Why can't you inject PMMA in buttocks? How come it is illegal and not approved?

Question

I have many friends who have had PMMA injections in their buttocks for years with no complications. None of the people I know had any complications from it, and it is safe for the face and skull so why is the buttocks considered dangerous?

J. Timothy Katzen, MD, FACS · Answer

Hello, I am sorry you and your friends had PMMA injected into your buttocks. Polymethylmethacrylate ( PMMA ) is also known as acrylic, acrylic glass, or plexiglass. PMMA is a PERMANENT filler. PMMA is marketed as Artefill. Artefill is composed of polymethylmethacrylate beads, collagen, and lidocaine. PMMA is made by Suneva Medical and received FDA on 10/27/2006 for injection of the nasolabial fold ONLY. Methylmethacrylate is a similar compound and is used to reconstruct cranial and bone deformities. However, PMMA is supposed to be used for the soft tissue of the face. Also, when companies like Suneva Medical seek FDA approval, they spend millions of dollars to receive approval for injection ONLY in certain body parts; they do not seek for all body parts. In this case, you need to ask Suneva Medical and the FDA, why PMMA is not authorized for the buttocks. I am sure there are reasons. The fact that that you and your friends are not having problems does not mean that buttock PMMA is safe, nor that you or your friends might develop problems in the future. Unfortunately, I have MANY patients who developed granulomas in the buttocks due to PMMA buttock injections. I specialize in the removal of PMMA from the buttock and subsequent reconstruction of the buttock. I am a lead investigator and founder of the Silicone Removal Institute. Since removing PMMA from the buttock is a big procedure, please seek an experienced, board certified plastic surgeon with significant experience in removing PMMA from the buttock. Do your research. Make sure your chosen plastic surgeon has performed many buttock silicone removal surgeries and has the before and after pictures to prove it. Carefully examine their before and after pictures and check their reviews on RealSelf. If you cannot find an experienced, buttock PMMA removal surgeon in your neighborhood, consider traveling out of state if you must. Sincerely, Dr. Katzen. (“Verified” Plastic Surgeon, Certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)

Jeremy S. Nikfarjam, MD · Answer

Hi BrittE92!

That's a really thoughtful question and you're not alone in wondering about this. It makes sense to be confused when many people seem to do fine with buttock injections, yet the procedure is labeled as dangerous. There are MANY health complications and issues associated with illegal buttock injections (which can sometimes be fatal). Even if someone has had PMMA or silicone for 10–15 years with no symptoms, they can still develop issues such as: chronic inflammation, pain, hardening or lumps (granulomas or nodules), autoimmune responses triggered by stress, illness, or trauma, hyperpigmentation (purple or back hue to the injected and migrated areas) to name a few. JUST BECAUSE COMPLICATIONS HAVEN'T HAPPENED YET, DOESN'T MEAN THEY WON'T. The buttocks contain large blood vessels, including the superior and inferior gluteal veins. If a filler is inadvertently injected into or too close to these vessels, it can lead to embolism (blockage from the filler traveling through the bloodstream), which can result in pulmonary embolism (blockage in the lungs), stroke, or sudden death. Even though PMMA or silicone might seem safe in small quantities, it isn't. You still run the risk of foreign body reaction, granulomas, migration, and infection increases dramatically. The buttocks are dynamic—they move a lot, are weight-bearing, and experience pressure from sitting and walking. This increases the risk of filler migration, asymmetry, and tissue distortion over time, especially with substances that aren’t meant to integrate naturally. So, while some people may do well for a long time—and you might know several of them—the medical risk profile remains high due to anatomy, volume, lack of regulation, and long-term unpredictability. Delayed complications are real and there is no way of removing 100% of free-standing silicone or PMMA which makes it all the more difficult to remove when problems arise (and they will). I hope this answered your question and I do hope you decide against these types of illegal injections in the future.

Raffy Karamanoukian, MD, FACS · Answer

The feasibility of Silicone biopolymer removal depends on the degree of inflammation and symptoms associated with the fillers. In our office, we gauge the level of soft tissue reaction in order to assess the candidacy for surgical excision vs. non-surgical management. 
Best, 
Dr. Karamanoukian
Realself100 Surgeon

Luis A. Cenedese, MD, FACS · Answer

This big butt craze has caused more mortalities and disfigurement than anything in the history of plastic surgery.Placed in small amounts in the face allows soft tissues to surround the microspheres which become surrounded by collagen and integrated. Larger amounts tend to pool, form lumps and migrate. The only FDA approved PMMA is Bellafill which costs over $300 per cc. The average volume increase injected into the butt for a BBL is 600cc.  If this amount is injected into the buttocks it will form lumps and migrate.  If you calculate the cost of FDA approved PMMA it would be $18,000 just for the product.  Most patients undergoing these injections are not willing to spend this amount.  Therefor they are either getting smaller amounts or some unkown product.Is a big butt really worth the risk?Unfortunately silicone and PMMA injected into tissues is extremely difficult to remove.  Often causing progressive deformity, its removal can cause more harm than good.
Please consult in person with an experienced Board Certified Plastic Surgeon prior to making treatment decisions.

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