Hello, Dr. George Yang and everybody else at this thread. Im from Denmark so sorry for any wrong spelled words.
I had Aquamid injectet i my lips and nasofolds 5 years ago. Now Im suddently swolled with hard lumps at every area the aquamid is placed. My doctor and Contura descibed Ciproxin antibiotics. The say that it cant be anything but and infection...late complications is never seen with Aquamid!! but I've learned that it cant bee true.
I have now been on antibiotics for nearly 4 weeks and its slowly getting worse, there have been no improvement at any time. This cannot be an infection after 5 years and no improvement with Ciproxin.
My doctor will now try steorid-pills. What do you think I should do?
Im terrified for how bad i will look in the end....please help me

Hi Signeann,

I'm sorry about your problems with Aquamid. You are not alone.

Antibiotic Treatment
Since you are not improving on Ciproxin antibiotic, the manufacturer has a secondary level of stronger antibiotics that they recommend. Here is the link: http://www.aquamid.com/downloadfiles/co ... otocol.pdf

1.Teicoplanin (glycopeptide), i.m. 400 mg immediately followed by 200 mg every 12 hours until complete remission, or
2. Lincomycin, i.m. 600 mg daily until complete remission, or
3. Linezolid, p.o. 600 mg x 2 daily until complete remission

The second level of stronger antibiotic may be worth trying prior to the steroid medication. If it is truly an infection, then steroids may weaken the immune system and make the infection worse. I will explain why your physician recommended steroid medication later in this post.

Infected Implants which are not responding to Antibiotics
In the Aquamid Complication Management protocol, they only discuss infection, and foreign body infection. All implants (breast implants, chin and cheek implants including all permanent and temporary injectable fillers) can get infected. If the infection related to the implant cannot be successfully treated with oral antibiotics or long term IV antibiotics, then the only way to stop the infection is to remove the implant and let the infection resolve prior to replacing the implant. This is easily done with solid implants such as breast, and facial implants, but not easily removed with permanent injectables. The temporary fillers will eventually go away.

Granulomatous Reaction or Foreign Body Reaction
The worry that physicians have regarding permanent fillers is with a type of reaction called a foreign body reaction or granulomatous reaction. These permanent fillers are in general non-reactive and the body ignores the material. However, in rare cases, the body does react to them and tries to use inflammation to try to "get rid" of the material or try to "wall off" the material since it can get rid of it. This is called a granulomatous reaction.

Since every location where the Aquamid was injected is simulataneously reacting, then this Foreign Body reaction is a distinct possiblility. It is unlikely that a lip infection can travel to the smile lines without a path. So it is possible that your body doesn't like the Aquamid anymore and is trying to use inflammation to tell you that.

Steroid Treatments
Prior to trying to remove a permanent filler, it may be worth trying steroid treatments to calm down the swelling and inflammation. Often it will calm down the inflammatory reaction and if treated long enough, many of these inflammations will become dormant. However, in other cases, the reaction may start up again when the steroid medications is stopped.

Here are two previous threads answering questions about Aquamid problems:

The first was was titled: Aquamid

The second one was titled: Aquamid Infection

I found an article about Aquamid published in 2005 in the European Journal of Plastic Surgery entitled:

Adverse reactions following injection with a permanent facial filler polyacrylamide hydrogel (Aquamid): causes and treatment

Lise Christensen1, 5 , Vibeke Breiting2, Jens Vuust3 and Estrid Hogdall4

(1) Department of Pathology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
(2) Holte Clinic of Plastic Surgery, Holte, Denmark
(3) Department of Clinical Biochemistry, Statens Serum Institute, Copenhagen, Denmark
(4) Department of Virus, Hormones and Cancer, Danish Cancer Society, Copenhagen, Denmark
(5) Department of Pathology, Bispebjerg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark

Received: 6 January 2005 Accepted: 18 August 2005 Published online: 15 November 2005

