Dermal & Soft Tissue Filler: Polyacrylamide gel (Aquamid)

Generic name: injectable water-based polyacrylamide gel (2.5% polyacrylamide, 97.5% water)

Brand(s): Aquamid

Maker / Website: Aquamid is produced by Ferrosan A/S and distributed by Contura (www.aquamid.com)

Cost: about $1000 per cc; cost per cc tends to drop with larger treatment volumes

Allergy test required: No

Durability: permanent; allegedly can be removed via aspiration, but it is unclear how completely and whether this is true in all cases

Function / Purpose:
Cosmetic augmentation and reconstruction of the face and body, including treatment of facial lines and folds (e.g. nasolabial folds), lip augmentation, depressed scars, enhancement of cheekbones and jawline, replacemnt of facial volume lost due to age, lipoatrophy and so forth. Polyacrylamide gel is not indicated for the treatment of fine wrinkles.

Summary:
Injectable water-based polyacrylamide gel contains a small percentage of polyacrilamide (2.5% in Aquamid) while the rest is water. Polyacrylamide has some history as a medical implant material, e.g. in intraocular lenses. It has been used for cosmetic augmentation since 1980s. It is non-biodegradable and removal may be tricky albeit possible. Hence the scope and targeting of the treatment should be precise. The results are considered permanent.

Details:
Injectable water-based polyacrylamide gel is produced by polymerization of acrylamide in water and results in a gelatinous material containing a small percentage of cross-linked polyacrylamide and water. While acrylamide itself is a neurotoxin, polyacrylamide is biologically inert polymer and non-biodegradable. The manufacturers of polyacrylamide for implants take steps to remove the residual acrylamide from the gel. While toxicity of acrylamide remains a theoretical concern, at this point there does not seem to be any evidence of chemical toxicity of polyacrylamide gel fillers or implants. Also, it appears that upon injection, polyacrylamide particles become enmeshed into the local fibrous matrix and, as a result, rarely migrate away from the treated area.

Since polyacrylamide is non-biodegradable, the augmentations are permanent, with corresponding pros and cons. A successful, well-placed augmentation may last without re-treatment or with minor touch-ups for a long time. On the other hand, poorly administered treatments and/or complications may be difficult to correct. Polyacrylamide gel fillers can be removed via aspiration. How successful and complete such removals typically are remains unclear although partial removal is clearly possible.

Aquamid is produces by Danish pharmaceutical company, Ferrosan A/S, and distributed by its subsidiary Contura. It contains 2.5% cross-linked polyacrylamide and 97.5% water.

There have been reports of bacterial infections of the implants. Whether it is due to contaminated batches of the product and/or injection procedure remains unlear. Other important albeit infrequent complications include granuloma and migration of the filler.