBS, FICS
Plastic and Aesthetic Surgeon