PMMA is currently used as a facial filler in the United States.
Here is some more information from
www.facialwasting.org
Polymethylmethacrylate (PMMA)
PMMA has been used for many years in reconstructive medicine as a bone bonding agent because of its unique ability to form a lattice structure which encourages infiltration by osteoblasts (
cells that
arise from
fibroblasts and which, as they
mature, are
associated with the
production of
bone) if placed in bone. In skin, PMMA also promotes fibroblast and vascular infiltration of the soft tissues it is implanted in leading to a high safety profile vis-a-vis non-vascular implants such as acrylamide gels and silicone oil. Most of the volume gained from PMMA filler is the body’s own tissues and blood vessels growing into the PMMA. And as the PMMA matrix does not dissolve like Radiesse (calcium hydroxylapitate or Sculptra L-polylactic acid, the implant is considered permanent.
PMMA is available in the United States under the trade name of Artefill (
http://www.artefill.com/consumer/). This formulation was developed and approved after many years of clinical trials by Dr. Gottfried Lamperle, but for one indication only; filling the deep folds next to the nose called the nasio-labial fold. Unlike Sculptra and Radiesse, this product is not FDA approved for HIV-related facial lipoatrophy. The single reported complication appearing in clinical trial results of ArteFill® and its predecessor products have been a small number of tiny palpable granulomas. The clinical experience suggests that granulomas with PMMA tend to develop in thin skin areas or when the product is dermally injected in a too shallow fashion. These granulomas often respond to treatment with Kenalog 40, a powerful glucocorticod. As ArteFill® was developed and purified over several generations from the original Atreplast, the appearance of granulomas have decreased dramatically. We also have noted from the clinical experience that NewPlastic® does not seem to produce granuloma formation when grafted sub-facially in the Nacul/Casavantes technique discussed in detail below.
ArteFill® costs medical providers $2,100.00 per 1.2 ml prepackaged in a box of 2 syringes containing 0.8 and 0.4 ml of product. This kit and the professional services of the provider are often sold to the patient for $3,500 to $4,000, thus making it impractical, as a corrective for large volume tissue loss. At a cost to the patient of $3,500 for the treatment, the per ml price comes to $2,917. Common in the faces of people with HIV tissue loss, are deficits which can require from 30 ml to 40 ml of filler. A face requiring 30 to 40 ml of Arte-Fill® would cost from $87,510 to $116,680. This calculation leaves aside the issue of the labor involved in administering the contents of 35 kits with 70 small syringes necessary for such a procedure.
The only reported problem with PMMA in the trials was the development of granulomas in thin skin areas; a concern of some significance to HIV positive men and especially women suffering with the depletion of fat in the skin. Many patients are attracted to PMMA because of its permanence and lack of ‘touch-ups’ necessary with the temporary or long lasting implants. Some patients also report small bumps that may be smoothed out by follow-up work.
Brazilian esthetic medicine doctors and dermatologists have been using PMMA as a treatment for HIV associated soft tissue wasting for the better part of a decade, virtually from the start of the identification of lipodystrophy syndrome.