Complicações relacionadas ao uso de polimetilmetacrilato na face: Análise de 209 casos / Complications related to the use of polymethyl methacrylate on the face: Analysis of 209 cases

Introdução: O polimetilmetacrilato é um produto de preenchimento permanente. A injeção deste material na face pode levar a complicações. O objetivo deste estudo é determinar em uma série de casos o tempo mediano de ocorrência de complicações, as áreas mais comprometidas, os tipos de complicações e tratamentos mais realizados. Método: Foram estudados 209 casos de pacientes portadores de complicações relacionadas ao uso de polimetilmetacrilato na face que buscaram tratamento entre o período de janeiro de 2000 a junho de 2021. Os dados analisados foram sexo, idade, número de injeções, momento da aplicação, intervalo de tempo até surgir a complicação, tipo de complicação, região comprometida e tratamento realizado. Resultados: A idade média dos pacientes foi de 45 anos (23 a 79 anos). Destes, 172 eram mulheres e 37 homens. O número de aplicações variou de 1 a 5. O tempo mediano de surgimento de complicações foi de 71 meses. As regiões mais comprometidas foram a malar, em 102 pacientes; mandibular, em 100; e zigomática, em 91. Granuloma foi observado em 135 pacientes; edema, em 120; e inflamação, em 78. O tratamento mais realizado foi a injeção de corticoide, em 111 pacientes, seguido de remoção cirúrgica, em 40. Conclusão: Os resultados podem servir como base de conhecimento para uma melhor compreensão das complicações com o uso de polimetilmetacrilato na face.

Introduction: Polymethylmethacrylate is a permanent filler product. Injecting this material into the face can lead to complications. The objective of this study is to determine in a series of cases the median time for complications to occur, the most affected areas, the types of complications, and the treatments most performed. Method: 209 cases of patients with complications related to the use of polymethyl methacrylate on the face who sought treatment between the period of January 2000 and June 2021 were studied. The data analyzed were gender, age, number of injections, moment of application, interval time until the complication arises, type of complication, affected region, and treatment performed. Results: The average age of patients was 45 years (23 to 79 years). Of these, 172 were women and 37 men. The number of applications ranged from 1 to 5. The median time for complications to appear was 71 months. The most affected regions were the malar, in 102 patients; mandibular, in 100; and zygomatic, in 91. Granuloma was observed in 135 patients; edema, in 120; and inflammation, in 78. The most common treatment was corticosteroid injection, in 111 patients, followed by surgical removal, in 40. Conclusion: The results can serve as a knowledge base for a better understanding of complications with the use of polymethylmethacrylate in the face.

Cavernous hemangioma of the lip: combined treatment with intralesional laser and surgery.

Infantile cavernous hemangioma is a benign vascular tumor in childhood. Cavernous hemangiomas have a tendency of slow enlargement with subsequent complications such as ulceration and bleeding. We report a case of a large cavernous hemangioma affecting the median upper lip in an 11-year-old girl. The lesion was growing and painful on pressure. The patient felt stigmatized. Treatment was wished for by patient and parents. After careful examination including Doppler ultrasound, we suggested a combined approach. In the first step the lesion was coagulated with an intralesional neodymium-YAG laser using a blunt tip. In the second step, immediately after the action of the laser, the lesion was removed completely by surgery. Defect closure was realized with bilateral tissue-expanding vermillion myocutaneous flaps. The patient was followed-up to 5 months. Disfigurement and functional impairment were eliminated. The result was satisfying for both patient and parents. Vascular lesions of the upper lip-particularly when close to Cupid's bow-can become disfiguring and cause functional impairment. We propose a combined approach with intralesional neodymium-YAG laser photocoagulation to avoid bleeding and to shrink the lesion before complete surgical removal. For defect closure, bilateral tissue-expanding vermillion myocutaneous flaps (Goldstein technique modified by Sawada) were used.

Defect closure after successful skin cancer surgery of the nose: a report of 52 cases.

