TOPIC: Complications following Dr. N pmma removal (Photos Inside)

Last month I had some PMMA removed from two different location. One near the base on the left side and the other on the right underside near the urethra. The lumps of PMMA that I had removed were hard nodules that moved freely under the skin, and were hard like steel ball bearings. Treatment with Kenalog and 5fu did little to help, they might have shrunk the masses a little but at the same time it definitely made them harder and less malleable. Aesthetically they weren't too noticeable but by touch it was very obvious there was something strange going on. More importantly the one at the base was causing mild but chronic pain for the last several years and the one near the urethra may have been contributing to urination issues I've been having. Lastly I feel like a reduction in size, no matter how slight would be a positive development as well. Considering all that and past members experiences I made the choice for Removal.

Everything seemed to be healing well following the procedure until this past weekend, which is now 5 week post op. Both incision points closed up quickly and were healing well. I still had that mild pain in the first couple weeks post Removal in the lower incision area, however it has gradually decreased and is barely preciable now. I feel that once everything is completely healed in this area there will no longer be any pain at all. Aesthetically things are not as good as there is a noticeable depression now. The scar is healing well but is more noticeable then the Nodule were though I'm confident that over time this will fade to being almost unnoticeable especially with the use of silicone strips. However touch is a different matter, the scar line is very noticable. Perhaps dmso use will soften it over time as well, we'll see.

The incision point by the urethra was healing well too, though the the tissue was noticeably whiter in color here. However late last week I noticed some swelling and redness near to the area. By friday night the swelling was all but gone but in it's place there was a tiny hole in the skin and some clear fluid was draining out(refer to images). It's located where there was a darken area below the original incision point. Seemed like there was some difficulties removing the PMMA in this area and the skin was damaged to the point where there was some fluid leakage out of this area in tiny hole for a few days following Removal. There is also an abrupt edge/ridge where the PMMA was removed and where it remains, this left me with a large depression which may need to be corrected later.

I wasn't too alarmed at first considering the intermittent leakage in this area initially following the procedure. However by Sunday the hole became larger to approximately 1/8th of an Inch in diameter and the discharge was thicker and yellowish in color. I saw my doctor on monday though he did not seem too concerned since the wound was already draining. He did prescribe some antibiotics just in case of infection; Teve-Cephalexin 500mg. According to him the wound would heal itself though he admitted he was no expert on the matter and thus referred me to a Urologist.

The drainage has seemingly reduced since then but is still present though clearer in color now. There was also a purulent smell at first but after a few days on the antibiotics there no longer is any smell to the drainage. Strangely perhaps there is no pain and barely any tenderness at all. What concerns me the most is that the wound has increased in diameter in the last few days(though not in depth).

1 week post op - stitches still in place, note black spot below incision point
Attachment 1

2 weeks post op - stitches removed
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1 month post op - incision point healing well, note slightly darken spot still present under the skin
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last friday - drainage begins
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Sunday - noticeable opening appears
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Tuesday;
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Today;
Attachment 7

I have no idea what's going on now. Is the wound infected and that's why it's not closing? Or is it healing naturally as best as it can but just can't close itself off and needs to be stitched? Or worse yet debrided? At the moment I'm left waiting to hear back from the Urologist but my gut feeling is that I should just go and get it stitched/closed up at the hospital RIGHT NOW.

Redness and swelling, followed by skin opening suggests your body is rejecting something. Seeing as you've had PMMA for a while and it's been fine, would indicate that infection got in after surgery. You mentioned a smell, which is also a classic sign of infection. If it is infected, then I don't think it will close until the infection is gone. You might require surgical debridement of the wound.

If I were you I'd get in contact with Dr C (assuming he did your PMMA) and ask his opinion. I'm not sure a Urologist is the ideal Dr to see. I'd speak to either a wound healing specialist, cosmetic surgeon or Dermatologist, who is experienced with complications resulting from fillers

I too have had major complications following PMMA Bellafill. Had done last year. Chronic pain and swelling ever since. Had some removed by Gelman last summer. Been even more swollen now. Chronic burning and pain. Scrotum is always red and on fire and now skin feels thicker in scrotum.

Toothman wrote: I too have had major complications following PMMA Bellafill. Had done last year. Chronic pain and swelling ever since. Had some removed by Gelman last summer. Been even more swollen now. Chronic burning and pain. Scrotum is always red and on fire and now skin feels thicker in scrotum.

Sorry to hear that. Seems like there is no right answer or solution. You can give it some more time or try to have some more removed in the hope that it'll resolve some of the issues. I'm just thankful that I don't have any pain myself from the open wound, which seems unusual to me.

I actually had a consult with Gelman as well to remove these nodules. He insisted on doing a complete degloving so I didn't follow through with him but maybe that would've been the better option, who knows?

hoddle10 wrote: Redness and swelling, followed by skin opening suggests your body is rejecting something. Seeing as you've had PMMA for a while and it's been fine, would indicate that infection got in after surgery. You mentioned a smell, which is also a classic sign of infection. If it is infected, then I don't think it will close until the infection is gone. You might require surgical debridement of the wound.

