Extracorporeal Acoustic Shock Waves to Treat Complications of Polymethylmethacrylate

Background: Polymethylmethacrylate (PMMA) fillers are permanent fillers known for their possible side effects. In case of complications, the only possible treatment is surgical removal, followed by procedures to minimize resulting deformity. The aims of this study were (1) to analyse the morphology of the PMMA material in the nodules, (2) to demonstrate that treatment by acoustic wave therapy (AWT) can help the removal of the nodules, and (3) to present an easy procedure to solve deformities. Methods: The data of 9 patients who underwent AWT, surgical PMMA removal, and deformity correction by enriched nanograft and dermagraft injections between April 2021 and May 2024 were presented. The leftover aspirated material was analysed by histology and scanning electron microscopy. Results: AWT resulted in no complications in all patients. After removal and correction surgeries, minor complications were observed in 5 cases. All the patients were delighted with the aesthetic outcome. In all patients, an important improvement of the deformities, with correction of the volume of the face, was observed. A substantial resolution of the initial clinical symptoms was documented. The ultrastructural analysis highlighted that PMMA appears in the form of laminar or prismatic formations with a paracrystalline structure. Conclusions: AWT acted directly on PMMA to facilitate its removal and reduce fibrosis around the PMMA filler. The lack of volume correlated with PMMA removal was resolved with the enriched nanograft and dermagraft injections, which led to very satisfying aesthetic results. Level of evidence v: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .