Hydrogel gel injected in buttock. No complications but should I get rid of it? And how?

Question

I had Aqualift (hydrologic gel) injected in my buttocks years ago. The product is still compact and has not moved in fragments nor has it caused any discomfort. I am thinking to transfer my own fat in that area. Should I remove the filler first? And proceed with fat transfer? Can I do the fat transfer on top? Has anyone experienced this before?

Raffy Karamanoukian, MD, FACS · Answer

Hydrogel can be removed from the buttocks if there is a longterm risk of inflammation. This all depends on the amount of filler and the amount of inflammation in the early and late phase. Deciding on whether to remove the fillers is a longterm/shorterm strategy. Best, Dr. Karamanoukian

Jeremy S. Nikfarjam, MD · Answer

Thank you for your question. This is a very important and nuanced situation. Aqualift is a type of hydrophilic gel filler (usually polyacrylamide hydrogel or a similar formulation). While it may remain stable and asymptomatic for many years, it is not biologically inert long term and can cause complications over time, including inflammatory reactions, migration, encapsulation (forming of nodules), and potentially lead to infection. Even if the product currently seems stable, that doesn’t guarantee it will stay that way, especially if disturbed by trauma (like fat grafting or liposuction in the area). To answer your question, technically, yes. Fat can be grafted on top of the hydrogel. However, it is not recommended as there is a risk the fat may not integrate well because the gel creates a foreign body environment. The gel may impede vascularization, reducing fat graft survival. Injecting fat may disturb the hydrogel, potentially triggering migration or inflammation. So, while it’s possible, it’s not considered the safest or most effective approach in many cases. Removing any foreign body material is always recommended first. Ideally. removal would be the safest path forward before fat transfer. This ensures as much foreign material is removed as possible, reducing the risk of adverse reactions. It allows for a more biologically “clean” plane for fat graft survival. It enables better long-term aesthetic results and reduces unpredictability. A consultation with a Board-Certified surgeon experienced in biopolymer/hydrogel/silicone removal is crucial. Typically, the surgical steps are as follows - Stage 1: Removal of hydrogel/silicone via open excision approach. Stage 2: performed typically within 24-48 hours after stage 1. This includes a secondary removal after wound vac placement and an internal buttock lift. After a 3-month recovery/healing process, we can perform Stage 3: Fat grafting once inflammation has resolved and tissue planes are healthy. Please keep in mind, these procedures can be covered by insurance.

I am a board-certified plastic and reconstructive surgeon 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, I developed a two-stage surgical excision process and a third stage of reconstruction (often referred to as a reconstructive BBL). This approach is designed to ensure the most complete removal possible while minimizing risks and optimizing patient outcomes. I'd be happy to see you for a clinical evaluation whether it be a complimentary virtual consultation or an in-office appointment to discuss your options. My Silicone Coordinator has undergone silicone removal and reconstruction and would be happy to share her silicone journey with you and see how we can help with yours.  (516) 279-2616

J. Timothy Katzen, MD, FACS · Answer

Hello, I am sorry you had "hydrogel" or Aqualift  injected into your buttock and that now, you are having problems.  Hydrogel or Aqualift is a PERMANENT filler composed of polyacrylamide.  Polyacrylamide is composed of many acrylamide molecules chemically bonded together.  Acrylamide is a known neurotoxin and is considered by the US FDA a "probable human carcinogen".  Hydrogel or Aqualift is NOT approved by the US FDA.  First, I would have as much hydrogel removed as possible and as soon as possible.  Second, once you are healed (about 4 to 6 moths), consider fat transfer to the buttock for buttock reconstruction.  
I specialize in the removal of illegal foreign products like hydrogel from the buttock and subsequent reconstruction of the buttock.  I am a lead investigator and founder of the Silicone Removal Institute. Since removinghydrogel from the buttock is a big procedure, please seek an experienced, board certified plastic surgeon with significant experience in removing hydrogel from the buttock.  Do your research.  Make sure your chosen plastic surgeon has performed many  buttock hydrogel removal surgeries and has 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, buttock hydrogel removal surgeon in your neighborhood, consider traveling out of state if you must. Sincerely, Dr. Katzen. (“Verified” Plastic Surgeon, 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 and RealSelf Hall of Fame.)

Hydrogel gel injected in buttock. No complications but should I get rid of it? And how?

Answers (3)

Recommended reading

Everything you need to know about Silicone Injection Removal

Our mission is to create a world where every investment in modern beauty is Worth It.

Hydrogel gel injected in buttock. No complications but should I get rid of it? And how?

Answers (3)

Browse related questions

Recommended reading

Everything you need to know about Silicone Injection Removal

Our mission is to create a world where every investment in modern beauty is Worth It.