We have read the comments of Ramires and Miccoli regarding our group's article about late-onset adverse effects related to PAI injections.1 They allege that we made mistakes in our conclusions because we were not able to demonstrate the causality between the PAI injections and the late-onset adverse effects. Their argument hinges on 4 of the 6 patients with supposedly systemic adverse effects having been previously injected with other fillers that shared similar adverse effects with PAI. While prior injection with other substances did occur in 4 cases, the latency between the injection of the different fillers and the onset of the symptoms seems to indicate the potential role played by PAI.
Alijotas-Reig J, Garcia-Gimenez V. Polyalkylimide Implant: Critical Evaluation of a Clinical Study—Reply. Arch Dermatol. 2010;146(8):918-935. doi:10.1001/archdermatol.2010.189