Laser in the Treatment of Granulomas on the Nose Produced by Polymethylmethacrylate: A Case Series

November 2021 | Volume 20 | Issue 11 | Original Article | 1161 | Copyright © November 2021


Published online October 21, 2021

Alberto Goldman MDa, Uwe Wollina MDb, Denise Cantrelli Machado PhDc, Daniel Rodrigo Marionwic PhDd

aPontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
bDepartment of Dermatology and Allergology, Städtisches Klinikum Dresden, Dresden, Germany
cPreclinical Research Center of Brain Institute of Rio Grande do Sul (BraIns), Pontifical Catholic University of Rio Grande do Sul (PUCRS) Porto Alegre, Rio Grande do Sul, Brazil
dPrecision Medicine and Biotechnology Laboratory - Brain Institute of Rio Grande do Sul (BraIns) Porto Alegre, RS, Brazil

Abstract
Background: The search for aesthetic non-surgical procedures is growing. The use of polymethylmethacrylate (PMMA) as a filling material in the nose represents one of the many options among these aesthetic procedures. Its use, however, can lead to complications. The treatment of these complications is often challenging.
Methods: We performed a retrospective clinical analysis of the medical records of patients undergoing treatment of PMMA granulomas of the nose at a private clinic from January, 2015, to January, 2021. A short-pulsed neodymium-YAG (Nd:YAG) laser was applied intranasally or directly by cutaneous incision in the granulomas. Laser-tissue interaction heats the alloplastic material, fragments the product and creates cleavage paths, thereby facilitating the removal of PMMA, either by intercartilaginous removal or aspiration.
Results: Twenty-seven patients were included in the study. All had a history of PMMA injection in the nose. All patients were treated with an intralesional pulsed 1064nm Nd:YAG laser. The material removed after laser-tissue interaction was sent for histopathological examination; this showed the presence of microparticles of exogenous material compatible with PMMA. The partial removal of the alloplastic material was shown to be effective in all cases. One patient developed a small blister in the nasal dorsum. Follow-up ranged from six to 47 months.
Conclusions: The use of intralesional Nd:YAG laser for the treatment of PMMA granulomas on the nose proved to be an effective and safe procedure with improvement of nasal shape, without compromising respiratory function. This technical option represents yet another alternative in the treatment of PMMA granuloma complications.

J Drugs Dermatol. 2021;20(11): 1161-1166. doi:10.36849/JDD.6550

INTRODUCTION

Non-surgical procedures aimed at rejuvenating and improving the appearance of the face and nose have grown in recent years. They seek an effective result, a reduction in risks or complications and a shorter recovery period compared to surgery.1 Among these options, injectable fillers have been increasingly used. They aim to correct folds or wrinkles, increase volume, and attenuate the signs of aging.2 The appeal of fillers is that they are simple, low-cost and have a quick recovery when used for aesthetic treatment or nasal deformities.1

Fillers can be temporary (degradable), such as hyaluronic acid, semi-permanent like calcium hydroxylapatite, or permanent (non-degradable), such as polymethylmethacrylate (PMMA). The latter is composed of microspheres suspended in different vehicles such as bovine collagen or methylcellulose.3 Temporary fillers need periodic reapplication to maintain the result. Although initially shown to be safe for soft tissue augmentation, adverse events (AEs), especially with permanent materials such as PMMA, have been unpredictable, sometimes severe, and difficult to handle in the medium and long term. These complications may occur early when they appear up to two weeks after application. Late complications develop during or after the first year following filler injection.4–6

The use of permanent fillers in the nose carries the risk of several severe adverse reactions such as vascular compromise, skin necrosis, and extrusion. Removing this material from the nasal structure is always difficult.7 Foreign body nodules and granulomas are the most frequent manifestations. The main resources used in the management of adverse reactions related to PMMA are its surgical removal, aspiration, injection of corticosteroids, and intralesional laser (diode and Nd:YAG).8–12

In this article, we report a series of patients with PMMA granulomas in the nose and their treatment with intralesional 1064nm Nd:YAG laser.