title: Long-term orbitofacial complications of polyalkylimide 4% (bio-alcamid).
abstract: OBJECTIVE
  To review our experience with the long-term orbitofacial complications of polyalkylimide 4% (Bio-Alcamid), including migration, infection, and recurrent swelling.
  
  
  METHODS
  A retrospective case series of 4 patients who received preperiosteal polyalkylimide 4% filler treatment: 3 patients received treatment to cheeks and/or nasolabial folds and 1 received treatment to the tear-trough region. All 4 patients were referred with delayed complications.
  
  
  RESULTS
  Four patients presented with the unusual delayed complications of infection including abscess formation, migration of filler, recurrent swelling, and inflammatory nodules.
  
  
  CONCLUSIONS
  Because of the hydrophilic and endoprosthetic nature of polyalkylimide 4%, migration of the product is unexpected. We hypothesise that in our patients, filler migration occurred after bimanual expression and/or manipulation of the product with disruption of the surrounding collagen capsule. Because removal of polyalkylimide 4% is only achieved via aspiration and bimanual expression, which itself may precipitate long-term migration of the product, it is vital that clinicians are mindful of these complications and the pitfalls of overfill and misplacement of the product, for informed patient consent.
authors: Corneoplastic Unit, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, Sussex, United Kingdom.
authors: Adam H
authors: AH
authors: Ross
authors: Raman
authors: R
authors: Malhotra
mesh_terms: D000038:Abscess / Q000139:chemically induced / Q000175:diagnosis / Q000188:drug therapy; D000180:Acrylic Resins / Q000009:adverse effects*; D003357:Cosmetic Techniques; D004487:Edema / Q000139:chemically induced / Q000175:diagnosis / Q000628:therapy; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D005148:Facial Dermatoses / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D015745:Granuloma, Foreign-Body / Q000139:chemically induced / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009916:Orbital Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D012189:Retrospective Studies; D015595:Skin Aging; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology
chemical_list: D000180:Acrylic Resins; C470344:Bio-Alcamid