Soft tissue augmentation with polymethylmethacrylate (PMMA) for correction of lipodistrophy related body fat atrophy.
Aim: we have been treating successfully facial atrophy with PMMA for the last 6 years, but in the last few years patients started to complain about body shape changes. (Fig. 1)
Specially for women, exacerbation of the appearance of superficial veins from arms and legs, loosing the shape of the hips became a problem making then changing the habit of dressing, for both genders the lost of fat in the buttocks can start to be painful when they have to be seated for a long time and sometimes can expose the anus leading to problems with clothes again. Fat transplant is an excellent option for treating these areas, but is not all the patients that have a donor area, so in these cases we started to perform PMMA implants for treatment of lipodistrophy body fat loss related. (Fig. 2)
Methods: body atrophic areas were treated with a PMMA solution containing methylcellulose and lidocaine. Treatment consisted of parallel and net-crossed retro-injections in the subcutaneous area of the PMMA solution in 3 different concentrations: 30% for buttocks, upper legs and around the knees; 30 or 20% for lower legs; and 10% for arms and hands. A five days course of antibiotics and anti-inflammatory medications was prescribed for each session, starting on day 1, right after the procedure.
Patients were photographed and followed every 45 days. Sessions were performed with a minimal interval of 10-12 weeks for each treated area.
Results: twenty-two patients were included in this study, 10 men and 12 women. Twenty-seven areas were treated: 14 butts, 9 legs, 3 arms and 1 pubis and perineum area. (Fig. 3-4)
Buttocks were treated with 40 ml of PMMA solution on each session, upper and lower legs around 20-30 ml, arms and hands with 10 ml of PMMA on each session.
Patients needed, in median, 2-3 sessions to achieve good cosmetic results. Some patients reffered excellent results in hiding the appearance of arms and leg veins. Good improvement of the overall appearance of arms and legs after filling the depressions between the muscles was observed, as improvement of the exposition of the anus. All patients whom had implantation on the butts felt more comfortable when having to be seated for a long time. Side effects were edema and redness of the treated area, and light to moderate pain that last for 2-3 days that improved with paracetamol. No infection or inflammatory granulloma were observed. Patients were satisfied with the results of the treatment and reffered felling more self confident. Women, especially, were satisfied with the fact that they could wear pants with shorter blouses again and be able to use shorter skirts, referring improvement in quality of life issues.(Fig. 5-6)
use of PMMA solution for treatment of body contour in lipodistrophy showed to be safe and effective, with good cosmetic results, helping patients get more self confident and improving quality of life.