Removal of Polyacrylamide Gel (Aquamid®) from the Lip as a Solution for Late-Onset Complications: Our 8-Year Experience

Abstract

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Aesthetic Surgical Pathway in Permanent Facial Filler Removal

“…Direct excision of a previously injected area may avoid to injury noble anatomical structure, although induce a visible scar with unpleasant aesthetic result. 18,27 In the present cases, we paid attention on aesthetic surgical approach, already used for facial aesthetic surgery or surgical rejuvenation, in order to remove facial filler, restore aesthetic balance of the area, and hide the scar needed for the surgical access (►Fig. 8A, B).…”

“…complications, as systemic antibiotic therapy, intra-lesional injections of corticosteroid and/or 5fluorouracil, needle aspiration, surgical drainage and laser therapy [7][8][9][10][11] ,although none of those techniques is able to totally remove previously injected permanent fillers. he mainstay for a proper preoperative filler-removal evaluation is represented by the Magnetic Resonance Imaging (MRI) 13 .Ultrasonographic evaluation may give infos related to the facial location of the filler and regarding the type of filler injected, although only the MRI let the surgeon to clearly evaluate the relationship between the fillers and the surrounding tissues such as muscles, fat compartments and fascia layers 13,14 .A careful preoperative evaluation is mandatory to reduce the risk of facial nerve damaging, a main issue why surgeons usually refuse to perform these surgical procedures.Although non-surgical procedures may solve and/or mitigate permanent fillers complications, the only way to remove the filler previously injected is represented by surgical excision [15][16][17][18][19][20] . A very poor literature is present about this topic, only some reports of permanent filler surgical removal have been published, especially focusing on lips area 3,5,19,20 .Permanent filler removal with direct excision induce visible and unpleasant scar.We present a pathway of facial surgical accesses to be performed in order to remove permanent fillers previously injected with hidden access achieving two goals: permanent filler removal and facial aesthetic balance restoration.…”

“…They stated that intraoperatively, none of their patients demonstrated a welldefined fibrous capsule separating the implant from the surrounding scar tissue,but rather general fibrosis and a diffuse distribution of the product within all the three layers of the lips. This finding, in general, is the problem related to all non-absorbable facial fillers, especially when they have been injected in areas where peripheric branches of facial nerve are present: tissue damage and scarring are the main factors why surgeons often prefer not to perform surgery in this patient population.Direct excision of a previously injected area may avoid to injury noble anatomical structure, although induce a visible scar with unpleasant aesthetic result 19,28 . In the present cases, we payed attention on aesthetic surgical approach, already used for facial aesthetic surgery or surgical rejuvenation, in order to remove facial filler, restore aesthetic balance of the area and hide the scar needed for the surgical access (Figure8a-b).…”

“…Although nonsurgical procedures may solve and/or mitigate permanent fillers complications, the only way to remove the filler previously injected is represented by surgical excision. 8,[15][16][17][18][19] A very poor literature is present about this topic, only some reports of permanent filler surgical removal have been published, especially focusing on lips area. 3,5,18,19 Permanent filler removal with direct excision induce visible and unpleasant scar.…”

Polyacrylamide Injection vs. Polylactic Acid in HIV Related Lipodystrophy: A RCT Systematic Review

“…Polyacrylamide application is a minimally invasive and effective procedure, but possible complications related to the injection are reported, such as migration of the gel, fibrosis and visible accumulations [23]. Surgical intervention could be needed to deal with these cases [23,24], and for these reasons polyacrylamide is still not approved in many countries.…”