Polyacrylamide hydrogel as a long-lasting and permanent soft tissue filler, 4 years experience

ABSTRACT

Soft tissues augmentation has been tried for decades and many materials were used including biological and artificial fillers. Many synthetic injectable augmentation fillers were used but unfortunately, none of them was ideal. Polyacrylamide gel [PAAG] is a group of non-absorbable, long-lasting, non allergic, malleable and relatively cheap soft tissue fillers that have been extensively used in the Europe, Middle East and many countries for more than 10 years with satisfactory augmentation results and few complications on the short-term follow-up duration. In this study, we report more than 4-years experience in using two types of injectable PAAG for facial and body soft tissue augmentation, We used Bio-alcamid for facial augmentation and Esteform for lower limb augmentation. A total of 618 patients were injected with PAAG. Bio-alcamid was used to augment different areas in the face in 571 patients. It was injected into the malar, nasolabial lines, buccal, lateral face, chin and temples, while Esteform was injected in the gluteal areas, thighs and legs in 47 patients. The follow-up period ranged between 15 and 48 months. The early post-procedure [after 2 weeks] augmentation results showed that 96.1% [594 patients] expressed satisfaction but the later aesthetic results and satisfaction were decreased over the follow-up time. Among our series, 73 patients [11.8%] required more than one session of injection either for more augmentation [52 patients = 8.4%] or touch up to correct asymmetry or irregularities [21 patients =3.4%]. The overall incidence of the reported complications was 6.6%, where 41 patients had developed delayed adverse reactions at or near the injection sites. 7 out of these 41 patients developed multiple complications along the follow-up period. Nodularity, infection, migration, induration and disfigurement represented the most common reported complications and were treated with either surgical or conservative treatment. PAAG is long lasting filler that gives high rate of early satisfaction but with several delayed adverse effects. It is not safe, especially in the face, and needs certain precautions to minimize its related complications. These complications usually occur months or even years after injection and are difficult to treat, which is why the best way to minimize complications is to avoid these types of fillers