INTRODUCTION: Malignant keratinocyte tumors-that is, basal cell carcinoma (BCC) and squamous cell carcinoma (SCC)-are commonly found on sun-exposed body areas such as the nose. The primary aim of tumor surgery is complete excision. Due to anatomical, functional, and aesthetic issues, reconstruction of such defects remains a challenge. PATIENTS AND METHODS: We report on a series of 52 patients that were treated from 2015 to 2019 at the Goldman Clinic in Porto Alegre, Brazil. The mean age was 63 years (range 28-82 years, standard deviation 14.25 years). Thirty-nine (75%) patients were male and 13 (25%) female. The histological diagnosis was BCC in 49 patients and SCC in three. RESULTS: Nasal defect closures were located on the nasal dorsum, tip, alar nose, and nasion. The nasal dorsal and alar region were the regions most commonly involved. All tumor specimens were 3D histologically investigated. A nasolabial flap was the reconstructive option in 40 subjects (76.9%). A bilobed flap was used in six patients (11.5%). Other flaps used for defect closure were a Rintala flap (n = 2), tunneled island flap (n = 1), and frontal flap (n = 1). Adverse events were rare and manageable. Three relapses were noted during follow-up. CONCLUSIONS: Nasal reconstruction requires an armamentarium of surgical techniques to tailor the procedures based on tumor localization, size, and depth, and patients' needs.

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

The lips are essential part of the beauty and attractiveness of the human face. Lip augmentation has become an increasingly used method to improve appearance. Soft tissue fillers are the most commonly used tools. Permanent fillers, however, have been associated with unwanted side effects after lip augmentation. In the present article the present authors will focus on permanent fillers based on polymethylmethacrylate (PMMA). The present authors provide a short review on PMMA fillers and known associated adverse events. The present authors provide a critical review of treatment options. Illustrated by clinical cases The present authors report our preferred treatment of PMMA nodules on lips by intralesional neodymium:YAG laser and blunt suction cannula with or without minor surgery.

Mondor's Disease after Aesthetic Breast Surgery: A Case Series and Literature Review.

BACKGROUND: Mondor's disease of the subcutaneous veins of the breast is an uncommon disorder. The etiology of Mondor's disease remains unclear. Usually, it is a self-limited disease. This condition has been associated with trauma, surgical biopsies, breast surgery (including silicone breast implant), physical activity, and a manifestation of breast cancer. MATERIALS AND METHODS: This is a retrospective analysis of 652 female patients who underwent aesthetic breast surgery in the last 10 years. RESULTS: We found three cases of Mondor's disease after plastic surgery of the breast (0.46%) and performed an analysis of the clinical aspects and therapeutic measures. The disease onset was a couple of weeks to 2 years after surgery, never within the first 2 weeks after surgery. We did not observe ulceration or breast cancer. Treatment was unnecessary in two patients, whereas hot compresses and nonsteroidal medical drugs were prescribed in one patient. All lesions healed within 2-3 weeks. CONCLUSION: Mondor's disease is a possible complication after aesthetic breast surgery but often runs a self-limiting course with spontaneous remission. It is important to exclude breast cancer. The patient should be informed that the disease runs a benign and self-limiting course.

Intralesional Neodymium YAG laser to Treat Complications of Polymethylmethacrylate.

BACKGROUND: Dermal fillers are widely used for facial and body contouring. Polymethylmethacrylate (PMMA) is a permanent biphasic filler for soft tissue augmentation. In case of unwanted side effects, drug therapy and surgical excision have been commonly used with mixed results. AIM: We report on a series of patients with adverse events to PMMA and an innovative minor invasive procedure to reduce disfigurement by nodules and lumps. METHODS: We employed a subdermal, intralesional 1,064 nm neodymium-doped yttrium aluminium garnet (Nd: YAG) laser in combination with suction using a blunt liposuction cannula of 2.0-2.5 mm of diameter. RESULTS: For 12 years, a total of 81 consecutive subjects (79 females and 2 males) were treated. The average age of the patients was 43.7 years (range 26 to 76 years). Granulomas and lumps could be removed in a minor invasive procedure with tumescent anaesthesia. In a minority of cases, the procedure had to be repeated. The results were impressive and not adverse events related to intralesional laser therapy were observed, 86.4% of patients were satisfied. CONCLUSION: The procedure should be used before or in combination with classical surgery to remove PMMA in case of adverse tissue reactions to PMMA.

