DISCUSSION



The results were shown to be permanent after 48 months from implanting. In the very fat areas, with increased motion, as the nasolabial sulcus, we noted a decrease in the original correction that must be revised in some time. In the areas with bone prominence, like nose, malar, chin and mandible, the correction persists with no modifications in the treated areas. In rare cases of nasal tip rising some degree of reinforcement was necessary some months later.

The complication rate is very small, if we do not compute the cases of more intense edema shown by few patients, as formerly stated. If we consider edema as a natural evolution after a surgical trauma, this is not considered a complication but an integral part of the organic response.

The easy with which injection is performed, the low cost, the lack of discomfort during injection and the fast reestablishment of the patient has been leading to an increase in the number of injectors and clients.

The amplitude of indications has increased because other specialties perform studies about the utilization of META<>CRILL® in their pathologies.

The biocompatibility has been demonstrated by the lack of complications or negative results, either locally or at a distance, in the great number of treated areas.

The migration of the micro spheres has been detected by some researchers but happens in a small number of spheres, as the diameter and lack of surface irregularities turns very difficult the phagocytosis. In the histological studies performed we found a small number of macrophages with micro spheres inside them but they remain definitively in the site of implant.

Microbiological studies have shown that META<>CRILL® is a substance of unfavorable characteristics to microorganism growth, because both bacteria and fungi seeded in it did not grow. Other than that, the product being inoculated in commonly used culture medium has shown META<>CRILL® to be totally sterile.

The medium used for the suspension in micro spheres, which turns its injection possible, is totally mineral, with no protein component in its composition. It keeps the particles of PMMA suspended in a gel like suspension.

META<>CRILL® is a new therapeutic modality, constituting the first soft tissue expander that is totally integrated in the tissues where it is injected, with no abnormal reaction in response to its presence. It does not change the histological, anatomical and functional characteristics of the tissue where it is placed and the micro spheres do not suffer any change in its physical and chemical properties after the implant.

The tissue histology where the META<>CRILL® is placed has been studied in biopsies of patients that had their implants with one year of intervals. The cuts have shown results that are similar to the results published in the literature.

In a period of eight years of clinical observation and with the number of cases in which it has been used, with no serious complications or side effects until now, it is a new therapeutic alternative, both for the plastic surgeon and for the other specialties, either surgical or clinical, as other medical specialties discover new uses for the substance.

In the areas of treatment related to Plastic Surgery, it has been shown to be very useful in the treatment of defects that could only be corrected by surgery before, even with the limitations and the inconveniences inherent to any surgical act. Also as a surgical co adjuvant, mainly of the face and in the nose, it has been shown to be very useful in the pre or post-operative period, improving the results and the quality of the final result.

New indications to the use of META<>CRILL® were recently developed: the increase in the diameter of the penis, the correction of the thoracic deformities, the facial recovery of AIDS patients and the treatment of contour alterations of inferior limbs and gluteus.

The use of META<>CRILL® in the above defined indications has been shown to be highly safe and efficient. The use in new procedures is in continuous process of development, and should be reported as the results are considered for use in the solution or improvement of many pathologies.