Ibrahim, S., El Kholosy, H., Abulhassan, A. (2024). Challenging Gluteal Augmentation Due to Late Complication of Permanent Filler: Case Report and Literature Review. The Egyptian Journal of Plastic and Reconstructive Surgery, 48(1), 65-72. doi: 10.21608/ejprs.2024.336331
Saad M S Ibrahim; Hassan M El Kholosy; Ali H S Abulhassan. "Challenging Gluteal Augmentation Due to Late Complication of Permanent Filler: Case Report and Literature Review". The Egyptian Journal of Plastic and Reconstructive Surgery, 48, 1, 2024, 65-72. doi: 10.21608/ejprs.2024.336331
Ibrahim, S., El Kholosy, H., Abulhassan, A. (2024). 'Challenging Gluteal Augmentation Due to Late Complication of Permanent Filler: Case Report and Literature Review', The Egyptian Journal of Plastic and Reconstructive Surgery, 48(1), pp. 65-72. doi: 10.21608/ejprs.2024.336331
Ibrahim, S., El Kholosy, H., Abulhassan, A. Challenging Gluteal Augmentation Due to Late Complication of Permanent Filler: Case Report and Literature Review. The Egyptian Journal of Plastic and Reconstructive Surgery, 2024; 48(1): 65-72. doi: 10.21608/ejprs.2024.336331
Challenging Gluteal Augmentation Due to Late Complication of Permanent Filler: Case Report and Literature Review
The Department of Plastic Surgery, Reconstructive Surgery and Burn Management, Faculty of Medicine, Alexandria University
Abstract
Polyacrylamide hydrogel (PAAG) has been used for more than two decades as a permanent injectable for facial and soft tissue augmentation. With the advent of so-called “minimally invasive” techniques, permanent injectables became popular with both patients and physicians. However, several late complications have been reported worldwide. Here, we present a 43-year-old female patient who experienced late complications 8 years after buttock augmentation with PAAG injections with a difficult reconstruction of the gluteal region. We also reviewed the literature on clinical management issues and available reconstructive options for this problem. The search in the clinical key using the term polyacrylamide hydrogel yielded 169 results in various fields of medicine, limiting the search in plastic surgery yielded 67 results, 14 in facial rejuvenation, 9 in breast augmentation, 7 in buttock augmentation, 2 literatures on the use of u/s in the diagnosis of PAAG complications, and 35 literatures on the composition, histologic analysis, and general complications from the use of PAAG. Searching for the term gluteal augmentation after excluding augmentation modalities other than PAAG ends at 7 literatures, however, the total number of these clinical reports on complications of PAAG use for buttock augmentation is striking, accounting for more than 50% of the studies. All literatures conclude that the PAAG filler is easy to inject, but once complications occur, they are difficult to manage.
Atiyeh B., Ghieh F. and Oneisi A.: Safety and Efficiency of Minimally Invasive Gluteal Augmentation: A Review [published online ahead of print, 2022 Aug 23]. Aesthetic Plast Surg., 10.1007/s00266-022-03049-5. doi:10.1007/ s00266-022-03049-5, 2022. 2- Wolters M. and Lampe H.: Prospective multicenter study for evaluation of safety, efficacy, and esthetic results of cross-linked polyacrylamide hydrogel in 81 patients. Dermatol. Surg., 35 (Suppl 1): 338-343, 2009. doi:10.1111/ j.1524-4725.2008.01040.x. 3- Narins R.S., Coleman W.P. 3rd, Rohrich R., et al.: 12-Month controlled study in the United States of the safety and efficacy of a permanent 2.5% polyacrylamide hydrogel soft-tissue filler. Dermatol Surg., 36 (Suppl 3): 1819-1829, 2010. doi:10.1111/j.1524-4725.2010.01736.x. 4- Manafi A., Emami A.H., Pooli A.H., Habibi M. and Saidian L.: Unacceptable results with an accepted soft tissue filler: Polyacrylamide hydrogel. Aesthetic Plast Surg., 34 (4): 413-422, 2010. doi:10.1007/s00266-009-9359-3. 5- Schelke L.W., Velthuis P.J. and van Dijk M.R.: Polyalkylimide: A Nonstable Filler Over Time. Dermatol. Surg., 44 (4): 563-567, 2018. doi:10.1097/DSS.0000000000001388. 6- Christensen L.H., Breiting V.B., Aasted A., Jørgensen A. and Kebuladze I.: Long-term effects of polyacrylamide hydrogel on human breast tissue. Plast Reconstr. Surg., 111 (6): 1883-1890, 2003. doi:10.1097/01. PRS.0000056873.87165.5A. 7- von Buelow S., von Heimburg D. and Pallua N.: Efficacy and safety of polyacrylamide hydrogel for facial soft-tissue augmentation. Plast Reconstr. Surg., 116 (4): 1137- 1148, 2005. doi:10.1097/01.prs.0000179349.14392.a4. 