Plastic & Reconstructive Surgery:
Aquamid: Where Is the Reality?
Abenavoli, Fabio M. M.D.; Servili, Andrea M.D.; Corelli, Roberto M.S.
“San Pietro” Hospital; Fatebenefratelli; Rome, Italy
Correspondence to Dr. Abenavoli; Via Savoia 72; 00198 Rome, Italy; firstname.lastname@example.org
When we read the numerous accounts of the astonishing results obtained by so many colleagues through the use of Aquamid (Ferrosan, Soeborg, Denmark) infiltrations, to treat depressed areas, for example, or to raise deep wrinkles of the face for aesthetic purposes, it occurs to us to think that the cases that sometimes come to our attention are absolutely rare.
Aquamid is a soft-tissue filler, a transparent polyacrylamide gel consisting of approximately 2.5% cross-linked polyacrylamide and 97.5% apyrogenic water. It is used for soft-tissue augmentation and contour correction, with minimal reports of significant complications after injection into the face.1–5 After discussing personal experience with other colleagues who report an increasing number of such cases, multiplied by the large number of practicing surgeons just in Rome, we think that many cases, really, have not been reported, certainly not intentionally, possibly because the patients did not return for follow-up.
Just to give an example, we present the case of a 30-year-old woman who presented with a swollen area that included the entire right cheek as far as the inferior palpebral region (Fig. 1). The patient had sustained an injury to the face years earlier and had already undergone numerous reparative operations, with results, according to the patient, that were not completely acceptable. Consequently, to correct a depression of the operated area, the patient had undergone treatment by infiltration of an indeterminate quantity of injectable polyacrylamide. Approximately 3 years after the operation, however, the patient noticed swelling that was fluctuant and, as time passed, tended to increasingly move into a dependent position. A magnetic resonance imaging study confirmed the presence of the material previously infiltrated and revealed no other noteworthy findings. The patient underwent surgery, during which the same preauricular incision was used that had been used during one of the previous operations. After a brief, blunt subcutaneous dissection, an area was reached that appeared fluctuant; it was lined by an easily lacerable membrane of reactive tissue and contained some pasty liquid material, exactly corresponding to the methacrylate placed previously (Fig. 2). We removed the methacrylate together with the lining capsule, which appeared, however, to be tenaciously adherent to the underlying tissue planes. Taking into consideration the patient’s need to maintain adequate filling of the area (which intraoperatively was deprived of the polyacrylamide support and again appeared depressed), we proceeded to prepare a dermoadipose graft, by drawing from the inguinal region and fixing it in the subcutaneous site. The patient had an optimal postoperative period and at 3 months after the operation showed an optimal result even in terms of aesthetic appearance. A certain degree of reabsorption of the inserted graft is probably to be expected, but this can be remedied by lipofilling over the next few years.
We wish, therefore, to emphasize the possible problems related to the use of so many foreign materials that perhaps are too easily used ever more frequently because of statistics and results that may overstate their success.
Fabio M. Abenavoli, M.D.
Andrea Servili, M.D.
Roberto Corelli, M.S.
“San Pietro” Hospital
1. von Buelow, S., von Heimburg, D., and Pallua, N. Efficacy and safety of polyacrylamide hydrogel for facial soft-tissue augmentation. Plast. Reconstr. Surg.
116: 1137, 2005.
2. Christensen, L., Breiting, V., Janssen, M., Vuust, J., and Hogdall, E. Adverse reactions to injectable soft tissue permanent fillers. Br. J. Dermatol.
154: 755, 2006.
3. Amin, S. P., Marmur, E. S., and Goldberg, D. J. Complications from injectable polyacrylamide gel, a new nonbiodegradable soft tissue filler. Dermatol. Surg.
30: 1507, 2004.
4. De Cassia Novaes, W., and Berg, A. Experiences with a new nonbiodegradable hydrogel (Aquamid): A pilot study. Aesthetic Plast. Surg.
27: 425, 2003.
5. Breiting, V., Aasted, A., Jorgensen, A., Opitz, P., and Rosetzsky, A. A study on patients treated with polyacrylamide hydrogel injection for facial corrections. Aesthetic Plast. Surg.
28: 45, 2004.
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David H. Song, M.D., M.B.A. is the President-elect of the American Society of Plastic Surgeons (ASPS). He is a consultant with BioMet, Emmi Solutions, LLC, a consortium-member providing senior debt for Brava, and consultant with and investor in HealthEngine.com. He receives author royalties from Elsevier. Scot Glasberg, M.D. is the President of the American Society of Plastic Surgeons (ASPS). He is a consultant with LifeCell Corp and Mentor Corp and an investor with Strathspey Crown. The authors have no sources of funding to report related to the writing or submission of this discussion.
The location and affiliation information should read as follows: Arlington Heights, Ill. From the American Society of Plastic Surgeons/Plastic Surgery Foundation.
David H. Song, M.D., M.B.A., 444 E. Algonquin Rd. Arlington Heights, IL 60005, email@example.com
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