Delayed Gel Indurations as an Adverse Effect of Polyacrylamide Filler and Its Easy Treatment

Abstract

Background. The more increasing use of permanent soft tissue fillers such as polyacrylamide hydrogel (PAAG) for aesthetic purposes, the more adverse events resulting from them are reported. Occasionally, nonserious complications and misdiagnosis result in unnecessary surgeries and sequels. Objective. To introduce delayed gel indurations (DGIs) as a late onset complication of PAAG and its easy treatment. Patient and Methods. Twenty patients (17 females and 3 males) referred to us with subcutaneous mass at injected site of PAAG. We diagnosed DGI based on clinical and sonography findings and treatment was performed with a hole by 16-gauge needle and squeezing. Results. From 20 patients with 21 cases of DGI, 5 (23.8%), 5 (23.8%), and 5 (23.8%) cases in cheeks, glabella, and lips were seen, respectively. The time range between PAAG injection and presentation of patients was 10–28 months (mean = 17.5%). All of the patients responded very well to treatment without recurrence and any complications. Conclusion. DGI is a nonserious, late onset, and easily treated complication of PAAG that is probably induced due to water exchange between gel and surrounding tissue and modest host immune reaction to gel.

Surgical Lip Remodeling Following Permanent Filler Injection: A Scoping Review

“…2,3 Although some reports indicate that permanent lip filler is safe, many others describe early-and late-onset complications. [4][5][6][7][8] Earlyonset complications usually relate to overfilling or improper injection technique. Late-onset complications are generally caused by foreign body reactions or by dehydration of the filler itself, leading to unfavorable results: many fillers are in fact composed by 2.5% to 5% of a permanent agent while the remaining portion is sterile water.…”

Complications of polyacrylamide gel filler in the Asian-Australian population

“…2,11,12 Complications of facial augmentation can be treated with needle aspiration, incisional drainage or stab incision of the collection of PAAG filler with good effect. 15 Radmanesh also describes a safe and effective technique using a fiberoptic laser by using the laser tip within a metal cannula to liquefy the material. 16 However, in many cases, diffuse distribution of the gel and injection into multiple tissue planes can make treatment difficult or impossible, with unsatisfactory cosmetic outcomes for patients despite surgical intervention.…”

Intra-Articular Polyacrylamide Hydrogel Injections Are Not Innocent

“…Polyacrylamide hydrogels are biostable and very commonly used as filling materials especially in esthetic and urologic surgeries [ 10 , 11 ]. Their popularity is increasing, particularly in the practice of orthopedics recently.…”

“…They contain 4.5 ± 1.5% polyacrylamide, 95.5 ± 1.5% distillated water, and 0.01-0.02% silver ions [ 8 , 9 ]. In particular after esthetic surgeries, transient surgical side pain, hematoma, irregularity, gel deposition, and asymmetry, tissue reactions including infection, foreign body granuloma, edema, inflammation, tenderness, and sensitivity, and adverse effects including gel migration and induration were very rarely reported [ 10 ].…”