Challenging Gluteal Augmentation Due to Late Complication of Permanent Filler: Case Report and Literature Review
Ibrahim, S., El Kholosy, H., Abulhassan, A. (2024). Challenging Gluteal Augmentation Due to Late Complication of Permanent Filler: Case Report and Literature Review. EKB Journal Management System, 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". EKB Journal Management System, 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', EKB Journal Management System, 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. EKB Journal Management System, 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 Egyptian Journal of Plastic and Reconstructive Surgery
Article 10, Volume 48, Issue 1, January 2024, Page 65-72  XML PDF (379.21 K)
Document Type: Case Report
DOI: 10.21608/ejprs.2024.336331
View on SCiNiTO View on SCiNiTO
Authors
Saad M S Ibrahim* ; Hassan M El Kholosy; Ali H S Abulhassan
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.
Keywords
Polyacrylamide; PAAG; Gluteal; Augmentation; Complications
References
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.

Statistics
Article View: 107
PDF Download: 111