Treatment of Biopolymer/Hydrogel Buttock Injections

Recently, there had been numerous cases of the use of industrial grade products injected into the body, such as the buttocks and thighs, performed by unlicensed or unskilled practitioners.  Some of these products range from injectable silicone or high-volume hyaluronic acid or hydrogel. Even though some of these products, such as silicone, may be biologically inert, these materials have been implicated in a variety of adverse reactions including granulomas, disfiguring nodules, and lymphedema, sometimes with latent periods of decades.  Often, they may cause disfiguring chronic infections that may require intravenous antibiotics or extensive surgical debridement.  

There had been a few cases that the chronic infections  resulting from illegally injected industrial grade products into the lower extremities, such as the legs, resulted in amputations as a life-saving procedure.  

Figure 1:  Chronic infection from an Biopolymer injections into the buttocks and thighs performed by an unlicensed and unskilled practitioner. 

Clinical Manifestations & Symptoms

• Chronic infection, such as cellulitis, that are recurrent despite antibiotics
• Firmess or hardening of the area of injections
• Chronic pain, such as buttock pain
• Numbness sensation of the area of injection
• Discoloration of the skin of the area of injection

Clinical Management

• We recommend obtaining an MRI of the area of injection to determine the extent of injection as well as the area where the material has potentially migrated.  The MRI would act as a map to determine where your surgeon would remove the biopolymer.

Treatment

• The treatment varies from patient to patient.  This may range from surgical excision, to hyaluronidase injection followed by VASER liposuction and fat transfer into the area to correct the resultant deformity.  Unfortunately, it is not possible to completely remove the biopolymer and not result in a significant deformity of the area involved.  Complete removal, such as surgical excision, may result in a life-changing deformity.  

Figure 2:  Hydrogel/Biopolymer removal from the buttocks using the VASER Liposuction with fat transfer to the buttocks to correct the resulting deformity from removal of the biopolymer.  Patient had resolution of a chronic buttock pain after surgery.

I recommend seeing a plastic surgeon for evaluation and possible removal of the biopolymer injected into one's body.  An MRI may be necessary to evaluate the location of the injected material.  Every person is different, and each treatment may be different.

Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon Houston, Texas

Keys to a Long-term Success in Liposuction

After liposuction, patient needs to have a realistic expectation to have a long-term succesful outcome.  There are 4 key elements to have a succesful outcome after liposuction:

1)Exercise - Exercising after liposuction is very important, especially after the initial surgery.  We encourage our patient to start exercising 2 to 4 weeks after their surgery.

2)Proper Diet - It is very important to eat a healthy diet consisting of fruits, vegetables and fish.  We recommend avoiding fatty food, drinking sodas, and eating excessively.  We recommend consulting with a nutritionist if one is having difficulty having a proper healthy diet.

3)Positive Lifestyle Changes

4)Succesful Body Contouring - It is important to choose the right surgeon who would perform your procedure.  Unfortunately, cosmetic surgery is unregulated here in the United States, and we recommend choosing a plastic surgeon who is trained in liposculpture surgery to perform your procedure.

Before & After Photos of VASER Liposuction (6 weeks after surgery) performed by Emmanuel De La Cruz MD, PLLC.

A clinical study conducted by Dr. Rohrich revealed that:

• "Among the 57 percent of patients who did not gain weight, 35 percent report exercising more postoperatively (compared with only 10 percent in the weight gain group, p = 0.002) and 50 percent report eating a healthier diet (22 percent in the weight gain group report eating a healthier diet, p = 0.002). "
• In the weight gain group, 67 percent report no change in their diet regimen and only 17 percent thought their productivity increased (compared with 25 percent among the no weight gain group, p = 0.002). Successful body contouring surgery requires a patient to embrace positive lifestyle habits. "

Thus, the long-term success of a liposuction procedure is dependent on having a healthy proper diet and exercise.  One can still gain weight after your liposuction procedure if one does not exercise and eat a healthy diet.

Reference: Rohrich, et al. The key to long-term success in liposuction: a guide for plastic surgeons and patients. Plast Reconstr Surg. 2004 Dec;114(7):1945-52; discussion 1953.

Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon

Houston, Texas

Tumescent Liposuction - Houston, Texas

What is Tumescent Liposuction?

• The word tumescent refers to anything that is swollen and firm. With tumescent liposuction, a large volume of very dilute solution of local anesthesia (lidocaine, bicarbonate and epinephrine) is injected into the fat beneath the skin, causing the targeted area to become swollen and firm. The local anesthetic lidocaine in the solution used for tumescent liposuction reduces the pain that one would experience after liposuction. The drug epinephrine (adrenalin) provides profound localized vasoconstriction that it reduces surgical bleeding during tumescent liposuction.

• Tumescent liposuction can be combined with other forms of liposuction such as in VASER liposuction.  In fact, the tumescent technique liposuction is essential for VASER liposuction to work since ultrasonic energy used in the VASER liposuction needs "water" to emulsify or liquefy the fat.  The fluid in the tumescent solution also prevents "skin burn injuries" from VASER liposuction.

