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.
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.
