From Dr Casavantes- Injecting PMMA around Bioalcamid?

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From the desk of Dr. CasavantesMonday, February 20, 2012Re: Combining different soft tissue fillers for the correction of facial lipoatrophy

Soft tissue fillers can be divided in three main groups, depending on the longevity ofboth the product and its effect:• Absorbable, like collagen and hyaluronic acid• Slowly absorbable, like polylactic acid (PLA) and calcium hydroxiapatite (CaHA)

• Non-absorbable, like polymetylmethacrilate (PMMA), silicone oil, and polialkylimide(BioAlcamid™, BA)Only slowly absorbable and non absorbable fillers have proven efficacy for the

correction of soft tissue deficits associated with facial lipoatrophy, but combining them isrestricted by their physical characteristics.Ideally, combinations of soft tissue fillers should be avoided, and only one type of filler

should be used in a given area; however, patients face different situations which caninfluence their decision to seek more than one type of product for the same given area.BA is the least combinable product, because it forms gel-filled cavities with impermeable

walls; it is common that bacteria organize around the implant, creating a clinicallydormant biofilm.  Manipulation, perforation, addition of other products, etc., can trigger a clinical infection. 

Furthermore, it is impossible to avoid migration of any soft tissue filler that is added next to or into existing BA. I do not recommend the use of any filler in areas of BA; and do not recommend the use of BA at

all.Silicone oil is also a non-compatible product because the chronic inflammatoryresponse or granuloma that it creates in the implanted areas can be worsened with the

presence of other substances. Patients that have had silicone oil injected, should stick

to it for future sessions. No combinations are recommended.The other three common soft tissue fillers (PMMA, PLA and CaHA) can be safelyimplanted in the same area, provided that they are not mixed during one single session.

Ideally, patients that used either PLA or CaHa, should wait until they are absorbed to getPMMA.Dr. Casavantes.