What Is Aquafilling? Complications That May Appear Years Later and the Treatment Process
Aquafilling is a filler material that was widely used in the past, particularly for breast and buttock augmentation. It is composed largely of water and a synthetic polyamide-based hydrogel structure.
Around 2013, Aquafilling became popular in Turkey and was promoted as a product that could serve as an alternative to breast implants and surgical buttock augmentation, with an expected durability of approximately five years. The product, which was said to be of Czech origin, attracted significant interest and was also used by many plastic surgeons for a period of time.
It was sold in 100 mL packages and was often injected in relatively large volumes for breast or buttock augmentation. In some patients, at least one package was used for each breast or buttock, meaning that a considerable amount of filler material could remain in the body.
I have never used Aquafilling in my own practice. However, over the years I have treated patients who developed complications following previous Aquafilling injections.
Early Complications After Aquafilling
In some patients, problems began shortly after the injection. One of the most important early complications was infection.
Removing infected filler material is often more difficult than it may initially appear. Because the hydrogel material may not remain confined to a single cavity and can spread between different tissue planes, it is not always possible to remove all of it through a single incision.
In my own clinical practice, some patients with infected Aquafilling required several sessions of drainage and tissue cleaning.
During this process, some wounds had to be left open for a period of time rather than being closed immediately in order to help control the infection. This can be physically and psychologically demanding for patients and also illustrates why treatment cannot always be completed in a single procedure.
Why Can Aquafilling Be Difficult to Remove Completely?
One of the main problems associated with Aquafilling complications is the ability of the material to spread between tissue planes.
Rather than remaining as a single, well-defined collection within a capsule, the filler may extend into fat, muscle and other soft-tissue spaces.
For this reason, removing the material that is visible during surgery does not necessarily mean that all of the filler has been eliminated from the body.
In patients with extensive involvement, attempting to remove every affected tissue aggressively may also result in significant tissue loss and deformity.
For this reason, I believe that a staged and controlled treatment approach may be more appropriate in selected patients.
Long-Term Migration Problems
One of the complications that may appear years after Aquafilling injection is migration.
Material injected into the breast or buttock may gradually move beyond the area where it was originally placed.
Removal can again be difficult in these patients. In some of the cases I have followed, recurrent reactions developed even after several sessions of drainage and cleaning.
One possible reason is that small or poorly visible amounts of the material may remain within different tissue planes.
For this reason, patients with Aquafilling complications should not necessarily be given the expectation that the material can always be “completely removed in a single operation.”
Aquafilling Complications in the Breast and Buttock
The use of relatively large filler volumes in the breast and buttock can make the management of complications more difficult.
Possible complications may include:
- Infection
- Recurrent discharge
- Hardness
- Pain
- Swelling
- Asymmetry
- Spread within the tissues
- Migration to other areas
- Recurrent inflammatory reactions
Treatment is not the same for every patient.
The presence or absence of infection, the extent of filler spread, the condition of the skin and soft tissues, and any previous drainage procedures or operations all need to be considered.
Aquafilling Injections in the Face
Aquafilling was not used only in the breast and buttock. Some patients also received injections in the face.
Complications in the face can create a different and sometimes more complex set of problems.
In addition to infection and migration, attempts to remove the material may result in soft-tissue loss, contour irregularities and facial deformities.
In these patients, the problem is no longer limited to removing the filler. Once infection or an active foreign-body reaction has been brought under control, the resulting deformity may also need to be corrected.
How Can Facial Deformities After Aquafilling Be Corrected?
There is no single treatment method for facial deformities that develop after Aquafilling complications.
In my own practice, the treatment depends on the type and extent of the deformity.
Possible options include:
- Fat grafting to restore volume in areas of tissue loss
- Hyaluronic acid fillers for selected, limited contour irregularities
- Liposuction in suitable patients to help improve contour irregularities
- Scar revision and subcision in selected patients with scar-related tethering or tissue depression
More than one technique may sometimes be required, either during the same treatment period or at different stages.
The basic principle is to control active infection and foreign-material-related problems first, and only then address the remaining deformity.
Why Can Aquafilling Treatment Require Patience?
One of the most important things patients with Aquafilling complications should understand is that treatment cannot always be completed in a single session.
The presence of material within multiple tissue planes, active infection or previous surgery may prolong the treatment process.
In some patients, treatment may need to proceed in stages:
- Controlling the infection
- Drainage and removal of as much foreign material as reasonably possible
- Allowing the tissues to heal
- Additional cleaning procedures if necessary
- Correction of any remaining deformity at a later stage
For this reason, the goal in treating Aquafilling complications is not simply to remove everything in one operation, but to control infection and inflammatory reactions while causing as little additional tissue damage as possible, and then correct any remaining deformity in a staged manner.
My Clinical Approach
In my own practice, I do not use permanent or semi-permanent filler materials other than hyaluronic acid-based fillers.
However, over the years I have treated patients who had previously received Aquafilling injections in the breast, buttock or face and later developed complications.
One of the most striking findings in these cases has been that the filler often does not remain confined to the original injection area and may spread into different tissue planes.
For this reason, particularly in infected or extensively involved cases, I prefer staged drainage and controlled tissue cleaning rather than attempting aggressive removal in a single procedure.
The aim is not only to remove foreign material. It is also to preserve as much healthy tissue as possible and to minimise deformity after treatment.
For more detailed information about filler selection and why I prefer hyaluronic acid-based products for facial fillers, you can read my article, “Why We Prefer Hyaluronic Acid Fillers for the Face.”
For more detailed information about dermal filler treatments, the products used, and treatment options for different facial areas, you can visit our dermal fillers page.
