Evacuation of Complicated Polyacrylamide Gel With the Help of Ultrasonographic Markings and Fat-Transfer Cannula

Background: Polyacrylamide gel (PAAG) has been used extensively for soft tissue augmentation. Complications of PAAG injection mandate evacuation of filler. Objectives: This study aimed to introduce a new method of evacuating PAGG with the help ultrasonography markings on face. Patients and Methods: We enrolled patients who were unsatisfied with the results of injection or had developed complications such as induration, gel migration, or infection referred to our clinic to evacuate the filler since 2011. Patients were examined by ultrasonography and a radiologist reported the volume, place, and depth of gel as well as fibrosis and marked them on the patients' face or its photographs. We used Barikbin's tumescent solution to facilitate the evacuation of concentrated gel and reduce the risk of injury to vital tissues. We inserted a 16G-fat-transfer cannula through a hole on the nasolabial folds and evacuated the gel by vacuum force and milking. We also used a Barikbin's blunt subcision blade to dissect fibrosis. The evacuated region was irrigated by tumescent solution. Patients' satisfaction was assessed by visual analogue scale (VAS). The procedure was repeated at four-week interval until achieving favorable results. Results: We treated 173 patients, including 164 females (94.8%), with the mean (SD) age of 43.75 (10.62) years. According to VAS, 95.4% of patients reported complete satisfaction while 2 (1.2%) were unsatisfied with the results. Patients reported no complication of therapy. Conclusions: Our method provided good results and performing evacuation under the guide of bedside ultrasonography is recommended.