Polyacrylamide gel filler lumps, and only offered surgery? Get assessed first

Polyacrylamide gel lumps, and only offered surgery? Read this before you agree to it

Patients come to Dr Sin Yong after being told that polyacrylamide gel, or another gel filler injected years ago, has to be cut out, or that nothing can be done. It is true that these gels cannot be dissolved. Before you agree to an operation, know what it means:

• A scar. Every cut through the skin of the face heals with a scar.
• A dent. Cutting out a lump takes tissue with it, and the area can heal hollow or uneven.
• Nerve injury. Nerves that give the face feeling and movement run close to where filler sits. An injured nerve can leave numbness, or weakness in a smile, a lip or a brow.
• Product left behind. Filler spread through tissue is hard to remove completely.
• No way back. Tissue that has been cut out cannot be put back.

With gel fillers, the last two matter most. The gel does not always stay as one neat pocket. In the lips it has been found spread through every layer of the lip and into the skin around the mouth, and removing it has meant leaving some gel behind (Kastner 2018).

Dr Sin Yong maps each polyacrylamide or polyalkylimide gel lump with ultrasound, treats any infection medically first, and treats the lump with the Sculpting mode of Time Freeze Laser LCLR®, without an incision. In Dr Sin Yong's practice, almost every hard lump is treated without surgery. If yours is one of the few that needs surgery, you are told plainly, and why.

Silicone is covered in silicone filler lumps and PMMA in PMMA filler lumps, and lumps from every kind of filler in hard lumps after filler or skin boosters.

What polyacrylamide and polyalkylimide hydrogels are, and why they cannot be dissolved

Polyacrylamide gel (PAAG) is a hydrogel: a water-based gel that the body does not absorb. Aquamid is one brand. Polyalkylimide gel, sold as Bio-Alcamid, is another non-absorbable gel, which sits within a collagen capsule (Ross 2009). Both were used to fill the face, and polyalkylimide was also used for facial fat loss related to HIV (Nadarajah 2012).

Polyacrylamide gel was tested as a filler. In a 12-month randomised trial in the United States in 315 people, a 2.5% polyacrylamide gel in the smile lines was as effective as a hyaluronic acid filler, with side effects of equal frequency, mostly mild, short-lived and related to the injection. One serious side effect, an infection thought to be related to the gel, cleared within 5 days of treatment, and the authors state that longer evaluation is needed to judge long-term safety (Narins 2010). The problems described below were reported months to years after injection.

These gels have been injected in many countries. One series of 98 patients with problems after polyacrylamide gel in the face or breasts came from Iran (Manafi 2010), and in a Beijing series of 116 people with temple fillers, polyacrylamide gel was the commonest material found, in 48 (Jiang 2023). Many people with gel in the face had it injected years ago, often overseas, and some were never told the name of the product.

Three things set these gels apart from the fillers most people have today:

• They cannot be dissolved. Hyaluronidase, the enzyme used to dissolve filler, acts on hyaluronic acid only. It has no effect on polyacrylamide or polyalkylimide gel, and no injection dissolves them. That does not mean they have to be cut out: gel lumps can still be treated without an incision.
• They stay, and they can move. The gel is not absorbed, so it can move or react long after the injection: polyalkylimide placed in the nasal bridge, temple or cheek has caused eyelid swelling 3 to 7 years later (Alharbi 2019).
• Bacteria can live in them. In reactions to polyacrylamide gel, bacteria were found in lesions up to five years after injection (Christensen 2013), which is why a red, hot or swollen gel lump is treated as a possible infection first: it needs a doctor the same day, or A&E if no doctor can see you today.

Polyacrylamide gel, polyalkylimide and other fillers compared

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“For hard lumps from mixed products, I use one tool, Time Freeze Laser LCLR®, to target the material without surgery.”

Dr Sin YongOn hard lumps from mixed fillers and skin boosters

Polyacrylamide filler complications: swelling, lumps and migration, sometimes years later

Gel fillers can sit quietly for years and then swell, harden or become lumpy. Because the material stays, the body's reaction to it can begin, or flare again, long after the injection.

Firm gel lumps and inflammation

In 20 patients with 21 firm gel lumps under the skin after polyacrylamide gel, the lumps appeared 10 to 28 months after injection, on average 17.5 months. Five each were in the cheeks, the area between the brows and the lips, and the lumps were identified on examination and ultrasound (Kavoussi 2012). In the series of 98 patients with problems after polyacrylamide gel in the face or breasts, the presenting problems were inflammation (51 patients), asymmetry (31), an irregular surface (18), infection and abscess (11) and gel migration (8); tissue samples showed granulomas in 17, fat necrosis in 9 and scar tissue (fibrosis) in 17 (Manafi 2010). More on granulomas is in filler granuloma.

