Background
Buttock augmentation is a commonly performed aesthetic surgery. Several methods have been described, but only the use of implants or autologous fat are consensually deemed safe and effective. Synthetic fillers in gluteal augmentation have been described despite potential severe long-term complications, both medical and aesthetic.
Objectives
The aim of this study is to report a series of two consecutive cases who underwent buttock- and hip augmentation with large volumes of permanent copolyamide filler requiring surgical removal due to significant complications. Based on these cases and a review of recent literature, a management algorithm is proposed.
Methods
We conducted a retrospective chart review of two consecutive cases of failed copolyamid filler augmentations in the gluteal and inguinal regions. We conducted a literature overview using PubMed (National Institutes of Health, Bethesda, MD) and Google Scholar (Google, Mountain View, CA) to include all articles concerning removal of large quantities of permanent copolyamide fillers.
Results
Two patients presented with complications after gluteal copolyamide filler treatments. Based on the physical properties of copolyamide, resection of the filler was performed by percutaneous aspiration with liposuction cannulas, with varying infiltration protocols. Both cases showed successful removal of major parts of the filler, however residual material tended towards migration, requiring a secondary intervention..
Conclusions
Hydrated low-pressure aspiration can manage non-integrated gluteal copolyamide filler but will achieve only partial resection. Literature shows that radical excision is possible, however with major drawbacks in function and aesthetics. Moreover, in acute inflammation and infection, an open approach should be preferred.
Explosion-related facial black powder injuries are difficult to treat due to traumatic tattooing of powder residue. A common treatment protocol consists of immediate debridement using a variety of surgical techniques with no other adjuncts. The results are often mediocre because of scarring or powder remnants in the skin. We present a patient who suffered innumerable black powder tattoos to the face after a canon explosion treated by initial debridement and serial treatments of 15% trichloroacetic acid (TCA) peelings with a highly satisfactory result.
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