What Are Potential Complications Of A PMMA Forehead Augmentation?

Q: Dr. Eppley, I am interested in getting a forehead augmentation. I know that there are different materials to use, one of which is PMMA. I have a few questions about PMMA. Does PMMA bone cement have a risk of granulomas like PMMA injections? Are the outlines of it visible? Does it have a risk of extrusion? Thank you!

A: In answer to your questions: 

1) PMMA cranioplasty material does not cause granulomatous reactions. That is a unique phenomenon of small PMMA particles in soft tissue

2) Besides getting getting the right contour and amount of augmentation, one of the major objectives of any form of cranioplasty is to get a smooth transition form the material to the surrounding bone. This usually requires intraoperative burring of the edges after the material is set to have feather edges so there are not visible outlines after surgery.

3) There is no risk of extrusion of a PMMA cranioplasty. Extrusion of any implant material occurs because it is either placing excessive pressure on the overlying soft tissues or is infected and it is being pushed out by the pressure of the purulent fluid build-up. A PMMA cranioplasty is rigidly fixed to the underlying bone by microscrews prior to it being placed as a rebar method. This prevents any micromotion or displacement after surgery. The material is also impregnated with antibiotics which provides several weeks of antibiotic release after surgery for infection prevention.

Dr. Barry Eppley

Indianapolis, Indiana