Unacceptable results with an accepted soft tissue filler: polyacrylamide hydrogel.

BACKGROUND: Polyacrylamide hydrogel, considered a safe and biocompatible soft tissue filler, is widely used in cosmetic procedures. Its use for facial contouring and breast augmentation in Iran has increased dramatically in recent years. Most patients and many doctors are unaware of possible and reported adverse effects related to its administration. METHODS: This study enrolled 98 patients experiencing unsatisfactory results and complications of polyacrylamide hydrogel. Adverse effects related to gel administration were documented for all the patients. Lab values were requested together with related medical care and surgical treatments, and gel was extracted by incision, milking, and irrigation. RESULTS: The most common findings at the time of presentation were inflammation (n = 51), asymmetry (n = 31), irregularity (n = 18), infection and abscess formation (n = 11), and gel migration (n = 8). In one patient, severe anaphylactoid reaction was observed 1 week after gel injection, which led to significant complications for the patient. Histologic findings showed granuloma formation (n = 17), fat necrosis (n = 9), and fibrosis (n = 17). Macroscopic gel-related complications resolved after extraction of the injected material, except for skin necrosis and hyperpigmentation, which remained unchanged. For eight patients, the gel could not be extracted by squeezing and irrigation entirely. Three patients experienced gel reaccumulation after seemingly complete removal of the gel. CONCLUSIONS: A wide range of complications seen among our patients showed that polyacrylamide hydrogel may not be as safe and biocompatible as it was thought previously. Both patients and physicians must be aware of the potential side effects of polyacrylamide hydrogel before gel administration.

Concomitant vesicoureteral reflux and gastroesophageal reflux: an analytic cross-sectional study.

PURPOSE: Vesicoureteral reflux (VUR) and Gastroesophageal reflux (GER) are both common disorders in children and could be associated with significant morbidities. Although they appear to be separate entities, their natural history and underlying pathophysiology are the same and they both tend to resolve over time. We aimed to appraise their concurrent occurrence and prevalence of GER in VUR patients to understand whether they can be considered different manifestations of a syndrome mainly caused by developmental delay resulting in dysfunction of the sphincters. METHODS: Totally, 174 children ≤ 2 years of age were enrolled and 87 of them with primary VUR constituted patients group. The rest of the cases with the same age and sex distribution entered control group. All the study population underwent ultrasonographic evaluation to detect GER. RESULTS: GER was more frequent in patients with primary VUR. GER was more prevalent in higher grades of VUR. We observed higher prevalence of GER and higher grades of VUR in younger infants demonstrating the tendency of both conditions to resolve overtime. Bilateral VUR was more prevalent among patients with higher grades of VUR. GER was more prevalent in patients with bilateral VUR and Prevalence of bilateral VUR decreased with increase in age. These findings show that the chance of concomitant GER and VUR is higher in children with more severe developmental defect of sphincters. CONCLUSIONS: Regarding the higher prevalence of GER among VUR patients and correlation of VUR severity with co-occurrence of GER, besides the natural tendency of both conditions to resolve overtime, they may be considered parts of developmental delay syndrome of sphincters.

Retrusive chin reconstruction after burn injuries using submental and labiomental fat flaps: an innovative method.

OBJECTIVE: A simple method has been introduced for augmentation and restoration of normal chin protrusion as an important element of facial contour in patients suffering from severe skin retraction and scar resulting from head and neck area burns. PATIENTS AND METHODS: For releasing skin retraction and compression of the mental area subcutaneous fat tissues, under general anesthesia, 2 incisions were made in the submental and labiomental areas, each about 3 to 5 cm. After dissection of the superior portions of labiomental and inferior pedicle of submental fat pads, turning over and attaching them together, the skin over the area was reconstructed as needed. RESULTS: Thirty-four patients with pseudomicrogenia were involved. In 32 patients, the procedure was performed successfully and the results were evaluated as excellent in 15 cases and good in 17 cases. However, in 2 patients, suboptimal results were obtained, which were corrected using genioplasty in one of them. The other one did not consent for any further surgeries. Split-thickness skin grafting was performed in 3 cases. Tissue expansion and full-thickness skin grafting were used in 3 others for resurfacing the area. CONCLUSION: Taken together, the current technique might be helpful in restoring normal chin protrusion and can be used besides available methods for resurfacing and reconstruction of the defective skin for enhancing the facial appearance.