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per page PMMA – An introduction

Scientists and dermatologists have been searching for improved materials for the correction of dermal depressions. This research has reached its apex with the development of PMMA injectable filler which combines safety and affordability. It provides permanent results and is currently being used by thousands of doctors in the USA and elsewhere.

 Materials PMMA does not require refrigeration. It is sterile and ready to use.The product is supplied in prefilled syringes, each containing a minimum of 3cc.

The product is valid for two years. The validity date is clearly stamped on label.

Composition PMMA is a biocompatible injectable implant composed of microscopic spheres of polymethylmethacrilate. This is a synthetic resin. The spheres of PMMA are 40/60 micra in diameter. (1 Micron = 1 millionth of a meter).

 The spheres of PMMA are dispersed within carboximethylcelulose, a cellulose substance. It is biologically inert and non-absorbable by the body.

 Because of their diameter the micro spheres are not absorbed into the body, but remain where they have been placed. They prompt the formation of collagen tissue and elastic fibers.

Application technique
The PMMA process is performed in an outpatient manner. It is simple, fast and painless.                 

 The patient can be positioned lying down with head at around 40 degrees, or they can be kept in a seated position. The latter is favored for facial injections. This allows the folds and depressions to be shown exactly as they are. Anesthesia use is optional. It is important to consider the impact of the anesthetic on the correction process.

The patient is prepped, using soap and water to wash the area to be treated. Use of a 1% iodinated alcohol solution or similar is advised.

A BD 22g needle is used for the implant process. The needle is attached to the 3cc syringe supplied.

While the correction is generally performed with a 22g needle, some physicians prefer to use cannula needles with a lateral orifice and 1mm width. This can decrease the incidence of ecchymosis at the site of puncture, because of minor trauma to the local vessels.

The penetration point of the needle must be at 0.5cm from the site of implantation, avoiding the possibility of contact between the implant and the outside environment.

Introduction of the substance is performed in a parallel, crossing or fanlike cylinder fashion. This is largely down to the experience and the preference of the physician.

During injection it is vital to avoid the formation of sequential bubbles, as this can result in the cutaneous surface showing irregularities.

If the area to be treated is demarcated into equal segments, this can allow the injection to follow a more uniform path. This is particularly advisable in cases where symmetry is important.


The anatomical plane of PMMA injection is extremely important. The majority of complications arise from inadequate technique. The implantation must be made IN THE SUBCUTANEOUS PLANE, immediately under the dermis, and never in its thickness. If the injection is performed in the deep part of the subcutaneous tissue, the result will be poor but there will be a platform of support for future implanting.


Hypercorrection should be avoided because PMMA is retained by the skin where it is placed. Therefore any over-correction will lead to abnormal results that can be difficult to remove if left.

Treatment of scar areas must be undertaken cautiously, taking care not to place too much pressure on the syringe. Be conscious of the poor elasticity of the scar tissue. While undertaking scar treatments it is recommended to USE THE FINGER TIPS TO LIMIT THE POSITIONING OF THE IMPLANT AS IT IS INJECTED. Since the result appears immediately, the injection should be ceased when the desired volume is achieved.


During the post-injection period, use cold compresses and rest the implanted area to minimize edema. Swelling can last 3 days, but there are individual variations. When the lip vermilion is implanted there can be intense edema. The possible existing ecchymosis is of spontaneous evolution.


Some ecchymosis could be present, due to needle trauma, however this will disappear spontaneously.
Analgesics may be used with hypersensitive patients. Systemic corticoids can be provided for edema.  After 4 weeks, if necessary, complimentary implants can be applied.

Contra-indications for the use PMMA are very rare. PMMA should not be injected during infectious or inflammatory processes either systemic or local.



There have been no side-effects directly attributed to PMMA. The few cases of more intense edema are easily controlled and have immediate resolution with the intra muscular administration of corticosteroids.

Provided that the injection protocol is strictly observed, mainly in relation to the plane of injection (subcutaneous), there will be an absence of side-effects.

If the injection protocol is strictly adhered to, then the rate of complications of PMMA is extremely low.

 In a low number of patients (less than 1%), a formation of nodules has been shown. These are in the area of the implants, almost always in the nasolabial folds. These nodules are not painful, and can be treated by puncture with a 1½ mm needle.

Inflammatory reactions, months or years after the implant, have occurred. These may be the result of inflammatory response due to disease in a nearby area. Treatment should address the original infection.

A kind of complication resulting from lack of anatomical knowledge of the surgeon is described as “Nicolau Syndrome”. This results in thrombosis and necrosis in some cases. It can affect PMMA implants in the glabella and nasolabial folds.

In the glabella, supratrochlear veins immediately under the glabellar wrinkles mean that an implant here can promote the introduction of the product into the supratrochlear vein. This can lead to thrombosis of the vein, loss of vision, lesions of orbital fat and extrinsic ocular muscles. Therefore PMMA should not be used in this region.

In the nasolabial fold the syndrome is caused by penetration of implant in the facial vessels, which are located deep in the region. The consequence of thrombosis of these vessels can result in necrosis, vascular obstruction, ischemia, and secondary infection. Occurrence of these symptoms can be minimized by use of sharp cannulas in this region.

It is vital that practitioners have full training and knowledge of the anatomy of this region, in particular regarding the position of facial vessels.