Brazil has officially banned the use of PMMA (polymethylmethacrylate) for cosmetic body enhancement procedures following the passing of a woman who received injections in her glutes and thighs in May 2026. The ban took effect on June 2, 2026.
Dermatologist and IFBB Pro women’s physique competitor Dr. Natalia Spierings talked about it in a podcast with Nyle Nayga. During the conversation, she spoke extensively about the medical realities of PMMA and why the internet remains flooded with misinformation about this plastic-based filler.
PMMA stands for polymethylmethacrylate, essentially tiny plastic microspheres suspended in a medium like bovine collagen. “It’s like plexiglass,” Dr. Natalia explained. The substance has been FDA-approved in the United States since 2006 for specific facial applications, marketed as Bellafill for treating acne scarring and HIV-related facial fat loss.
The product comes in small 0.8ml syringes because it was designed only for facial use under the skin, not for large-volume body contouring.
Contrary to claims circulating online, PMMA remains legal in the United States and Europe for its approved dermatological uses. The legality issue exists only in Brazil, where using PMMA for large-volume aesthetic injections into muscles became properly restricted following the May fatality.
She stated, “So PMMA is not illegal because that’s what people a lot of people say that the actual treatment itself has been used in dermatology and plastic surgery for over 20 years and it’s been FDA approved in the United States since 2006.”
The mechanism of PMMA creates permanent volume by stimulating inflammation and collagen production around the plastic microspheres. While this works as intended in facial skin, injecting it intramuscularly presents serious medical concerns.
“If you put a bunch of plastic balls between those moving filaments, you’re going to damage the muscle fiber,” Dr. Natalia explained. The average time to complication onset in one study was 27 months, though complications can appear anywhere from 40 days to eight years post-injection.
The most concerning long-term complication involves kidney function. When PMMA stays in muscle, it creates granulomas that trigger biochemical events raising blood calcium levels.
“You’re looking at kidney failure, you’re looking at dialysis. This is not a joke,” Dr. Natalia emphasized. The risk of career-ending muscle dysfunction and potential organ failure makes accusations against top athletes particularly problematic, as no competitive bodybuilder at their peak would rationally accept such risks.
Dr. Natalia expressed skepticism about allegations that IFBB Pro Natalia Coelho used PMMA, particularly regarding claims that a Brazilian doctor possessed video evidence and medical records. Brazilian law like medical regulations worldwide, strictly prohibits doctors from disclosing patient information.
“This doctor would lose his license straight away” if the evidence became public, she noted. The supposed whistleblower would face immediate disciplinary action from Brazilian medical authorities, criminal penalties including three months to one year detention, and potential battery charges since PMMA aesthetic use became restricted in June.
The timing of these allegations, emerging just four weeks before the Olympia competition, struck Dr. Spierings as suspicious. She found it illogical that any medical professional would commit career termination by violating patient confidentiality, especially traveling to another country to present such information to a competitor who placed second the previous year.
Regarding detection, Dr. Spierings firmly stated that judges cannot reliably identify PMMA use by visual inspection.
“You cannot look at someone and be like, oh look, they’ve used PMMA.” Muscle irregularities can result from various injectable substances, including standard oil-based compounds and peptides that many athletes use. Lumps or asymmetries in muscles like deltoids occur naturally from routine injections, making visual assessment unreliable for determining PMMA use specifically.
Synthol, a different substance consisting of mixed oils including medium-chain triglycerides and lidocaine, has been used by bodybuilders for approximately 30 to 40 years according to medical literature. While also problematic, synthol presents a different risk profile than PMMA.
The oil can partially disperse over time, though it doesn’t disappear completely and requires repeated applications. Both substances cause mechanical muscle damage, but synthol lacks the permanent plastic microspheres that characterize PMMA.
Common complications from both substances include infection, abscesses requiring drainage or surgical intervention, painful oil deposits, and progressive muscle function impairment. The inability of muscles to contract properly under load becomes particularly problematic for competitive athletes who require optimal muscle performance.
Dr. Spierings suggested that Brazilian authorities compiled substantial data before implementing the ban. A 2016 audit by the Brazilian Association of Plastic Surgeons documented 17,000 reported cases of complications from aesthetic PMMA use, though the total number of users remains unknown, making precise risk calculation difficult.
The lack of comprehensive data stems from the underground nature of these treatments. “We will never have that data until a whole bunch of bodybuilders stand up and say, I did PMMA three years ago, and this is what happened,” Dr. Natalia acknowledged.
Medical confidentiality prevents doctors from reporting cases, and athletes experiencing complications years later rarely disclose their injection history.
For female athletes concerned about performance enhancement stuff, Dr. Natalia emphasized watching for early signs of virilization, particularly skin changes like acne and facial hair growth, which typically manifest before voice changes or other permanent alterations. She strongly recommended that women who cannot earn a pro card naturally should reconsider competing professionally, as extended substance use over many years compounds health risks significantly.
