Granuloma from extensive PMMA. Unevenness from steroid injections. (Photos)

Question

Ten years ago I foolishly had a PMMA-based injectible. placed on my face... I had no idea how much they doctors were injecting. My skin is thin and the outcome is disfiguring. My immune system's rejection results in numerous large, hard lumps. The kenalog that was injected exacerbates my issues. Indentations create additional lumps I have been extremely depressed, embarrassed and suicidal...Is there any hope?

John L. Burns Jr., MD · Answer

This is a permanent filler.  Injection of steroids won't dissolve the product and can dissolve much needed fat.  The only solution is surgically removing the filler and replacing with a shorter acting hyaluronic acid filler.

J. Timothy Katzen, MD, FACS · Answer

Hi, Thank you for your questions about how to remove PMMA injections from your face.  These injections and associated scar tissue must be removed from your face as soon as possible. PMMA removal from the face is no easy surgery, so please seek an experienced, board certified plastic surgeon with significant experience in removing silicone from the face.  I specialize in silicone removal.  If you cannot find an experienced, silicone 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

Dear Barbara,
First and foremost, I hope you are physically safe. This condition is treatable though I know the process and current symptomology are difficult to work through. I encourage you to see a board certified plastic surgeon who specializes in PMMA/ Silicone removal. I believe this can only be achieved through an open, surgical technique followed by a reconstruction with fat grafting. 
I wish you the best of luck in your search for treatment!
-Dr. Nik

Raffy Karamanoukian, MD, FACS · Answer

Complications from silicone biopolymers, Artefill, Bellafill, PMMA, and biopolimero should be addressed by an expert in the field.  
In my practice, I specialize in the removal of Bellafill and Artefill injections, in addition to silicone biopolymers, from the face and body. Initially, treatments are non-surgical with corticosteroids and immune modulators. If unable to be corrected, we can also perform surgery in some cases. 
Patients should undergo biometric screening, clinical assessment of Karamanoukian Grade of Soft Tissue Reaction, and ultrasound examination. 
Silicone biopolymers can also be removed from the body if there are signs of migration or inflammation. All of these filler-types should be removed as early as possible. 
Lastly, our office is conducting ongoing studies of plasma-assisted corticosteroid application, which allows for diffusion of the treatment medication in superficial tissue without causing atrophy. 
Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Granuloma from extensive PMMA. Unevenness from steroid injections. (Photos)

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