TOPIC: Infections, Complications, Risks of PMMA?

Hm, I'll pass word along that multiple people are having issues.

@ttar: Is the problem still happening? I am not experiencing similar issues. Is it localized to this thread, or do other threads have that appearance as well?
@eq Is post 20 still only partially showing up? I am not having any problems.

I also have similar concerns, i am 23 and i am leaning towards this being the best route. How on this board has had PMMA injected the longest?

is this page really messed up for anyone else? i have several posts appearing on top of one another, so you can't really read them, with the last one extending way past the "quick reply" dialogue box that's usually at the bottom. I'm using a Mac...just wanted to see if I'm the only one with this issue?

I have mentioned before if a doctor wants to use a sharp needle (instead of the blunt micro-cannula) for the injection of PMMA he has to use the technique back & forth (injecting PMMA while withdrawing the needle) and never inject at REST.
I think most of the doctors in the US use a sharp needle for Artefill injection into the face and I have never read any case of skin Necrosis or blindness in the US, because they use the technique I have mentioned above.
e.g. watch the technique of this doctor during the injection of Artefill he is doing it while withdrawing the needle :-

The doctor has to be well trained about how to inject Artefill in a safe way.
Injecting the beads directly into a vessel (an artery or a vein) e.g. a sharp needle ---> serious complications (embolism).
In the other hand injecting the beads outside a blood vessel, the beads cannot enter the blood vessel by itself ---> i.e. NO embolism.
To prove that for you :- There are thousands of patients in the US who had Artefill injection into the face (which contains a lot of arteries and veins) by using a sharp needle but without any serious complications e.g blindness or skin Necrosis i.e. No beads had entered the blood vessels because these doctors are well trained.
If Dr.C. or any other doctors using a sharp needle for PMMA injection (e.g. in the US) and if they had one case of e.g. blindness , would we think they will continue to use it ??

@eq,


1-
(( @smartman ' arguing against small particle migration is as silly as you arguing that one can't have an infection because the millions of macrophages surrounding the PMMA will any infection. Anyone with a basic understanding of biology will get these issues.))
I am just trying to understand the whole thing much better may be the reason is: I dont have a basic understanding of biology like you have, so could you explain (or may be the two local doctors in your area) Why we dont need antibiotic after Artefill injection ??? even after the second session ( that was the answer of Dr.Cohen and Lemperle , may be these two persons have no basic understanding of biology like me ?? ).
Do your two local doctors advice an antibiotic after Artefill ??
We could ask Artefill's company about the need of an antibiotic.


2-
You have mentioned (( A key requirement for FDA approval was that Artefill could not contain spheres smaller than 20 microns which were shown to be eaten by marcophages and in the animal studies found in migrated to lymph nodes and lungs!)).

But in the study (I have mentioned before) states

Skeptical One wrote: My reaction was to a photo uploaded with the intent to demonstrate the extreme deformities related to PMMA without the relevant background to go along with it. The Caldellas and Castro studies you stated are NOT in relation to the picture shown above and therefore are irrelevant. I'm just not a big fan of showing pictures of Necrosis without any sufficient background, that is all. Pardon me if my reaction seemed harsh....

The picture is from the de Castro paper. The link to the paper is right under the picture and contains the full paper. The paper clearly has a discussion on bioplasty and it's use of micro canulas etc. As far why the paper did not state the doctor or brand of PMMA the obvious litigation concerns exist. You are correct that I cannot be 100% sure that the de Castro product is Newplastic it could also be Metacril which is also Brazil FDA approved. So from now on we should always state the PMMA brand in all our posts and not use the generic PMMA label?

