Complications from repeated injection or puncture of old polyacrylamide gel implant sites: Case reports

Polyacrylamide gel has been used for soft tissue augmentation outside the United States since 1997. Despite some adverse events, the long duration of the augmentation and the tangible filling effect has increased its use in Asia and the Middle East. In this era of mesotherapy and fillers, patients are more likely than ever to have additional injections. The response of old polyacrylamide gel implant sites to puncture or repeated injection has not been reported previously. A total of 12 cases were treated for acute inflammation after puncture of polyacrylamide gel implants with injection needles or minor surgical intervention. The duration of augmentation after the initial injection was from 6 months to 4 years. Acute inflammation followed a certain pattern. Patients presented with pain, swelling, redness, and significant induration after puncture of the dormant implant. Resolution was achieved gradually with drainage, empirical antibiotics, and antiinflammatory agents in 1 to 2 weeks. Cultures of removed gel were negative. The cause of inflammation was difficult to define, but a definite link to puncture of the implant could be found in all patients. Puncture of the implant violates the tissue-implant barrier and induces inflammation or introduces bacteria that are not detectable in culture but may contribute to inflammation in the presence of the filler material. Further research is needed to assess the inflammation observed with repeated puncture of old polyacrylamide gel implants and its implications. In the meantime, patients should be warned about the possibility of inflammation in the case of puncture or surgery to the implant site, even years after the polyacrylamide gel injection.