Successful Treatment of Reticular Blue Veins of the Lower Eyelid by Long-Pulse Nd: YAG - Case Report with 8-Year Follow-Up.

BACKGROUND: Facial reticular blue veins are of esthetic concern. Most often these veins develop on the lower lids. The safest and most effective way of treatment is by vascular lasers. CASE REPORT: We report on a successful reticular vein treatment using a long-pulsed 1064 nm Nd: YAG laser. We present a follow-up of 8 years with constant esthetic improvement without unwanted adverse events. CONCLUSION: There was no relapse demonstrating the efficacy of Nd: YAG laser.

Chronic Encapsulated Seroma Persisting for Three Years after Abdominoplasty and a Successful Surgical Solution.

Abdominoplasty is listed among five most common esthetic surgical procedures in the Western World. Despite all efforts, abdominoplasty bears a high risk of complications. We observed a 39-year-old-woman with previous classical abdominoplasty performed elsewhere three years ago. Clinical examination demonstrated a swollen and tense abdominal mass. Laboratory findings were normal. Clinical examination was completed by abdominal ultrasonography which demonstrated both, a significant fluid volume in this area and a dense fibrous "capsule". The diagnosis was a late or chronic encapsulated seroma with a thick pseudocapsule or "bursa". We performed a revision abdominoplasty with a standard supra-fascial dissection. Surgical resection of infra-umbilical flap containing skin, subcutaneous tissue and capsulectomy were performed under general anaesthesia. A new umbilicus was created attaching small skin flaps in the muscular fascia. No drains were used. We observed no seroma formation. Follow up after six and ten months was unremarkable. The fibrous pseudocapsule of chronic seroma results in different degrees of deformities, abdominal scar deviation and asymmetry. Surgical capsulectomy combined with revision abdominoplasty with preservation of Scarpa's fascia and placement of progressive tension sutures resulted in being effective and leads an esthetic outcome without seroma recurrence.

Lip Repair after Mohs Surgery for Squamous Cell Carcinoma by Bilateral Tissue Expanding Vermillion Myocutaneous Flap (Goldstein Technique Modified by Sawada).

Squamous cell carcinoma is the most common malignancy of the lower lip. Environmental factors such as ultraviolet light exposure, arsenic and smoking are contributing factors to the increasing incidence. Mohs surgery is the treatment of choice ensuring the lowest recurrence rates. The closure of the surgical defects, however, can be a challenge. Multiple and versatile methods of reconstructing vermilion defects have been described. Among these options, Goldstein developed the adjacent ipsilateral vermilion flap based on an arterialized myocutaneous flap. The original technique was modified by Sawada based on bilateral adjacent vermilion advancement flap for closure of central vermilion defects. We report the use of bilateral flaps - Sawada's technique (instead of unilateral as suggested by Goldstein) in medium (2 cm of extension) to large defects (> 2 cm) to achieve an effective and functional reconstruction of vermillion defects after Mohs surgery for lip cancer.

Dog bite injury - alar repair with composite graft.

Dog bite injuries are an important emergency. Facial dog bites can lead to disfigurement and stigmatization. Dog owners themselves are the usual victims of facial dog bites. Early surgery provides best results. A 28-year-old male patient presented 1 year after he had been bitten on his nose by his own dog. The pronounced nasal disfigurement with nostril stenosis was treated by reconstruction using a free composite graft from the crus of the ipsilateral ear with good results. Delayed reconstruction can provide satisfying results.

A Primary Cutaneous Nocardiosis of the Hand.