Gel that moves

In 11 patients with polyacrylamide gel in the lips, the gel had moved into the lining of the lip and the skin around the mouth, even years after injection (Kastner 2018). In 16 women, polyalkylimide injected into the nasal bridge, temple or cheek had moved and caused swelling of the upper or lower eyelids 3 to 7 years after injection (Alharbi 2019). Filler that has moved, whatever the product, is covered in filler migration.

Polyalkylimide (Bio-Alcamid) problems

In a survey by a Dutch society of cosmetic medicine covering 3,196 patients treated with polyalkylimide, complications were reported in 4.8% of patients, most often inflammation, followed by hardening, migration and gathering of the product, typically appearing several years after injection. Because of the rate, the severity and the difficulty of treatment, the society advises against its use (Schelke 2009). In a series of four patients who had polyalkylimide placed deep, just over the bone, in the cheeks, smile lines or tear trough, all developed late problems: infection including abscess, migration, recurrent swelling and inflammatory nodules; the authors warn against overfilling and misplacing the gel (Ross 2009).

In a trial in people with HIV-related facial fat loss, 32 were assessed four years after polyalkylimide: 15.6% had a confirmed infection, 9.4% a possible infection and 25% nodules. Most were satisfied with the overall treatment (94%) and 69% with the gel itself, but the authors note high rates of infection and nodules (Loutfy 2011).

Late infection in gel fillers: bacteria, dental work and other triggers

In a study of 59 patients with reactions to polyacrylamide gel and 28 without, bacteria, mostly ones that normally live on the skin, were found in small clusters in 53 of the 54 patients with reactions who could be tested, and in none of the 24 controls, in lesions up to five years after injection. The authors conclude that low-grade bacteria can cause long-term infection in the gel, possibly as a biofilm, a protected film of bacteria (Christensen 2013).

Triggers. In a published case report, a woman with earlier polyacrylamide filler developed a facial abscess after a decayed tooth was extracted, and the authors warn of late infections with this filler. The abscess was confirmed on MRI and healed, leaving slight darkening of the skin and a contour deformity over the cheekbone and temple, and the authors suggest that preventive antibiotics may be needed before procedures that can let bacteria into the blood (Kose 2022). In 267 people treated with polyalkylimide for HIV-related facial fat loss, infections were documented in 56, a median of 32 months after the first treatment. Possible risk factors included touch-up injections, cosmetic surgery, injury to the face and dental work; most patients needed surgical drainage in addition to antibiotics, and the authors advise considering preventive antibiotics before dental work or facial procedures (Nadarajah 2012).

What this means for you. Tell your dentist, and any doctor who plans to inject or operate on your face, that you have a gel filler. Touch-up injections are among the possible risk factors, so Dr Sin Yong does not inject new filler to hide a gel lump. A gel lump that becomes red, hot, tender, swollen or draining needs a doctor the same day, or A&E if no doctor can see you today, and is treated medically first, before any device. An abscess can need draining through a small opening alongside medical treatment; that is a smaller procedure than an operation to cut the gel out. More is in filler infection.

Ultrasound first: what the scan shows with gel fillers

Ultrasound shows where the filler sits, how deep it is and how far it has spread, and what it is likely made of. With gel fillers, it also shows whether the gel sits as a defined collection or is spread through the tissue, and whether there is fluid or an abscess.

Gels have their own appearance on the scan. In the Beijing series of 116 people with temple fillers, polyacrylamide gel showed as fluffy or dotted dark areas that could pool into cyst-like collections or spread out, and that moved when the probe pressed on them; each material had a distinct appearance, so the scan helps identify what was injected into the temple (Jiang 2023). In 60 people with earlier fillers, polyacrylamide and polyalkylimide gels shared one rounded, cyst-like pattern with hyaluronic acid soon after injection, and 12 people showed a mixed pattern, mainly from different treatments at different times (Urdiales-Gálvez 2021). In 72 people with earlier facial fillers, water-attracting fillers showed directly on the scan, and ultrasound also showed how long filler had persisted, the tissue reaction around it, and complications including migration and granulomas (Schelke 2010).

That overlap is why your history matters, and why the scan shows what a lump is likely made of; it does not prove it. Where a lump does not look like filler, further tests are arranged. Dr Sin Yong performs the scan himself, and the plan follows what it shows. More on scanning is in ultrasound-guided filler correction.

Is it polyacrylamide gel or something else?

