Understanding the Side Effects of Paz Gel Injection
Paz gel behaves like a tumor. To treat its complications, you need to pay attention to certain points. Everyone who has received Paz gel injections will eventually experience its side effects. This is the outcome that ultimately affects all users of this gel no one is completely safe.
Now, let’s see what can be done for these individuals. Paz gel in the body acts like a tumor. The body reacts to it, and over time, this gel causes damage to the surrounding soft tissue. Like a tumor, it can spread to nearby areas and affect healthy parts of the face. Another similarity between this gel and tumors is the recurrence of symptoms. As long as the gel remains in the face, it periodically causes inflammation, infection, or irregularities, such as bumps and depressions.
One very dangerous action regarding Paz gel is massaging or pressing the areas where it has been injected. Doing so will almost certainly cause the gel to contaminate healthy areas of your face. To illustrate this, I can share two cases from individuals who consulted me, which may help better understand the issue.
First patient: A young woman had received Paz gel injections in her nasolabial folds a few years ago. Recently, she developed irregularities in this area. She visited a general practitioner due to a sore throat and cold, and during the consultation, she mentioned the irregularities caused by the Paz gel. The young general practitioner, who was not fully aware of the complications and consequences of Paz gel, attempted to help by first massaging the injected area. While distracting the patient, he suddenly applied pressure to the raised area, intending to spread the gel and solve the problem. Although he did this out of goodwill and without charging the patient, unfortunately, due to his lack of knowledge about the gel’s consequences, the Paz gel spread to surrounding areas of the nasolabial folds. When I later attempted to remove the gel, instead of 2 to 3 points, I had to extract it from six different points on each side of the face.
Second patient: A middle aged woman had received Paz gel injections only in her cheeks, approximately 13 years earlier. During this time, she had not sought any professional treatment. Instead of consulting a doctor, she attempted to massage and press her cheeks to evenly distribute the gel. This caused the gel to migrate to surrounding areas, and she continued massaging and pressing the new areas. When she eventually came to me for treatment, an ultrasound revealed that gel deposits had spread throughout her face, including the jawline, areas around the mouth, lower and upper eyelids, temples, and around the nose, forming 2–25 mm lumps. One of her upper eyelids was completely filled with gel, which had even penetrated into the eye socket. Her condition was extremely critical, and infection in her eyelid and eye could have led to blindness.
The above examples illustrate unnecessary manipulation of Paz gel, which can worsen the situation. Therefore, my strong recommendation is to avoid any pressure or massage in areas where Paz gel has been injected. Even a minor impact to the area can cause the gel to migrate to surrounding tissues. For instance, one of my young patients experienced gel displacement to her lower eyelid and temples after her 2 year old child accidentally hit her cheek.
Another very dangerous action regarding Paz gel is attempting its removal by a physician who does not have sufficient knowledge or skill in extracting this gel. Many of us doctors feel embarrassed to honestly admit to ourselves and to our patients that we are not trained or experienced in a particular procedure, and this is especially common among young and inexperienced physicians.
Perhaps one of the main reasons for this mindset is the fear of others’ reactions. I have repeatedly experienced unpleasant looks and behaviors from colleagues and patients when I honestly told them that something was not within my area of expertise. In any case, if a physician whether a general practitioner, specialist, or surgeon without sufficient skill attempts to remove your Paz gel, you are the only one who will suffer the negative consequences of this action.
Approximately 80% of patients who come for gel removal and require multiple sessions are those who, due to previous ineffective removal attempts, have developed fibrotic and scarred subcutaneous tissues. This makes accessing the injected gel much more difficult. This situation is similar to a tumor being manipulated by an unskilled person, which only causes it to spread further.
Your physician should meet the following conditions:
1. Experience with Paz gel removal:
The physician should have prior experience removing Paz gel, which you can verify by reviewing photos or videos of their previous patients.
2. Anatomical knowledge and technical skill:
They should have sufficient knowledge of facial anatomy and the techniques required to remove gel from different areas of the face. Some of my colleagues are skilled at removing superficially injected Paz gel and have achieved good results. If your gel is superficial and limited to subcutaneous areas, they may be able to help. However, for deeply injected gel especially those placed on the bone or that can only be felt through the mouth removal should only be performed by surgeons with adequate expertise.
3. Precise localization of the gel:
Finding the exact location of the gel is crucial. Some gels are easy to locate because they are superficial and not surrounded by fibrotic tissue. But when gels are located in deeper areas of the face, prior manipulations or infections may make them difficult to locate, or their small size may make them impossible to palpate. Removal in these cases becomes challenging. A physician who cannot precisely locate the gel is like a soldier trying to fight an invisible enemy. In this situation, no matter how skilled the physician is, success is unlikely, and failure is almost certain.
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4. Not All Gel Complications Require Surgery:
Not all complications of dermal fillers, including Paz gel, require surgical intervention. Some time ago, a patient who had undergone multiple Paz gel removal procedures came to me with a highly asymmetrical face that appeared much older than her actual age. She had previously undergone three removal procedures with one of my well known and skilled colleagues. However, her ultrasound still showed dark areas (hypoechoic regions), which we commonly see in previously injected gel. She requested a facelift to remove the gel.
During a facelift procedure, we can directly see and remove the gel, but in ultrasound images, what appears to be the gel may not always be actual gel it could be the body’s reaction, such as cellulitis, micro abscesses, granulomas, or other tissue changes. Acting hastily to remove these areas can be disastrous. Blind attempts at removal may not extract any gel and can cause more damage to facial tissues, resulting in increased asymmetry and irregularities.
My colleague had suggested another blind gel removal, which initially seemed reasonable based on her ultrasound images. However, my preferred approach was a facelift, which allows direct visualization of the gel and its removal, as well as the correction of irregularities using fat grafts and surrounding tissues. The patient accepted this recommendation. During surgery, we found that the areas seen in the ultrasound contained no gel at all only granulomatous tissue. We were able to perform the facelift along with facial symmetry restoration and smoothing. After the surgery, the patient looked youthful and attractive and was very satisfied, with no further facial damage. From my experience, among patients with complications from dermal fillers:
For every 3 patients with non Paz gel complications, 2 are mistakenly subjected to unnecessary Paz gel removal.
For every 2 patients with Paz gel complications, 1 is mistakenly subjected to improper removal.
This unnecessary intervention not only fails to solve the original problem but also leads to higher costs and more complications.
In summary, Paz gel behaves like a tumor. Avoid unnecessary manipulation by yourself or by an inexperienced physician. Leaving the gel alone is far better than improper or blind removal attempts.
Dr. Akbar Bayat
Board Certified Facial Plastic Surgeon, Europe