Why do we make things so complicated we have two products to compare Artefill and Newplastic :-
smaller beads carrier
Artefill < 1% bovine collagen
Newplastic > 1% ?? methylecellulose

The carrier difference has nothing to do with the serious complicatios , we all agree the it has to do with the beads and your body reaction to them, and both of these products have small beads of PMMA but one has a smaller amount than the other .
So if we suppose to have a serious complication from the movement of these phagocytosed small beads ---> wouldn't we have the same complication in both products but of course in Artefill will be lower than Newplastic.
At least one case from Artefill ????
But what we have in regard of Artefill there is no serious complication (i.e. from the movement of the small beads) so small beads have no serious effect on our health.
If somebody tell me it is dangerous to have small PMMA beads (in regard of migration) I will ask him to give me one case which has a serious complication (e.g. migration of distant organ) in the US from Artefill, (there are thousands of people in the US who had Artefill during the last 5 years)

Skeptical One wrote: Both articles you linked did nothing to address the very contentions made by PMMA proponents.
If we are talking about getting an unknown brand of PMMA injected to us by unqualified persons, then sure, by all means avoid PMMA for tissue augmentation. I can only imagine how many underground injection parties go on in Mexico and South America...hell they even go on in the states.
The above lady was the first ever reported case of her "type," and the article failed to mention ANY background on her injections.

I am very surprised by your reactions. The Caldellas paper specifically stated that he and his team did the procedures that were part of the 21 cases studied. They are a Brazilian Clinic and he specifically stated Newplastic was the PMMA product used.The de Castro paper on the facial Necrosis is also a Brazilian publication. He stated that the procedure was 'a bioplasty with PMMA, performed by an experienced plastic surgeon.' We know that the product is not Artefill given the locale and description 'In its injectable form, it is made up of microspheres spread within a colloid medium of carboxymethylcellulose'.The Salles, also a Brazilian hospital, case review detailed 'Sixteen injection procedures were performed by certified plastic surgeons, nine by dermatologists, two by urologists, and one by a nonphysician'.As far as satisfying 'proponents of PMMA' I am not sure who or what you are referring to. I am just attempting to present factual articles which were presented in established peer reviewed publications. If this a problem please let me know. EDIT: removed incorrect conclusion of the PMMA brand.

@EQ,
Thanks a lot for your 3 minutes research , I thought you still remember what was my Q. is about :- (( Any study about the Migration of the beads of the Newplastic or at least other products to a DISTANT ORGAN in human ---> distant organ disease or failure )), our argument was about the possibilty of the danger (e.g. migration) of the small beads migrating to distant organ, do you remember that EQ ??
In regards the 3 points you have mentioned above :-
1- 'The Polymethylmethacrylate Effects on Auricle Conchal Cartilage: Report of 21 Cases' by Caldellas et al
Is that a distant organ e.g. liver or lung ??? it is only a local (at the same area of injection) complication ???
Let us say this paper is 100% correct , the Q. is: Is this local complication due to the presence of small beads (e.g. in Newplastic) ?? If that is true why did FDA give the approval for Artefill i.e. it is safe ?? In Artefill there is <1% of the beads are smaller than 20 micron , I know it is low (<1%) but i.e. Artefill is not 100% pure, so is there any distant fatal organ damage after Artefill injection in USA, that will be a Q. for Dr. Cohen ( he will not answer me but of course we know his answer anyway).
www.ncbi.nlm.nih.gov/pubmed/19787393
2- 'Extensive facial necrosis after infiltration of polymethylmethacrylate' de Castro et al
I like that one , are you saying that the picture shown above is due to the product (e.g. Newplastic) ??? So do you mean if the same doctor used Arefill instead of (the Brazilian's product) wont happen this complication ???
First of all this complication can occur from injecting any product of PMMA directly into an artery ( in this picture is due to injecting PMMA into one of the branches of the Facial artery) which will occlude the artery---> necrosis .
So it is due to the TECHNIQUE of the doctor esp. by using sharp needle, and not due to the product per se .
Believe me EQ if you decided to have Artefill for chin augmentation (as you have mentioned before fft or Artefill) be careful esp. if your doctor use a sharp needle , he has to move it back and forth to avoid injecting the beads into your artery, otherwise the chance of having the same complication as in the picture is high.
BTW that is not the answer of our Q. it is not talking about migration of the beads to distant organ it is about the bad technique of the doctor by injecting the beads into an artery, as I said it can happen with Artefill also , correct me if I am wrong ?? i.e. the BEST product with a bad doctor ---> Disaster .
That was the opinion of Dr.Cohen ((the technique and not the product per se)).
So do you regard this case as a distant organ disease (e.g. liver) ??