Abstract
Background Polyacrylamide hydrogel (Aquamid), an atoxic non-immunogenic gel of the non-resorbable type, has gained widespread popularity as an injectable filler for facial augmentation. However, adverse events (AEs) have occurred, the nature of which seems obscure because of negative findings on culture and a pattern of foreign-body response on microscopy.
Design This is a prospective study of case reports provided by physicians injecting Aquamid during the period 21 May 2001 to 15 September 2003.
Materials Among 40,000 persons injected, 55 were reported to have experienced AEs. Information from questionnaires distributed along with the product and follow-up information from involved physicians was collected into a database.
Results AEs occurring mainly in lips and nasolabial folds were reported in 55 patients, with 51 requiring treatment. The time from the last gel injection to the debut of the AE varied from 2 to 364 days, with a median of 12 days. Seventeen patients presented with different types of reaction to the injection, and the exact cause of the AE was established in another 19. A complete follow-up until full recovery was available in only 43 cases (84%). A broad-spectrum antibiotic in high dosage was effective for a short time. Steroids and non-steroidal anti-inflammatory drugs (NSAIDs) tended to aggravate symptoms and to prolong treatment time.
Conclusions AEs presenting clinically as nodules or swellings later than 1 week and less than 1 year after the injection of polyacrylamide hydrogel (Aquamid) should be treated immediately with a broad-spectrum antibiotic (quinolone) in high dosage. Steroids or NSAIDs are contraindicated.
Keywords Adverse event - Inflammation - Polyacrylamide hydrogel - Facial filler - Worldwide - DNA sequencing

The authors have no relevant financial interest in this study

--------------------------------------------------------------------------------


Lise Christensen
Email: liserh01870christensen@rh.dk
Phone: +45-35312631
Fax: +45-35313901

In this article, over 40,000 patients in Denmark were injected with Aquamid, and only 55 people had an adverse reaction (AE) occuring on average within 12 days after the injection. This is about a 0.1% chance of having an early adverse reaction, which does not differ much from other injectables.

In general if a patient starts having redness and inflammation soon after an injectable, it is most likely from an infection. So the treatment is antibiotics, since it is too early for the body to "reject" the filler material. Why do infections happen? Anytime an foreign object is inserted into the tissues, there is a risk for infection. In general, with good sterile technique, the chance of infection is less than 0.1%, so this study matches up with this number.

I believe that this study is implying that Aquamid is safe and there is a 0.1% chance of having any problems with this filler; however, it is not the early problems that I and many other conservative doctors worry about, it is the late complications, long after your injection.

A similar problem occured with injectable silicone in the 1980's, when everyone was getting silicone injections. Most people did not have problems until 5-10 years later. This is why many surgeons who worry about "harming" their patients will not try new fillers unless they have been in use for at least 10 years. Why 10 years? Most of these permanent injectables don't have any problems initially, it is during the following 10 years which is the true test of whether it will have a late complication. Since 40,000 people in Denmark were injected in 2001-2003, we will see if there are more and more people who will have the same problem as yourself in the upcoming years.

I wish you luck with your treatments, hopefully the reaction will go away with either the stronger antibiotics or steroid injections or pills. It is the hope that you will not need to have the material removed, since it cannot be removed easily, the same way that it is injected.

Best,

Dr. Yang

Dear Dr. Yang, thank so much for your long answer. I am very greatful.
I I do have one more question... you mentioned steroid injections. My doctor wont use it, he says it carres a very big risk.
I have read at lot of articles about foreign body reactions and granulomas. In these cases the doctors use steroid injections, but my own doctor wont use it, only pills.
Is it dangerous to use injections? does it give better results?
maybe I should find another doctor who will do it? I mean if the antibiotics dont help....

I thought Ciproxin was the stongest antibiotichs there is.....

best regards

Hi signeann,

Is it dangerous to use injections?

Injections of steroids (Kenalog) do come with potential side effects. So many physicians and surgeons may be wary when recommending steroid injections and may choose not of offer them at all, especially if they had a bad experience treating one of their own patients. If you google Kenalog and side effects or adverse reactions you will find that this treatment is not without risks. Here is a previous question I answered about steroid side effects: http://messageboards.makemeheal.com/vie ... ht=kenalog

does it give better results?

The kenalog injection gives a more localized and concentrated treatment of the affected area. For example, most facelift surgeons will often use these steroid injections behind the ears for thickened scars. This helps this thickened scar tissue to soften and flatten out. I would guess that the same affect would not occur by giving oral steroid medications.

