Complication of a Polyalkylimide Implant in a Patient with Facial Trauma JORGE OCAMPO-CANDIANI, MD, SALVADOR SOBREVILLA-ONDARZA, MD, LEOBARDO VELA ´ ZQUEZ-ARENAS, MD, AND OSVALDO T. V A ´ ZQUEZ-MARTI ´ NEZ, MD Ã The authors have indicated no significant interest with commercial supporters. F iller materials have been used for contouring fine lines and wrinkles caused by aging, as well as to improve scars and congenital defects. 1 A filler must be versatile in its usage, have a low possibility of adverse effects, and have a low potential for abuse. 2 One of the main limitations of filler materials is the volume that can be injected, because there are dis- eases like facial lipoatrophy and congenital defects that require large amounts to repair them. 3 Polyalkylimide (Bio-Alcamid, Pur Medical Corp., Toronto, Ontario, Canada) has advantages, such as greater stability, better integration with living tissues, and simpler removal if required. In addition, previous studies have demonstrated it to be nontoxic and easy to inject and remove and that it can be used in large quantities 4 as a permanent, nonabsorbable, nonmigrating implant of a consistency similar to the soft tissues of the receptor. It can be used in small or large volumes (up to 500 cm 3 in one site) and there is the possibility of removing it partially or totally without harm to the patient only by puncturing the capsule and squeezing the gel out with the fingers. 4 Its use for increasing body and facial volume has been reported. 5 It was certified by the European Community in 1999, and in Mexico it was regulated in 2003 by the Health Secretariat and was classified as a Type IIb medical article. Until today it has not been approved by the U.S. Food and Drug Admin- istration. It is an injectable colorless gel composed of 3% polyalkylimide and 97% apyrogenic water, dis- tributed in preloaded syringes of 1, 3, and 5 cm 3 . Once implanted it produces an acute self-limited inflam- matory response, mediated by lymphocytes and mac- rophages, which lasts approximately 2 months, forming a 0.2-mm-thick collagen capsule. The greatest advantage of polyalkylimide over other fillers is that it maintains the corrected volume and provides a soft natural tactile sensation in the treated areas. Serrano and Serrano 6 presented the first case in which polyalkylimide was injected into the nasogenian fold and lips, presenting a localized infection 3 months later. Multiple acute as well as chronic reactions to implants, which respond to intralesional steroids or 5- fluorouracil, have been reported, reserving surgery for cases that recur or do not respond to conventional treatment. Clinical Case We report a 26-year-old male with a history of Treacher Collins syndrome who was treated with multiple reconstructive facial surgeries to elevate both malar bones and cheeks with a graft of false ribs and a silicon prosthesis. Reconstruction of the pinna of the ear with false ribs, mentoplasty with an unspecified artificial prosthesis that was rejected presenting migration treated with prosthesis removal, other bone grafts, and rhinoplasty were performed in the past 12 years. After these surgical procedures, he received seven applications of polyalkylimide gel filler implants during a 3-year & 2008 by the American Society for Dermatologic Surgery, Inc.  Published by Wiley Periodicals, Inc.  ISSN: 1076-0512  Dermatol Surg 2008;34:1280–1282  DOI: 10.1111/j.1524-4725.2008.34275.x 1280 Ã All authors are affiliated with the Dermatology Department, School of Medicine and University Hospital, U.A.N.L., Monterrey, Mexico