Management of a Large Quantity of Permanent Gluteal Copolyamide Fillers (Aqualift/Activegel): Literature Review and Algorithm

Abstract

Background Buttock augmentation is a commonly performed aesthetic surgery. Several methods have been described, but only the use of implants or autologous fat are consensually deemed safe and effective. Synthetic fillers in gluteal augmentation have been described despite potential severe long-term complications, both medical and aesthetic. Objectives The aim of this study is to report a series of two consecutive cases who underwent buttock- and hip augmentation with large volumes of permanent copolyamide filler requiring surgical removal due to significant complications. Based on these cases and a review of recent literature, a management algorithm is proposed. Methods We conducted a retrospective chart review of two consecutive cases of failed copolyamid filler augmentations in the gluteal and inguinal regions. We conducted a literature overview using PubMed (National Institutes of Health, Bethesda, MD) and Google Scholar (Google, Mountain View, CA) to include all articles concerning removal of large quantities of permanent copolyamide fillers. Results Two patients presented with complications after gluteal copolyamide filler treatments. Based on the physical properties of copolyamide, resection of the filler was performed by percutaneous aspiration with liposuction cannulas, with varying infiltration protocols. Both cases showed successful removal of major parts of the filler, however residual material tended towards migration, requiring a secondary intervention.. Conclusions Hydrated low-pressure aspiration can manage non-integrated gluteal copolyamide filler but will achieve only partial resection. Literature shows that radical excision is possible, however with major drawbacks in function and aesthetics. Moreover, in acute inflammation and infection, an open approach should be preferred.

Long-term Complications of Gluteal Augmentation Using Aquafilling Filler: A Case Report

“…According to the suggested algorithm by Elahi et al, aspiration techniques can lead to satisfactory results; however, infectious cases should always be treated with a direct approach. 6 This case report is an excellent example of an exceptional long-term complication of Aquafilling filler, which shows the migration of the product all the way from the buttock to the lower leg, causing communicating abscesses and inflammation. Not to mention, the oncogenicity as well as toxicity of polyacrylamide, the core material of Aquafilling filler, remains uncertain.…”

“…According to the suggested algorithm by Elahi et al, aspiration techniques can lead to satisfactory results; however, infectious cases should always be treated with a direct approach. 6 …”

Filler Migration after Facial Injection—A Narrative Review

“…The kinetics of HA degradation by hyaluronidase is dependent on crosslinking filler technology, but not the concentration of HA [35]. Permanent fillers have been associated with possible delayed adverse events occurring even years after injection and with unwanted systemic side effects including myalgia, arthralgia, fever, lymphadenopathy, and malaise [36,37]. A great danger for patients arises from the use of illegal injectable fillers [38].…”

Subcutaneous Washout Procedure (SWOP) zur Behandlung schwerwiegender Komplikationen einer ästhetischen Glutealaugmentation durch Copolyamid-Filler

“…Aktuell wird in der Literatur mehrheitlich eine operative Therapie mit Entfernung des Fillermaterials, einem Débridement des umliegenden Gewebes und einer Lavagierung in zwei bis vier Sitzungen, in Kombination mit einer intravenösen antibiotischen Therapie beschrieben [1,2,5,[13][14][15][16][17]. In bislang nur zwei Fallberichten wurde eine SWOP-Technik, wie von uns durchgeführt, vorgestellt [18,19]. Die Reoperationsraten bei konservativem chirurgischen Vorgehen wird mit 88.89 %, bei radikaler Exzision mit 22.73 % angegeben [20].…”