BACKGROUND: Nocardiosis is caused by an aerobic actinomycete, most commonly introduced through the respiratory tract. The Nocardiae are gram-positive, partially acid-fast bacteria. Primary cutaneous nocardiosis infections are rare and caused by the traumatic introduction of organisms percutaneously. The manifestation is usually an opportunistic infection. Cutaneous involvement may develop as one of four types: mycetoma, lymphocutaneous infection, superficial skin infection, or systemic disease with cutaneous involvement. Diagnosis and evaluation of appropriate specimens are principally by culture. CASE PRESENTATION: A 55-year-old female patient with diabetes type II presented with chronic skin lesions on the hand. Otherwise, her medical history was unremarkable. There were no signs of systemic disease. Direct examination of swabs demonstrated gramme bacteria and culture on Sabouraud agar was positive for Nocardia spp. The specimen of nocardiae was not identified. The patient was treated during nine months with sulfamethoxazole plus trimethoprim. There was an important clinical improvement of the cutaneous aspect of the lesions in hand. Some scars and fibrosis remained after nocardiosis. CONCLUSIONS: Primary cutaneous nocardiosis of the hand is a rare condition. The clinical diagnosis is difficult, and culture is mandatory.

Severe unexpected adverse effects after permanent eye makeup and their management by Q-switched Nd:YAG laser.

Permanent makeup is a cosmetic tattoo that is used to enhance one's appearance, and which has become more popular among middle-aged and elderly women. A couple of benefits seem to be associated with permanent tattoos in the elderly: saving time (wake up with makeup); poor eyesight (difficult to apply makeup); and saving money. On the other hand, cosmetic tattoos bear the same risks as other tattoo procedures. We report on fading and unintended hyperpigmentation after tattooing on eyebrows and eyelids, and discuss the scientific and anatomical background behind the possible cause. Dermatochalasis may be a possible risk factor for excessive unwanted discolorations. Q-switched neodymium-doped yttrium aluminum garnet laser is an appropriate and safe therapeutic tool that can manage such adverse effects. Consumer protection warrants better information and education of the risks of cosmetic tattoos - in particular, for elderly women.

Evaluation of Tissue Tightening by the Subdermal Nd: YAG Laser-Assisted Liposuction Versus Liposuction Alone.

BACKGROUND: Skin tightening is a desirable outcome for skin flaccidity. OBJECTIVE: We evaluated the applicability, safety, capacity and intensity of skin tightening with the subdermal 1,064 nm Nd: YAG laser application to the upper arms, and compared the results with liposuction. MATERIALS AND METHODS: Patients with lipodystrophy and mild-to-severe skin laxity of the arms were included (n=28). In half of patients, a single treatment with a subcutaneous laser and liposuction was performed, while the other 14 had a regular liposuction. Treatment parameters, adverse effects and photographic documentation were recorded. RESULTS: Aesthetic improvement and skin retraction was superior by laser lipolysis. The procedure was well tolerated without significant complications. CONCLUSIONS: The subdermal laser-assisted liposuction using a 1,064 nm Nd: YAG laser achieves improved skin tightening.

Facial rejuvenation for middle-aged women: a combined approach with minimally invasive procedures.

Facial rejuvenation is a significant process involved in restoring youthfulness. The introduction of less invasive procedures has increased acceptance of such procedures. Often a combination of different techniques allows individualized treatment with optimal outcomes. Furthermore, this leads to a natural look without a significant downtime. We report herein the use of such a combined approach in middle-aged women with particular emphasis on botulinum toxin type A, dermal fillers, and chemical peels.

Elevation of the corner of the mouth using botulinum toxin type a.

Indications for botulinum toxin type A have been constantly evolving, and it can currently be used in virtually any area of the face and neck. The authors present their experience with this neurotoxin in treating the platysmal bands and depressor anguli oris muscle with the purpose of cosmetically improving the anterior neck and lifting the oral commissure.

Laser-assisted liposuction.

In the United States, as in many other countries, liposuction is the most commonly performed cosmetic surgical procedure. Advances in technology have enabled surgeons to improve the safety and efficacy of the procedure. One such technological advance is laser-assisted liposuction. This minimally invasive technique employs laser energy in direct contact with adipose tissue to induce lipolysis and, at the same time, coagulate tiny blood vessels and stimulate dermal and subdermal neocollagenesis. These features of laser lipolysis permit a fast, comfortable postoperative recovery, a rapid return to activities of daily living, and excellent skin redraping as a result of laser-induced skin tightening.