3- 'Complications after polymethylmethacrylate injections: report of 32 cases' by. Salles et al
Again it is not a distant organ disease ?
5 cases tissue necrosis (acute complication) due to technique.10 cases granuloma (subacute complication) leave it or Kenalog injection.10 cases chronic inflammatory reaction in the same area were it is injected.Again they mentioned 10 cases chronic inflammatory reaction which is the same as above complication but in the lips (lymphedema).1 case of infection.
He mentioned one of the person who did the injection was not a doctor , I wonder which one was his patient ??
So are these the answer of our Q. in regard the possibility of small beads migration and the chance of distant organ complication ???

I think I did find the proof that skin necrosis complication depends mostly on the technique of the doctor more than the filler per se so it can happen with any other safe absorbable products :-
(1) I think most of us had or heard about Lidocaine 2% injection (a local anesthesia).
Did any one hear that this drug can cause tissue necrosis ??
jcp.sagepub.com/content/49/7/872.extract
So does it mean we should not let our doctors to inject us with any local anesthesia?? lol
(2) Did anyone hear that temporary fillers (biodegradable fillers) e.g Hyaluronic acid or collagen fillers can also cause skin necrosis ??
They said the nasal area, the perioral region and the glabella are the most dangerous areas .
a) www.cosmetic-medicine.jp/list/fillers.htm
also in this paper they mention Nasal Alar necrosis can happen and also they mention Granuloma formation can happen after the injection of temporary filler e.g. Hyaluronic acid :-
b) www.drdayan.com/pdfs/risk-of-alar-necrosis.pdf

(3) Some people said that FFT is the safest technique and has no serious complications , actually there are serious complications from this technique (liposuction & fft injection) :-
Acute Respiratory Distress , central nervous system , skin and retina
www.scielo.br/scielo.php?pid=s1806-37132...=sci_arttext&tlng=en

I am not trying to frighten anyone about these complications from these products I just want to prove for everybody that the Technique of the Doctor is the most important and the area ( e.g. Glabella)
There is another paper which prove that :-
onlinelibrary.wiley.com/doi/10.1111/j.15...006.32052.x/abstract
injection necrosis is a rare but clinically important potential complication caused by interruption of the vascular supply to the area by compression, injury, and/or obstruction of the vessel(s).

In conclusion :- These papers prove that skin necrosis if it did happen (reported esp. in the face) it can happen with any products and not only with Newplastic .

@ justabitmore- It usually occurs if it did happen approximately between12-72 hrs post injection and not before 6 hrs .

smartman wrote: @EQ,
Lets say the migration of these small beads is true :-
...
So from these points ( it is like human experiments and not animal experiments ) wouldn't be enough to show at least one ill-patient???
EQ I am only trying to get the truth as all of us from the whole thing, Dr. Cohen will make it easier for us if he can show us at least one patient , could you help us to get this information from him or from other doctors , I have tried but he unfortunately didn't answer my Q. (i.e. our Q.) .

@smartmanI was not sure if you were serious implying that there were no studies recording serious issues with (PMMA) Newplastic. Here are 3 I quickly found on the web. I suspect Portuguese speakers could find a bunch more fairly quickly'The Polymethylmethacrylate Effects on Auricle Conchal Cartilage: Report of 21 Cases' by Caldellas et alhttp://www.ncbi.nlm.nih.gov/pubmed/20601571'Extensive facial necrosis after infiltration of polymethylmethacrylate' de Castro et al www.scielo.br/scielo.php?script=sci_artt...lng=en'Complications after polymethylmethacrylate injections: report of 32 cases' by. Salles et alhttp://www.ncbi.nlm.nih.gov/pubmed/18454007 That's 54 cases after just a 3 minute search!!