Before & After Photos:  4D VASER Liposuction 6 weeks after surgery.  Procedure performed by Dr. De La Cruz

Benefits of Tumescent Liposuction

• Less blood is lost.

• Intravenous fluid replacement is not necessary.

• Bacteriostatic lidocaine may decrease the risk of infections.

• Tumescence magnifies defects; therefore, the likelihood of needing a secondary procedure may be less.

• Lipid-soluble lidocaine is somewhat suctioned out with the aspirated fat.

• Vasoconstriction minimizes absorption.

• The epinephrine may increase the cardiac output, which, in turn, hastens the hepatic metabolism of the lidocaine.

• The duration of anesthetic effect may last as long as 24 hours.

• The lidocaine may be given safely up to 45 mg/kg and even higher in certain conditions.

Does VASER Liposuction Employs Tumescent Liposuction Technique?

• It is standard of care to employ the tumescent liposuction technique in most liposuction methods, including the VASER liposelection/liposculpture.
• Infilitrating the area of fat with tumescent solution reduces the risk of burn injuries that may occur in VASER liposuction or Laser-assisted liposuction.

Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon

Fat Graft Harvested via VASER Liposuction is Viable and Suitable for Fat Transfer in Brazilian Butt Lift Patients

Although there's clinical evidence of successful autologous fat transfer (AFT), such as in Brazilian Butt Lift, using VASER liposuction is readily available, no study has quantified adipocyte viability using standardized methods until recently.

• The UAL system (VASER; Sound Surgical Technologies, Inc, Louisville, Colorado) was set at 60% amplitude in pulsed mode with vacuum aspiration of 15 in Hg or less.
• Laboratory analysis included free lipid volume, viability via lipolysis and propidium iodide staining, and cytological analysis, including cell surface protein examination and hematoxylin and eosin staining.
• The lipolysis assay revealed metabolically active adipocytes with a mean (SD) correlative viability of 85.1%
• Direct measures of acute viability via propidium iodide staining resulted in a mean (SD) viability measure of 88.7%
• Adipose tissue acquired via VASER liposuction is viable at harvest and isa suitable source for autologous fat grafts, especially for Brazilian Butt Lift.
• Adiposed-derived stem cells (fat for fat transfer) obtained via VASER liposuction were of equal quality when directly compared with the current gold standard harvest method according to a study conducted by Duscher.   "UAL- and SAL-derived samples demonstrated equivalent ASC yield and viability, and UAL ASCs were not impaired in their osteogenic, adipogenic, or chondrogenic differentiation capacity."

4D VASER Liposuction performed by Dr. Emmanuel De La Cruz of Houston, Texas

Reference:

Duscher, et al. Ultrasound-Assisted Liposuction Does Not Compromise the Regenerative Potential of Adipose-Derived Stem Cells.  Stem Cells Transl Med. 2016 Feb;5(2):248-57. doi: 10.5966/sctm.2015-0064. Epub 2015 Dec 23.

Schafer, et al.  Acute adipocyte viability after third-generation ultrasound-assisted liposuction. Aesthet Surg J. 2013 Jul;33(5):698-704. doi: 10.1177/1090820X13485239. Epub 2013 May 29.

Lymphatic Massage after Liposuction

One may notice a hardness or lumpiness to the areas treated with liposuction and/or with other body contouring procedures (such as fat injections for what is popularly known as the Brazilian Butt Lift).   This post-surgical lymphedema is caused by inflammation and trauma from the cannula (instrument that sucks out the fat) moving under the skin.  Channels are formed by the cannula that can fill up with fluid and the tissue also becomes swollen.  Manual Lymphatic Massage helps to move the fluid by gently pumping it back into the lymph vessels.  Reducing the swelling can reduce discomfort and may reduce contour irregularities after a   liposuction procedure.  Without Lymph Massage (LDT or MLD) the inflammation can evolve into fibrosis (a permanent hardening of the tissue) or a seroma ( pocket of serum) can form.  It is imperative that one should follow the post-operative protocol of your plastic surgeon to achieve the best possible results and avoid developing fibrosis and even possibly contour irreguarities.

Clinical studies have shown that lymphatic massage also improved the clinical outcome after a cryolipolysis procedure.   The study had shown that post-treatment manual massage resulted in a mean fat layer reduction was 68% greater in the massage side than in the non-massage side as measured by ultrasound at 2 months post-treatment.  At 4 months, mean fat layer reduction was 44% greater in the massage side.   Histological results showed no evidence of necrosis or fibrosis resulting from the massage.

I do NOT recommend receiving a general therapeutic, deep tissue or Swedish Massage in lieu of a lymphatic massage therapy after a liposuction procedure.

Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon, Houston Texas

References:

Boey, et al.  Enhanced clinical outcome with manual massage following cryolipolysis treatment: a 4-month study of safety and efficacy.  Lasers Surg Med. 2014 Jan;46(1):20-6.