Lipoma treatment with a subdermal Nd:YAG laser technique.

BACKGROUND: Lipoma is the most common benign mesenchymal tumor composed of mature fat cells. The standard treatment for lipoma is excision. Many treatments have been described in order to minimize the scars produced by surgical excision. The treatment of lipoma using a subdermal laser produces an effective disruption of fat cells and results in a small scar. OBJECTIVE: To evaluate the efficacy of subcutaneous intralesional application of a pulsed Nd:YAG laser as an option for the treatment of lipoma. METHODS: From January 2001 to November 2007, 20 patients (11 women and nine men) with lipomas were treated using a subdermal, pulsed, 1064-nm Nd:YAG laser. After laser treatment, the oily solution, the product of laser action, was removed with a 2-mm cannula using a negative pressure of 350 mmHg. Histology and cytology of the treated tissue were used to analyze the effects of the laser on the fat cells. Ultrasound was performed in some subjects before and after laser treatment. RESULTS: Subdermal lipoma treatment using a 1064-nm Nd:YAG laser resulted in complete or almost complete removal of the tumor in 100% of patients. Four partial relapses were observed that were treated successfully by the same procedure. Adverse effects were mild and temporary. The combination of a 1064-nm Nd:YAG laser and removal of the cell debris by a suction cannula presented an effective therapeutic option for patients with lipoma. CONCLUSIONS: The treatment of lipoma using a 1064-nm Nd:YAG laser is a minor invasive procedure which does not result in large scars. Laser treatment is an effective and safe option for cellular disruption.

Hand rejuvenation using intense pulsed light.

BACKGROUND: The aging of the hands is typically characterized by wrinkles, skin thinning, and solar lentigines. The search for effective treatments has led to the use of laser and intense pulsed light (IPL) technologies. OBJECTIVE: To assess the effectiveness of an IPL device for the improvement of dyspigmentation and overall skin quality on the dorsa of the hands. METHODS: Twenty-three patients with sun damage and solar lentigines on the dorsal hands were treated with four IPL sessions at 3- to 4-week intervals. Prior to treatment, photographs were taken and informed consent was obtained. Pre- and post-treatment photography and investigator clinical assessment and patient questionnaires were collected for data analysis. RESULTS: After four treatment sessions, good to excellent results in the improvement in solar lentigines and skin quality were assessed by investigators in 100% of the cases and in 86.94% (20 of 23 subjects) by patient self-assessments. No significant side effects were observed. CONCLUSION: IPL is an effective and safe treatment option to improve solar lentigines and skin texture for hand rejuvenation.

Subdermal Nd-YAG laser for axillary hyperhidrosis.

BACKGROUND: Axillary hyperhidrosis is a common but difficult-to-treat condition with major social, labor, and emotional consequences. OBJECTIVE: The aim of this study is to present the Nd-YAG laser as a safe and effective option for the treatment of axillary hyperhidrosis. MATERIALS AND METHODS: From January 2002 to April 2007, 17 patients (15 women and 2 men) with axillary hyperhidrosis were treated using a subdermal 1,064-nm Nd-YAG laser. The results were evaluated by the patients as well as by the physician. The objective evaluation was realized by Minor's iodine starch test combined with planimetry. Histology was performed in axillary skin after the laser treatment. RESULTS: The subdermal laser-assisted axillary hyperhidrosis treatment using a 1,064-nm Nd-YAG laser resulted in significant clinical improvement. CONCLUSIONS: The treatment of axillary hyperhidrosis using the 1,064-nm Nd-YAG laser has the advantage of a minor invasive procedure without leaving large scars and causing temporary impairment. The laser proved to be effective and safe. Although the laser treatment has shown promising results in this pilot trial, further studies are necessary for final conclusions. The authors have indicated no significant interest with commercial supporters.