The Rt. facial necrosis in the picture is due to a bad technique (the doctor has injected pmma into an artery (branches of the facial artery)) esp. if the doctor used a sharp needle for the injection, they usually advice in pmma injection is to use a blunt cannula or if the doctor used a sharp needle he shouldn't inject the pmma at rest he should move the needle back & forth and the injection should be done during the movement to avoid any direct injection of pmma into an artery.
It has nothing to do with the amount of pmma it is due to the technique e.g. :-
A small volume of pmma injected by a sharp needle into an artery ----> a chance of necrosis.
A large volume of pmma injected by a blunt cannula and not into an artery--> no necrosis.
A necrosis of a tissue from an arterial embolism is not a long term complication it is an acute short term complication hours after the injection.
But if the injection was into a vein ---> possibility of pulmonary embolism
BTW the volume injected in the butt (around 500 cc) is 10 times more by volume than typically injected in the penis (around 50 cc in total) and I have never read any report of skin or tissue necrosis of the butt.
I agree with supa that there are other products beside pmma if you injected them in an artery---> embolism---> serious complication.
e.g. injecting steroid into the inferior turbinate (inside the nose) (used to be one of the treatment for chronic nasal block (allergic or vasomotor rhinitis)) can cause blindness
archopht.ama-assn.org/cgi/content/abstract/97/1/79
My doctor in Brazil used a micro-cannula during the injection of Metacrill but in some area of my penis he wanted to use a sharp needle (back & forth technique) but I refused even he told me he has a long experience of using a sharp needle. So I am sure some brazilian doctors still sometimes used a sharp needle beside the micro-cannula (so it is not a 100% a bioplasty technique (a blunt micro-cannula) what Dr.Almir Nacul has advised).
So the technique of the doctor is most important to avoid any serious complication and not the product per se.

supa wrote: ... I would not be so sure of that. The choice of placing the product very near the ophthalmic artery can be a poor one. The material is indeed not supposed to move from the location where it has been injected but if it was administered very near the artery it is conceivable that some of it has reached it during the procedure;...

Are you saying one should not do work in the Glabella? Once you work in that area you are going to be near a blood vessel. All the arteries in that region have significant anastomoses. Look again at the Dr C. video, was he near a blood vessel? The technique is fine, the area is risky. A lot of well-respected surgeons will not put any type of filler in this area.

supa wrote: ...The material is indeed not supposed to move from the location where it has been injected but if it was administered very near the artery it is conceivable that some of it has reached it during the procedure;....

Thank you for bringing this discussion back to the central point. The Caldellas Newplastic study of 21 patients showed Macrophage phagocytosis in all 21 patients. If the PMMA particles are small enough to be eaten by a Macrophage they will move!

supa wrote: ...Can I ask you again: would you consider bioplasty to the penis using Artefill? Not that you would actually go now and have it. Rather, if you feel that it is a sound procedure to seriously consider. Or, on the contrary, if you would also equally and firmly reject it, at this point in time;...

If one must have PE then IMO Artefill, if it performs in the penis like it does in the face in the 36 month interim study, may be sounder than all the other PE alternatives. Having said that we should be clear that for every 10 people that have the procedure, at the 5 year mark it is likely that 1 or 2 will have some adverse effect including lumpiness, swelling and redness, lesions, treatable granulomas, and granulomas that will need to be surgically removed. We do not know how the higher volumes (10x) required in the penis will change the risks.

Re: The horror picture portraying a disfigured face.

It would seem down to poor technique; I read in the article:

" ... the PMMA microspheres were injected very near branches of the ophthalmic artery, which caused embolism in the vassel.2 We also know of complications also associated with the use of an autologous graft when the injection is carried out in the glabellar region.6
In this report, the complication mechanism was similar. PMMA was injected in the nasogenian groove, or directly into the right facial artery, or very near it. There was arterial embolism: right angular artery, right superior and inferior labial coronal arteries".

Not the product is to blame then, if we take the excerpt literally, but rather the location where it was injected.

Thoughts?

P.S.
I truly and deeply think that challenging info/doc/research documents are absolutely crucial for our long journey to a thorough assessment of PMMA. Thank you eqstudent for your contributions. Please, keep it up.

At the same time I did resent your patronizing attitude when replying to smartman. He has brought wealth of technical info to this forum on top of sharing his long-term experience with us: both extremely valuable assets.
I personally would welcome more imperturbability when objecting to points of view of a fellow forum brother. Rest assured that I still would avidily read your inputs. We are all here to learn and contribute. Btw, I confess, I do ignore the basic facts of biology, so I am happy to know more.

Final question: you "will not be using Artefill for chin augmentation" ... would you use Artefill for penis Girth augmentation?