If I were you I'd get in contact with Dr C (assuming he did your PMMA) and ask his opinion. I'm not sure a Urologist is the ideal Dr to see. I'd speak to either a wound healing specialist, cosmetic surgeon or Dermatologist, who is experienced with complications resulting from fillers

I used Dr N. I believe it likely was infected at first but I'm confident or at least hopeful that it isn't anymore as the smell is gone and the drainage is thinner.

The surgeon I saw is recommending dripping siliver nitrate solution on it to chemically cauterize the local tissue which he says with eventually cause the wound to close by itself. I still feel like I should get it stitched but he makes a good point in that if it's still draining its going to pool up and need to be drain again anyways.

The hole is larger still today but it's clear that the skin next to it(yellow tissue) was basically already dead and is just sloughing off since it was no viable anyways. It actually looks like new tissue is forming at the base but I'm not sure, I'll post a pic when I can.

You haven't had any silicone right?

Dr Gelman does a good job. He is a straight shooter. He is just very expensive. Not his fee but the hospitals fee is astronomical.

I have not had silicone.

I meant @wemustbecrazy. It just looks like he has some skin peeling and that the hole doesn't appear to be at the incision line, but simply close to it. It just reminded me more of silicone trying to get out, than a PMMA related wound closure issue.

I had two spots the derm tried to treat my PMMA granulomas with steroid. Both spots ulcerated and wouldn’t heal. Ended up I had to have those areas cut out. Gelman said tissue was very unhealthy where PMMA was. It just wouldn’t heal. I think it was 8 weeks later. PMMA, despite what some studies say, never seems to allow healthy vasculature to form. It creates scar tissue. Imagine lymphatics and blood vessels forming through scar tissue. Ain’t gonna happen.
I would keep it clean and covered. Moist wounds heal better than dry ones. Bandage and bacitracin. Neosporin has neomycin which, in some, causes allergy. It over time may granulate in and heal.

But from what i can see, this doesn't look like the incision not healing or re-opening. It looks like a hole has opened up in the skin near by. I can also see some skin peeling. I've never seen PMMA rejected and open a hole in the skin, hence I thought it could be something else. But Dr N has never used silicone, so obviously it isn't.

It's probably just an opening in the incision and the PMMA granulation tissue is causing a problem with healing. But from the photo, it doesn't actually look like it's on the incision, but it could just be he angle and lighting etc. To me it just looks a bit like some bacteria got in during surgery and caused for the filler to be rejected. It's just I've not seen that from PMMA in all the time PB has existed.

So after rereading original post, I would say the problem is delayed healing caused by both steroid and 5fu. Both of these inhibit both healing and collagen formation. The doctor should know that no incision or surgery should be done for at least 6 mos after last injection. I bet a million dollars that is why the incision not healing. That being said, if u keep area clean, I may just granulate in over time.

Does it even say when he had Kenalog?

To me it sounds and looks like his body is rejecting something. But if it is on the actual incision line, then it's more likely to be a healing issue. Really we need @wemustbecrazy to clarify.

I second Hoddle's opinion. Seek out more than just one opinion, especially if you can get a hold of a medical professional trained in wound care (this doesn't appear to be a PMMA issue, although I could be wrong. It appears pathogens were introduced during or after Removal the Removal process). Sorry if I missed it but whereabouts do you reside? Maybe I can get a regional Doctor to chime in.

Just spent half the night in the hospital yesterday as the skin degradation has gotten worse. Would be nice to know what I'm even looking at. Is the tissue on the base of the wound the buck fascia or is that still areolar tissue?

Last night;
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Today;
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Stitching is not an option now, probably never was and the doctor advised against applying silver nitrate claiming it would damage the area even more. All the areas where the skin turned white after that one day of inflammation last week were clearly non-viable anymore and mostly sloughed off width wise, a little more to go lengthwise. Makes sense now that I didn't feel any pain while this ulcer was forming, that skin was dead already and the body is just getting rid of it. I can accept that but I'm concerned that it might be spreading beyond those border into healthy tissue, not to mention it's only very slight but I'm starting to feel a sting in the area.

Last week when I went to the hospital they didn't seem too concerned when it was a pinhole this time around they took things a little more seriously. I had blood work done which checked out ok and ultrasound scheduled which will probably show nothing since PMMA blocks it completely and a bacteria culture test taken - which is what I wanted the first time around for fucks sakes! Finally I'll know for sure whether it's infected or not.

I think what's needed is to apply the silver nitrate to cauterize the leading edges of the wound and stop further degradation. Problem is finding someone to do it as doctors seem reluctant and my surgeon is not local but will write me a script to do it myself as apparently it's rather simple.