A lump in a face that once had gel filler can be:

• The gel itself, as a collection or spread through the tissue, or the scar tissue and granuloma around it.
• Hyaluronic acid placed over or beside the gel, which can be dissolved, leaving the gel behind.
• Another non-absorbable filler, such as silicone or PMMA; see silicone filler lumps and PMMA filler lumps.
• A collagen stimulator from a later treatment, such as Ellansé, Sculptra or Radiesse.
• An infection or abscess in the gel, which is usually red, hot, painful or draining and needs a doctor the same day; if no doctor can see you today, A&E.
• Something unrelated, such as a cyst, a lymph node or, rarely, a growth, which needs a different plan.

A granuloma is not always the gel: in an international ultrasound study of 240 granulomas after cosmetic fillers, half followed hyaluronic acid (Wortsman 2025). A lump that keeps growing, sits where nothing was injected, feels fixed to deeper tissue, changes the skin over it or comes with swollen glands elsewhere is assessed for other causes before anything is treated as filler. If the gel was injected overseas without records, see correction of filler done overseas.

PAAG filler removal by draining or squeezing: what it can and cannot do

Because polyacrylamide gel is soft and water-based, drainage is sometimes offered: a needle or a small opening, and the gel drawn or pressed out. What the published series report depends on whether the gel sits as a defined lump or has spread through the tissue.

• Where it worked. In 20 patients with firm gel lumps 10 to 28 months after polyacrylamide injection, a hole was made with a wide (16-gauge) needle and the gel squeezed out; all 21 lumps responded, and the authors report no recurrence and no complications (Kavoussi 2012).
• Where it was incomplete. In the 98 patients with problems after polyacrylamide gel in the face or breasts, the gel was removed through an incision, by milking it out and washing the area through. It could not be fully extracted in 8, and it built up again in 3 after removal had seemed complete; skin necrosis and darkening of the skin did not improve (Manafi 2010).
• Where it was not possible. In 11 patients with polyacrylamide gel in the lips, the gel had spread through all three layers of the lip, with scar tissue in every patient, and aspiration was not possible (Kastner 2018).
• Where it may have made things worse. With polyalkylimide, the authors of a four-patient series write that removal is achieved only by aspiration and pressing the gel out with both hands, and they suggest that the migration they saw may have followed that pressing, or other handling that broke the capsule around the gel (Ross 2009).

Draining suits a defined collection or an abscess. Where gel had spread through tissue with scar, as in the lip series, it could not be drawn out. Do not squeeze or massage a gel lump yourself. Dr Sin Yong maps the gel first and treats gel lumps with the Sculpting mode of Time Freeze Laser LCLR®, without an incision.

Polyacrylamide filler removal surgery: what it involves and the problems reported

Surgical removal means an incision, through the skin or inside the mouth, and cutting out the gel together with the tissue it has spread into. In the lips it has meant reconstructing the lip. The published numbers run both ways.

• Gel left behind. After lip reconstruction for polyacrylamide gel, the authors state that gel remaining in the lining of the lip must be accepted (Kastner 2018). After removal through an incision in 98 patients with gel in the face or breasts, gel could not be fully extracted in 8 and built up again in 3 (Manafi 2010).
• Tissue loss. One of the 11 patients in the lip series had severe necrosis, death of tissue, in the upper lip (Kastner 2018).
• Eyelid problems and recurrence. After migrated polyalkylimide masses of 1 to 3.5 cm were cut out from around the eyes in 16 women, one developed eyelid retraction, a lid pulled out of its normal position, and one had a recurrence 3 years later (Alharbi 2019).
• Scars, dents and nerves. Every incision leaves a scar, removing tissue can leave a dent or an uneven contour, and an injured nerve can leave numbness, or weakness in a smile, a lip or a brow.
• No way back. Tissue that has been cut out cannot be put back.

Surgery has a place. In the lip series, 10 of 11 patients had an aesthetically satisfying outcome (Kastner 2018). Of the 16 women with migrated polyalkylimide near the eyes, the rest had an uneventful course over 1 to 8 years of follow-up, and the authors advise assessing facial nodules and swelling because filler may migrate years later (Alharbi 2019). For infected polyalkylimide, most patients in one group treated for HIV-related facial fat loss needed surgical drainage in addition to antibiotics (Nadarajah 2012). The point is the order: scan first, decide after.

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Dr Sin Yong explains the risks and limits of each option at the assessment, including waiting where that is reasonable and surgery where it is needed. Get assessed before you agree to surgery: an operation can still be done later if it is ever needed, but it cannot be undone. More on operations to take filler out is in filler removal surgery.

Polyacrylamide gel in the lips: spread, lumps and lip reconstruction

In 11 patients with polyacrylamide gel in the lips, the gel had spread through all three layers of the lip, with scar tissue in every patient, and into the lining and the skin around the mouth, even years after injection. Aspiration was not possible, so removal meant reconstructing the lip with a lip-reduction technique, with fat grafting in eight (Kastner 2018). Cutting into the lip leaves a scar that can be felt and can change the shape of the lip.

