Intraoperative Discovery of Permanent Gluteal Filler During Implant Revision: A Case Report on Surgical Adaptation and Risk Awareness.

BACKGROUND Gluteal augmentation has gained significant popularity worldwide, with a parallel increase in complications related to unregulated procedures. The use of permanent fillers by non-medical personnel poses serious risks and can complicate future surgical interventions. CASE REPORT We report the case of a 29-year-old woman seeking revision of a prior gluteal augmentation performed abroad with subcutaneous silicone implants. The patient desired greater upper-pole projection and improved contour. During liposuction of the lower back, an unexpected gel-like material was encountered throughout the subcutaneous tissue of the lower back, hips, and infra-gluteal fold, consistent with previously injected permanent filler. The procedure was immediately adapted: fat grafting was abandoned due to the risk of infection and poor graft viability, and thorough manual extraction and irrigation were performed. Implant exchange was completed successfully, with new biconvex silicone implants placed in intramuscular pockets. The postoperative course was uneventful, and at 3-month follow-up, the patient demonstrated improved contour and was satisfied with the outcome. CONCLUSIONS This case illustrates the need for accurate preoperative evaluation and the ability to adapt intraoperatively in response to unsafe prior procedures. It also highlights the growing concern over illegal filler use and reinforces the importance of regulation, patient education, and adherence to evidence-based surgical practices to ensure safety and satisfactory outcomes.