PAAG removal - what can be done?

Question

I had polyacrylamide gel injected into my hips 6 years ago. It became inflamed 2 years later, requiring multiple removal procedures. Despite its already 1 year w/o inflammation I still experience constant thigh pain, especially after activity. Ultrasound shows small gel remnants, causing discomfort. What can be done?

Raffy Karamanoukian, MD, FACS · Answer

Silicone biopolymers are commonly used in the face and body. They may sometimes cause noticeable symptoms that we gauge using the Karamanoukian Soft Tissue Reaction Grading Scale from I to V. The severity of your complications dictates the interventions needed, ranging from itching and burning to severe necrosis of the soft tissue. Nerve pain and symptomatic swelling is also possible. Insurance may cover your surgery, but that is a discussion that requires you to contact and appeal to your insurance carrier. Options for removal are complex and depend on whether you have the material in your face or body. We reverse BBL with silicone commonly and remove silicone from the lips very commonly. Diffuse silicone in the face is not likely to respond to removal. Filler migration, swelling, and granulomas can cause significant discomfort and cosmetic ramifications. Our office specializes in the use of enzymes and filler reversal techniques without hyaluronidase to help improve the results of botched cosmetic fillers, whether caused by Juvederm, Restylane, or foreign fillers. We can also test for the material to determine the likelihood of silicone granulomas and silicone reaction.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Jeremy S. Nikfarjam, MD · Answer

Hi Maria_Eva!

I'm really sorry you're still dealing with this—polyacrylamide gel (PAAG) complications can be persistent and frustrating. Based on your history and symptoms, here’s a breakdown of what might be going on and some options to consider: Chronic Inflammatory Response - even if there's no acute inflammation, the body can mount a low-grade immune response to residual PAAG. This can lead to fibrosis, nerve irritation, and pain. Gel Migration or Encapsulation - PAAG can migrate or get encapsulated within fibrotic tissue, potentially entrapping nerves or putting pressure on muscles—especially after activity. Neuropathic Component - constant thigh pain that worsens with use might also suggest nerve involvement—either from scarring, gel impingement, or past inflammation.

*What Can Be Done - Here are several options, depending on the findings from imaging and your clinical exam:

1. High-Resolution MRI (preferably with STIR sequences) - more sensitive than ultrasound for identifying gel remnants, fibrosis, and nerve involvement. This will help plan whether further removal surgery is feasible or warranted.
2. Surgical Exploration & Targeted Excision - if remnants are accessible and well localized (especially superficial or near fascia), further conservative excision or debridement may be possible.
3. Pain Management / Neuropathy Evaluation - If imaging shows no clear surgical target, working with a pain specialist can help.

Although I can't diagnose any of the above without a clinical evaluation, I'd be happy to discuss further at either a complimentary virtual appointment or in-office consultation. I am a board-certified plastic and reconstructive surgeon based out of New York with a specialized focus on silicone and biopolymer removal. Over the years, I have dedicated my practice to safely addressing complications arising from these materials. Recognizing the unique challenges they pose. Please call to schedule your complimentary consultation (516) 279-2616.

J. Timothy Katzen, MD, FACS · Answer

Hi, thank you your question regarding what can be done for removal of PAAG from the hips.  Most plastic surgeons would agree that if the PAAG in your hips is still causing problems, then further removal is necessary.

Please seek an experienced, board certified plastic surgeon with significant experience in removing PAAG from the hips.  Do your research.  Make sure they have performed many hip PAAG removal surgeries and have the before and after pictures to prove it.  Carefully examine their before and after pictures and check their reviews on RealSelf.   If you cannot find an experienced, hip PAAG removal surgeon in your neighborhood, consider traveling out of state if you must. Sincerely, Dr. Katzen. (President of the American Society of Bariatric Surgeons, Certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery, RealSelf Hall of Fame, and RealSelf Doctor Advisory Board for Medical Review and Consumer Panel.)

I hope that I have answered your questions regarding removing silicone from the buttock

Daniel P. Markmann, MD · Answer

Thank you for your question.  Unfortunately, the only fix for PAAG is removal.  It is nasty stuff!  Here's a picture of what it looks like after your bady has reacted to it.   
ars.els-cdn.com/content/image/1-s2.0-S2096691122000796-gr1_lrg.JPG

It has been banned in China since 2006 due to too many complications.  The only way to remove it is to cut it out along with the tissue it is injected into.  
Sorry to hear that you're have to deal with this.

PAAG removal - what can be done?

Answers (4)