Dr. Sam Lam Plastic Surgery Forum

Hi Dr Lam,
I'm hoping you can help me. I was injected in Mexico with a 10% PMMA product called Precise. This product was injected into the tear trough and under my eyes 2 years ago and I just recently developed lumps (white in color underneath the skin). They are long, thin, somewhat rubbery and run along the malar ligament (from inside corner of eye running down along orbital rim to just below the cheekbone). After approx two years, they developed very quickly, one of them seemed to develop in about 3 days time the other over the course of a few months. None of the surgeons I have seen in the US want to deal with it but the general consensus after simply looking at them is that the lumps are an overproduction of collagen or scar tissue not an actual granuloma. I find it very odd that it took years for these to develop.
Do you have any suggestions or ideas as to what this might be or how to treat and would you be able to perform the procedure? I have pictures if you'd like me to send them to you. Thanks very much for your help!

boy, that sounds bizarre. obviously, i am not excited about taking care of this either to be honest with you. if it is just overproduction of collagen, then 5-FU scar dissolver would be the first line of treatment. O/w it sounds as if you need this stuff cut out if that fails. Make an appointment to see me, and let's take a look.

Hi Dr Lam,
Thanks for responding so quickly! Can I send you the pictures so you can take a look at them? I'm flying in from Austin so it would be helpful to get an idea as to whether or not you feel they would be something you can/want to treat.
Thanks.

send me a PM with a link. honestly a photo probably won't help me much because it is hard to see anything with skin issues but it is okay with me.

Hi Dr Lam,
I sent you a PM with a link. I hope they help.
I look forward to your comments. Thanks again!

I got both of your PMs. Your photos are pretty good, actually. However, obviously, I cannot guarantee an accurate assessment without seeing you in person and touching and feeling the affected area. Here are my thoughts:
1. They don't look like granulomas or scar tissue. What they really look like to me is that over time you have lost your own natural soft tissue coverage revealing the PMMA as I see a smooth whiteness there in the very sensitive thin skin. If you look back at your photos two years ago you probably will notice some loss of fat around the eyes.
2. How then to deal with it if we suppose that is the issue? That is actually very tough. I personally do not think 5-FU will do anything given a look at the photos. I also would not add fat to that area as the lumps will actually become more visible when the fat lifts them forward. Perhaps, if I am right in my diagnosis, a few drops of silicone will help blend them in with the surrounding tissue better if you and I think that outright excision of these areas is too risky. I would have to see it. I would probably move against that idea as I do not want to create a further problem.
3. Your second PM asked me about fat grafting. Yes to the entire face but no to the area where the PMMA resides, as mentioned. I would truly have to see you in person for consultation to make some decisions. Since we are corresponding already, bring a couple of photos when you thought you looked the best. I am booked out a few months as it is so you will have time to get your travel plans in order. You can put yourself on the waiting list for an earlier appointment. Try to book your appt. tomorrow since I would like to get you in sooner than later.

All that being said, I may be totally wrong with my diagnosis until I see you. Don't worry I will treat you with respect and try to figure out the best course of action if I can conceivably help you.
best,
sml

Hi Dr Lam,
Thank you for taking the time with this. In reference to the product showing through (PMMA), due to fat loss, I think it's important to note that the lump on the left side of my face grew in just a couple of days (no evidence of it before that) and the original lump grew over several months in length and width also went from rubbery to firm. The new lump is still very soft. It's hard to imagine this all happened from fat loss. Does the speed of development change the picture?
I'm disheartened to think nothing can be done. I really hope that when you see me you'll find a way to treat them. At this point the idea of silicone scares me but if you feel there is not any risk involved (lumps, etc) we can certainly consider it. Please let me know if I can provide any other info. that might further guide the plan.
Thanks,

I think anything else at this point is conjecture. If they blew up that fast, silicone is not a great idea in putting a permanent filler into a moving target. That may compound things. I don't know what is going on. I don't use PMMA (as you probably know if you watch my video "Why I don't use Artefill/Artecoll" in my video logs section of this website). In all fairness, you had this done with a different brand in a foreign country so I can only guess what you had put in. I had a lady from the Virgin Islands who had "Restylane" placed in her tear trough but it was anything but. The company could not match out the numbers with anything that Medicis (the manufacturers of Restylane) made. Same thing with another lady from South America who had "Restylane" but turned out to be some permanent filler. I had to remove part of her lip to help matters. I think if the area is rapidly evolving without signs of infection (redness, tenderness, drainage, fever, etc.) then perhaps 5FU may still help. Let's hold on further commentary until I see it. If it truly gets worse rapidly, you might want to see a local doctor who can help you more expeditiously.

Hi,
I will call tomorrow and hope for an appointment in the near future. Thanks again for all your help and I look forward to meeting you.

One more question, is surgical removal an option?

same here. hope you have a restful remaining memorial day weekend.
best,
sml

possibly. if it is rapidly evolving, the answer is probably no. if it is static, i would consider it.

When I make the appointment do I make it for a procedure or just a consultation? I'd like to make sure there is time to treat with injections if you feel they will help.

injections take 2 minutes. you'll be fine.
sml

Hi Dr Lam,
I'm still trying to find a way to resolve (or improve) the artecoll lumps under my eyes. Would you consider removing the artecoll with a transconjunctival Blepharoplasty?
Thanks,
Wendy