Dr Sin Yong treats gel in the lips the same way as elsewhere. He maps it with ultrasound, including how far it has spread into the lip and around the mouth, treats any infection medically first, and treats the lumps with the Sculpting mode of Time Freeze Laser LCLR®, without an incision. Hyaluronic acid lip filler placed over old gel is dissolved first, after a skin test. For hyaluronic acid lip filler on its own, see lip filler dissolving; for other lip problems, see lip filler gone wrong.

Red, hot, swollen or draining: medical treatment first

A firm gel lump that has been there for months is not an emergency on its own. These are different:

• A lump that is red, hot, tender, swollen or draining may be infected or actively inflamed: see a doctor the same day; if no doctor can see you today, go to A&E. It is treated medically first, before any device and before any talk of surgery. With gel fillers this matters, because bacteria have been found in reacting polyacrylamide gel up to five years after injection (Christensen 2013). A fever needs a doctor the same day; if no doctor can see you today, A&E.
• Redness that is spreading, with a fever, feeling faint, confused or very unwell, or swelling around the eye with pain: call 995 or go to A&E now.
• Difficulty breathing, a tight throat, swelling of the tongue or throat, or swelling that spreads quickly across the face, after any injection, including hyaluronidase, can be a serious allergic reaction: call 995 now. Itch, hives or swelling that spreads beyond the treated area: contact the clinic that injected you the same day.

Urgent: a change in vision or eye pain after filler: call 995 now. Skin that turns pale, dusky or mottled, or pain that is getting worse, needs urgent assessment by the doctor who injected you, or at A&E, now. See the warning signs of a blocked blood vessel after filler.

Skin that is dying after a blocked blood vessel (necrosis) is an emergency. It needs urgent, more intensive care than a lump does, starting now.

Tried other treatments and almost given up?

Many patients who come to see Dr Sin Yong about polyacrylamide and other gel filler lumps tell him they have tried almost everything else and had given up hope. Having tried other treatments does not mean nothing more can be done: what is done next depends on what the scan shows.

That history is useful. Knowing what was injected, when, and what has already been tried often explains why a problem has stayed: hyaluronidase acts only on hyaluronic acid and only where it reaches, some fillers are not hyaluronic acid at all, and swelling or fluid can look like filler. Ultrasound helps show which of these applies, and the plan starts from there. For material that cannot be dissolved, Dr Sin Yong uses the Sculpting mode of Time Freeze Laser LCLR® for nodules large and small, without an incision. How each person responds varies.

If you have been told nothing more can be done, it is still worth having the area scanned: ultrasound helps show what is there, and the plan is made from that. Bring any records of past treatments, product names and dates if you have them. More on this is in when filler dissolving has not worked.

How Dr Sin Yong treats gel filler lumps without surgery

1. History. What was injected, where and when, if known; any dental work, infection or new filler before the lump appeared; what has been tried and what you were offered. Having no records is fine.
2. Ultrasound mapping. Dr Sin Yong scans each lump himself: the likely material, its depth, how far the gel has spread and the vessels nearby.
3. Infection first. A red, hot, tender or draining lump needs a doctor the same day, or A&E if no doctor can see you today, and is treated medically before anything else.
4. Hyaluronic acid over the gel. Where hyaluronic acid filler sits over or beside the gel, he dissolves it. Your allergy history is checked. Before planned dissolving, Dr Sin Yong always does a skin test: a small amount of hyaluronidase is injected just under the skin to check for a reaction. A small first dose goes into the mapped filler, with a review at about 48 hours, because dissolving more than the excess can leave a hollow. In an emergency such as a blocked blood vessel, dissolving is not delayed for a skin test.
5. The gel itself. He treats gel lumps with the Sculpting mode of Time Freeze Laser LCLR®, his own protocol on a long-pulsed 755 nm and 1064 nm laser platform, directed at the mapped lump, without an incision. Like any laser, it can cause blistering or a change in skin colour, so settings are chosen for your skin.
6. Review. Each lump is reassessed, and any further visit is planned from what is seen.

He does not inject new filler to hide a gel lump. Where the face has lost shape because of lumps, that is considered only after they have been addressed. Dr Sin Yong developed the Time Freeze Laser LCLR® protocol himself and performs every scan and treatment himself on Orchard Road. He has been invited to share his clinical expertise in Seoul, Dubai, Bangkok and São Paulo, including as a Global Key Opinion Leader. More on the laser is in the Sculpting mode of Time Freeze Laser LCLR®.