8- van Dam D., van der Lei B. and Cromheecke M.: Statements on the safety of permanent soft tissue fillers in Europe. Aesthetic Plast. Surg., 33 (4): 479-481, 2009. doi:10.1007/s00266-009-9369-1. 9- Cheng N.X., Xu S.L., Deng H., et al.: Migration of implants: A problem with injectable polyacrylamide gel in aesthetic plastic surgery. Aesthetic Plast. Surg., 30 (2): 215-225, 2006. doi:10.1007/s00266-005-0081-5. 10- Amin S.P., Marmur E.S. and Goldberg D.J.: Complications from injectable polyacrylamide gel, a new nonbiodegradable soft tissue filler. Dermatol. Surg., 30 (12 Pt 2): 1507- 1509, 2004. doi:10.1111/j.1524-4725.2004.30551.x. 11- Chalcarz M. and Żurawski J.: Injection of Aquafilling® for Breast Augmentation Causes Inflammatory Responses Independent of Visible Symptoms. Aesthetic Plast. Surg., 45 (2): 481-490, 2021. doi:10.1007/s00266-020-01949-y. 12- Wu H., Moser C., Wang H.Z., Høiby N. and Song Z.J.: Strategies for combating bacterial biofilm infections. Int. J. Oral Sci., 7 (1): 1-7, 2015. Published 2015 Mar. 23. doi:10.1038/ijos.2014.65. 13- Christensen L.: Normal and pathologic tissue reactions to soft tissue gel fillers. Dermatol Surg., 33 (Suppl 2): S168-S175, 2007. doi:10.1111/j.1524-4725.2007.33357.x. 14- Lahiri A. and Waters R.: Experience with Bio-Alcamid, a new soft tissue endoprosthesis. J. Plast. Reconstr. Aesthet. Surg., 60 (6): 663-667, 2007. doi:10.1016/j.bjps. 2006.07.010. 15- Campana M., Lazzeri D., Rosato L., et al.: Late-onset gluteal Escherichia coli abscess formation 7 years after soft tissue augmentation with Bio-Alcamid in a HIV-positive patient. J. Plast. Reconstr. Aesthet. Surg., 63 (9): e709-e710, 2010. doi:10.1016/j.bjps.2010.04.025. 16- Lemperle G., Morhenn V. and Charrier U.: Human Histology and Persistence of Various Injectable Filler Substances for Soft Tissue Augmentation. Aesthetic Plast. Surg., 44 (4): 1348-1360, 2020. doi:10.1007/s00266-020-01827-7. 17- Kadouch J.A., Kadouch D.J., Fortuin S., van Rozelaar L., Karim R.B. and Hoekzema R.: Delayed-onset complications of facial soft tissue augmentation with permanent fillers in 85 patients. Dermatol Surg., 39 (10): 1474-1485, 2013. doi:10.1111/dsu.12313. 18- Urdiales-Gálvez F., Delgado N.E., Figueiredo V., et al.: Treatment of Soft Tissue Filler Complications: Expert Consensus Recommendations. Aesthetic Plast. Surg., 42 (2): 498-510, 2018. doi:10.1007/s00266-017-1063-0. 19- Sadashivaiah A.B. and Mysore V.: Biofilms: Their role in dermal fillers. J. Cutan Aesthet. Surg., 3 (1): 20-22, 2010. doi:10.4103/0974-2077.63257. 20- Ibrahim O., Overman J., Arndt K.A. and Dover J.S.: Filler Nodules: Inflammatory or Infectious? A Review of Biofilms and Their Implications on Clinical Practice. Dermatol. Surg., 44 (1): 53-60, 2018. doi:10.1097/ DSS.0000000000001202. 21- Christensen L., Breiting V., Bjarnsholt T., et al.: Bacterial infection as a likely cause of adverse reactions to poVol. 48, No. 1 / Challenging Gluteal Augmentation Due to Late Complication o 72 f Permanent Filler lyacrylamide hydrogel fillers in cosmetic surgery. Clin. Infect. Dis., 56 (10): 1438-1444, 2013. doi:10.1093/cid/ cit067. 22- Sclafani A.P. and Fagien S.: Treatment of injectable soft tissue filler complications. Dermatol. Surg., 35 (Suppl 2): 1672-1680, 2009. doi:10.1111/j.1524-4725.2009.01346.x. 23- DeLorenzi C.: Complications of injectable fillers, part I. Aesthet. Surg. J., 33 (4): 561-575, 2013. doi: 10.1177/ 1090820X13484492 24- Blanco Souza T.A., Colomé L.M., Bender E.A. and Lemperle G.: Brazilian Consensus Recommendation on the Use of Polymethylmethacrylate Filler in Facial and Corporal Aesthetics. Aesthetic Plast. Surg., 42 (5): 1244-1251, 2018. doi:10.1007/s00266-018-1167-1. 25- Chacur R., Sampaio Menezes H., Maria Bordin da Silva Chacur N., et al.: Gluteal Augmentation with Polymethyl Methacrylate: A 10-year Cohort Study. Plast. Reconstr. Surg. Glob. Open., 7 (5): e2193, 2019. Published 2019 May 31. doi:10.1097/GOX.0000000000002193. 26- Grippaudo F.R. and Mattei M.: High-frequency sonography of temporary and permanent dermal fillers. Skin Res. Technol., 16 (3): 265-269, 2010. doi:10.1111/j.1600- 0846.2010.00428.x 27- Suchyta M.A., Hunt C.H., Eiken P. and Mardini S.: Intraoperative Ultrasound Imaging in Silicone Filler Removal. J. Craniofac. Surg., May 1; 32 (3): e276-e278, 2021. doi: 10.1097/SCS.0000000000007196. PMID: 34779591. 28- Echo A., Menn Z.K. and Friedman J.D.: A minimally invasive approach for the correction of a traumatic buttock deformity via wire subcision and volume replacement. J. Plast. Reconstr. Aesthet. Surg., 65 (6): e163-e165, 2012. doi:10.1016/j.bjps.2011.12.020.