Oral steroid medications can cause its own set of side effects with Cushings'-like symptoms. I would prefer to keep the medication treating the area that I want and minimize the affects on the body.

maybe I should find another doctor who will do it? I mean if the antibiotics dont help....

Its worth getting a second opinion. You can also ask your surgeon/physician what adverse reactions they have seen when using steroid injections which made them not use it.

Best,

Dr. Yang

Dear All,

Stay away from Aquamid or any permenant fillers. Doctors who say these are ok are just trying to make money and not tell their customers the real truth. Aquamid themselves take no action when problems occur. Why would anyone want to inject something in their bode when the manufacturers have this kind of approach?
I had Aquamid injected 8 years ago in my lips and I still have complications. The product lumps up and causes lumps which are visible to the naked eye. It is also extremely painful.
I was 19 when i got this done in Australia in About Face clinic. The doctor Michael (sorry i forgot his last name) told me that it would last at least 6 years, implying it would be gone after that.
Thankfully throughout the years the Aquamid lumps came close to the skin and every so often I go to my plastic surgeon for him to puncture and suck out any product that is easy to access. I have already passed by this process a few times and am currently removing another lump. I am hoping this will be one of the last as I feel there is not much left since I did not have very big amounts inserted. Sometimes it does create problems as there are big portions of the gel which are stuck together and it seems to block the canals causing infections as it does not allow all fluid to come out. With antibiotics this is controlled but painful as sometimes the lip swells up until it breaks open with an inflammation. However this allows the product to come out, so I see it in a positive way.
It really worries me people that have had big amounts injected as I think they will not be as lucky as me for the removal.

All the best for all of you.

Hi smsm1,

Thank you for sharing your first hand account about the dangers of permanent fillers such as Aquamid. I agree with your opinion. Luckily you were able to eventually get the Aquamid out. Many others are not so lucky with other permanent fillers which can not be squeezed out or shrunk down with steroid injections.

Best,

Dr. Yang

i have read that implants can get infected after many years without problems, is this true? i have a chin implant for 2 years, how would i be able tell that my implant got infected? how does an implant get infected after years without infection? what causes it? could be that if u have an infection in your body, then the infection spreads out to the implant?

Hi orlandopunk,

The chance of infection is low if it doesn't get infected during the early post-operative period. Obviously any part of our human body can become infected, but because our natural tissues have a live blood supply, our immune system can fight any infection, and if we take antibiotics, the blood supply can deliver the antibiotic medication to the infected area.

The main issue of implants versus natural tissues is that the implant does not have a blood supply to it. One type of implant that has tiny holes in it is called Medpor, made of porous polyethylene, is supposed to be more resistant to infection, because our tissues can grow into the implant and potentially deliver antibiotics deeper into the implant. However, these Medpor implants can also become infected and antibiotics may not be able to fight the infection in every case enough to keep the implant in.

The most common type of chin implant is made of silicone. If the implant is infected, the patient will have the typical signs of infection. These signs of infection was recognized back in the Roman times, and in Latin the signs were: tumor, rubor, calor, and dolor. Tumor = swelling, Rubor = redness, Calor = heat or warmth, and Dolor = pain. Just think of a pimple, and that will be easy to remember. Since a pimple is so small, the person may not notice the warmth, but swelling, redness, and pain is obviously there.

Any medical or dental procedure which has a risk of infection has a small risk of traveling through the blood stream to the implant, whether a knee replacement, or a heart valve replacement. So patients who have a knee replacement or artificial heart valves typically will take antibiotic prophalaxis prior to the dental procedure to reduce the risk of infection. If patient informs (always inform your doctors of all medical information and let them decide what is or is not important) their doctor or surgeon prior to any medical, surgical or dental procedure that they have some kind of foreign implant (pacemaker, cosmetic implant, joint replacement, heart valve, etc.) most likely they will put you on some kind of antibiotic prior to the procedure.

Since the human mouth has a lot of natural bacteria, dental procedures are commonly known to use antibiotic prophalaxis. A human bite has more bacteria than a dog bite. However, most surgical procedures are clean, meaning that in the operating room we can prep the skin with antibacterial cleansers, and iodine (betadyne) prior to making the incision. All of the instruments are sterilized, so the chance for infection after a clean surgical procedure is lower than a dental procedure.

I hope that makes more sense.

Best,

Dr. Yang