Polyacrylamide hydrogel (PAAG) has been used for more
than two decades as a permanent injectable for facial and soft
tissue augmentation. With the advent of so-called “minimally
invasive" techniques, permanent injectables became popular
with both patients and physicians. However, several late complications
have been reported worldwide.
Here, we present a 43-year-old female patient who experienced
late complications 8 years after buttock augmentation
with PAAG injections with a difficult reconstruction of the
gluteal region.
We also reviewed the literature on clinical management issues
and available reconstructive options for this problem. The
search in the clinical key using the term polyacrylamide hydrogel
yielded 169 results in various fields of medicine, limiting
the search in plastic surgery yielded 67 results, 14 in facial
rejuvenation, 9 in breast augmentation, 7 in buttock augmentation,
2 literatures on the use of u/s in the diagnosis of PAAG
complications, and 35 literatures on the composition, histologic
analysis, and general complications from the use of PAAG.
Searching for the term gluteal augmentation after excluding
augmentation modalities other than PAAG ends at 7 literatures,
however, the total number of these clinical reports on
complications of PAAG use for buttock augmentation is striking,
accounting for more than 50% of the studies.
All literatures conclude that the PAAG filler is easy to inject, 
but once complications occur, they are difficult to manage.