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Aquamid is a non-resorptive injection implant for increasing the soft tissues. It consists of 97.5% of water gel and 2.5% of polyacrilamide. Aquamid is extremely biocompatible, which means that the organism accepts it excellently. Aquamid is available on the market in the sterile packaging of 1 ml syringe. The action of Aquamid is evident in the increasing volume of the soft tissue. After implanting in the body, Aquamid becomes the stable part of the subcutaneous connective-adipose tissue.

Indications

Aquamid is specially designed for the aesthetic corrections or contouring of the face. It can be used in the following areas of the face: glabella (the central part of the forehead above the root of the nose), nasolabial folds (the folds that connect the nasal wings and the corners of the lips), mentolabial folds (the folds below the corners of the lips), cheeks, chin and lips. Aquamid can be used for the correction of the aesthetic defects which are caused by the congenital factors or traumatic process of aging. Aquamid may be applied only in the subcutaneous tissue.

Contraindications

Aquamid must not be injected if there is an acute skin infection. In addition, Aquamid should not be applied in patients who suffer from diabetes and autoimmune diseases. The frequent episodes of the lips herpes and a number of active acne on the face are the relative contraindication for the application of Aquamid. Aquamid also may not be applied during pregnancy or breastfeeding. After the application of Aquamid, a patient must not take corticosteroids for at least half a year. Taking a high-dose of nonsteroid antirheumatics is also not recommended in the first postoperative weeks because it increases the risk of infection.

Facial areas which can be treated with Aquamid  

The deep vertical forehead lines, glabellae, or “frown lines”. The picture shows the technique of injection: the peaks of the triangle represent the needle stitches, and the triangles indicate the area where Aquamid must be applied in the subcutaneous tissue.

The treatment of the nasolabial folds with Aquamid

The application of Aquamid into the cheek folds

The treatment of the atrophic facial scars with Aquamid

The treatment of the mentolabial folds with Aquamid

The aesthetic enlargement of the lips with Aquamid

The augmentation or reinforcing the middle third of the face with Aquamid

Aquamid is very successfully used for repairing of the small irregularities of the external nose after the rhinoplasty.

Aquamid in Croatia

Aquamid was registered in Croatia four years ago thanks to the initiative of Dr Ostojić who was the first to apply Aquamid in the aesthetic surgery in Croatia. In the past four years more than 400 patients were treated with Aquamid at the “Polyclinic Ostojić”, with the excellent cosmetic results and very satisfied patients, and only one case of lip infection.

Aquamid can be applied only by a qualified doctor who was educated abroad and in Croatia. The correct injection technique is required for the optimal results. In the last few years Aquamid rapidly penetrated the European Union and Croatian market because of the proved safety, nontoxicity, durable results, easy techniques of application. The allergies to Aquamid have not been described so far. The complications are very rare if the indications are set correctly, and the surgical procedure performed under sterile conditions. Aquamid becomes the stable and integral part of the body tissues after the application. Aquamid never disappears or travels through the organism away from the place of application. After the application of Aquamid a patient has completely normal facial mimic, and the recovery period is very short. Aquamid, a medical product of the Danish company “Ferrosan”, exists on the EU market for sixteen years already.

Procedure

The first step is preoperative medical examination in which a patient gets to know the detailed characteristics of Aquamid and its possibilities. At the first examination the most important thing is the proper selection of patients, or the assessment whether a patient can receive Aquamid at all. Therefore, the patients who suffer from autoimmune diseases, diabetes, pregnant women and women who breastfeed, people with many active acne on the face, or the patients who are dependent on the chronic corticosteroid therapy or high-dose of nonsteriod antirheumatics (especially Ibuprofen) must be excluded. All other patients can receive Aquamid. Aquamid is considerably more often applied in the upper than in the lower lip because the upper lip is more subjective to the natural variations of the shape and volume. Enlarging of the upper lip is therefore more demanding than enlarging of the lower lip and requires a great experience such as “Polyclinic Ostojić” can guarantee.

Surgical procedure

The picture shows the syringes of concentrated Aquamid Reconstruction, which are used to reduce the nasolabial and mentolabial folds and deep vertical, glabellar lines. Aquamid Reconstruction is successfully used to aesthetically increase the volume of the middle face, cheeks, chin, minimal post-rhinoplasty irregularities of the external nose and atrophic scars.

Applying the Aquamid Reconstruction in the right nasolabial fold. Two typical needle injection places are shown: the first stitch is being done at the angle of 45 degrees towards the fold, and the other at the angle of 30 degrees.

The comparison of the right fold filled with Aquamid, and the left, non-treated fold. The image on the left shows the nasolabial fold, filled with Aquamid, which is very shallow and looks youthful. The picture on the right shows the deep nasolabial fold,  clearly emphasized and revealing the older life age.

Postoperative period 

The swelling and/or bruises usually last for 1-3 days. Every patient should take antibiotic Ciprobay (ciprofloxacin) of 500 mg (two capsules a day during 5 days) and locally apply Betrion (mupirocin) antibiotic ointment 3 times a day, for 7 days. The patients must not locally apply cold compresses or visit the sauna, solarium or cold storage for ten days after the treatment. The facial make up must not cover the treated areas of the face for at least 48 hours. The result is considered to be final two weeks after the procedure. The patients must not take corticosteriods and high doses of nonsteroid antirheumatics for several months after the treatment (optimally 6 months). 

Complications 

So far only one complication of Aqumid application has been described, and that is a very rare infection. The infection does not occur because of the “dirty hands”, but in the following way: if the needle of Aquamid syringe breaks through the deep hair follicle in which there are skin saprophytes, then the bacteria (Propioni acne bacteriae) can be transferred into the subcutaneous tissue and cause the infection there. The infection does not leave lasting consequences, it is not life threatening, and it can be successfully treated with antibiotics, incisions and drainage.