Delayed Inflammatory Reaction to Bio-Alcamid Polyacrylamide Gel Used for Soft-Tissue Augmentation

Abstract

Background: Given the recent boom of the cosmetic industry, there is a wealth of new products available to patients and physicians, including soft-tissue fillers. Bio-Alcamid polyacrylamide gel (Polymekon, Milan, Italy) is a filler that has potential to cause adverse reactions. Observations: Two patients who had previously been treated with Bio-Alcamid outside of the United States presented with different manifestations of inflammatory responses to the product. These reactions were challenging to treat. Conclusions: Despite claims of safety, Bio-Alcamid and possibly other soft-tissue fillers available worldwide have the potential to cause adverse reactions. Physicians should be aware of the various presentations and treatment options for these reactions.

Are Bacterial Growth and/or Chemotaxis Increased by Filler Injections? Implications for the Pathogenesis and Treatment of Filler-Related Granulomas

“…However, well-designed human studies are lacking in this field. Besides, patients affected by granulomas are frequently treated with drug combinations, making it difficult to determine the true effect of each drug [35]. …”

Complications caused by injection of dermal filler in Danish patients

“…Some studies suggest that the chronic infection with noduli and granuloma is due to the making of a bacterial biofilm [8,9], and once a biofilm is established, repeated active infection is common. Chronic, suppressive doses of antibiotics are needed, and sometimes the only cure is total removal of the implant and thereby the biofilm [8,10]. The optimal therapy for complications to dermal fillers depends on the nature, the onset of the complication, and the type of injected substance.…”

Polyalkylimide filler in human immunodeficiency virus-associated facial lipodystrophy: Ophthalmic complications

“…2 However, complications were subsequently reported including infection, product migration, recurring inflammation, inflammatory sterile abscesses, granulomas and hypersensitivity reactions. [2][3][4][5] Said complications appeared between one month and 3 years after application 2 and affected approximately 4.8% of patients. 5 The cause appeared to be a disruption of the fibrocellular capsule.…”

“…5 The cause appeared to be a disruption of the fibrocellular capsule. 3 Complications were treated with antibiotics, steroids, NSAIDs, drainage or extraction with diverse results. 3 In the patient of this report, the polyalkylimide filling was complicated with a subcutaneous abscess which, probably because it was adjacent, led to the development of an uncomplicated left preseptal cellulitis.…”

“…3 Complications were treated with antibiotics, steroids, NSAIDs, drainage or extraction with diverse results. 3 In the patient of this report, the polyalkylimide filling was complicated with a subcutaneous abscess which, probably because it was adjacent, led to the development of an uncomplicated left preseptal cellulitis. Aggressive empiric antibiotic therapy, covering the most frequent germs (S. aureus, Streptococcus pyogenes, Streptococcus pneumoniae, Haemophilus influenzae, anaerobics), clinic follow-up and supplementary tests for discarding more severe conditions (orbit cellulitis) or complications (preseptal abscess, necrosis, meningitis, cavernous sinus thrombosis) determined the positive evolution of the patient.…”