You can add
HA over
PMMA or to add
PMMA over
HA. The reason for doing both differs. Generally, people start with
HA and then, if they like the results, they add
PMMA so they have something more permanent. Sometimes patients who have had some unevenness or bad experiences with
PMMA like a granuloma and were reluctant to add more. In this situation generally we take a dual track. Treat the granuloma and use
HA to help smooth things out. In short, you can go either way,
PMMA to
HA or
HA to
PMMA.
Dr. S