Longevity Science • Category 12 · New

Biopolymers, ASIA Syndrome and Plasma Exchange.

What millions of people in Latin America don't know about the modelling substances injected into their buttocks, hips and other regions — and why the clinical conversation does not end with surgical extraction. Here: ASIA syndrome (Shoenfeld 2011), the Colombian-authored evidence (FUCS-Hospital San José, Bogotá), and the role of therapeutic plasma exchange as a complementary strategy acting on systemic inflammatory and autoimmune response — never as a substitute for surgery.

A silent epidemic still walking into the wrong consulting rooms

Colombia ranks 6th globally in cosmetic procedures. Behind that statistic sits another that doesn't appear in rankings: a significant proportion of biopolymer infiltrations — mineral oil, liquid silicone, methacrylate, paraffin, Biogel, polyacrylamide — occurred in "clandestine clinics" by unqualified personnel, with prohibited or untraceable substances. The Montealegre, Rojas-Villarraga et al. paper in Toxicology Reports (2021), published by physicians at FUCS and Hospital San José in Bogotá, states it explicitly: the problem has reached "epidemic proportions, especially in Latin America."

Most patients — and they are overwhelmingly women — received injections in buttocks, hips, breasts and thighs. The mean latency between infiltration and the first symptoms, per the FUCS case-series, was 27.8 months. Almost three years of silence before the first warning. Then: induration, nodules, migration of material, chronic fatigue, joint pain, brain fog — and in many cases, progression toward ASIA syndrome.

"The problem has reached epidemic proportions, especially in Latin America." — Montealegre, Uribe, Martínez-Ceballos, Rojas-Villarraga · Toxicology Reports 2021
Montealegre, Rojas-Villarraga et al. · Toxicology Reports · 2021

Patients with foreign body modelling reaction who developed ASIA syndrome

The Bogotá-based group from FUCS and Hospital San José followed 13 patients with gluteal biopolymer infiltration and modelling foreign body reaction for two years. All patients met Shoenfeld's ASIA criteria. It is the best indexed Colombian-authored evidence on the link between biopolymers and systemic autoimmunity.

  • Clinical latency

    27.8 months (mean)

    Mean time between biopolymer infiltration and onset of clinical manifestations of modelling foreign body reaction. Almost three years of silence before the first documented symptom.

  • Progression to ASIA

    100% in FUCS case-series

    All 13 patients with foreign body modelling reaction met diagnostic criteria for Shoenfeld's ASIA syndrome during follow-up. More than half had a family history of autoimmunity.

  • Autoimmune risk

    +45% (Watad 2018)

    Real-world analysis by Watad et al. in Int J Epidemiol reported a 45% increased risk of autoimmune/rheumatic disease in women with silicone implants — extrapolable conceptually to other modelling materials.

  • Systemic autoimmunity

    ~50% (Cohen Tervaert)

    Cohen Tervaert's series reported that approximately half of patients with silicone implant incompatibility syndrome and ASIA develop an established systemic autoimmune disease during follow-up.

What exactly is ASIA syndrome

ASIA — Autoimmune/Inflammatory Syndrome Induced by Adjuvants, also known as Shoenfeld's syndrome — was described by Yehuda Shoenfeld and Nancy Agmon-Levin in Journal of Autoimmunity (2011). It defines a systemic autoimmune and inflammatory condition triggered by exposure to adjuvants: silicones, biopolymers, mineral oils, aluminum salts and other materials the immune system recognizes as foreign bodies.

The condition rests on four major criteria: prior exposure to the adjuvant, typical clinical manifestations (myalgia, arthralgia, chronic fatigue, brain fog, sleep disturbance, neurological manifestations), improvement after removal of the inciting agent, and characteristic biopsy of involved organs. Minor criteria include the appearance of autoantibodies and eventual evolution toward established autoimmune diseases — systemic sclerosis, lupus, Sjögren's.

In 60% of ASIA patients, the triad appears: polyarthralgia, myalgia, cognitive and sleep disturbances.
Ch. 03 · Clinical manifestations

What appears locally · What appears systemically

The condition has two axes that may appear sequentially or simultaneously. The Colombian literature published by FUCS documents each in detail. If you have biopolymers and recognize several of these symptoms, a serious clinical assessment is reasonable — regardless of how many years have passed since infiltration.

  • Local · Foreign body

    Modelling reaction

    Tissue induration, tender nodules, edema, panniculitis, progressive hyperpigmentation, cutaneous ulceration, fistulization with sterile drainage or drainage of modelling material.

  • Local · Migration

    Buttocks → low back / groin / thigh

    When infiltration was subcutaneous, material migrates to the lower back. When deep, it migrates to the inguinal region, perineum, and lower extremities. It also enters the lymphatic system.

  • Systemic · Musculoskeletal

    Arthralgia · myalgia · weakness

    Migratory polyarthralgia, diffuse myalgia, muscle weakness, occasionally myositis. Appears with or without classic inflammatory joint signs.

  • Systemic · Neurocognitive

    Fatigue · brain fog · sleep

    Chronic fatigue, unrefreshing sleep, brain fog, difficulty concentrating, working memory alterations. In some cases, neurological manifestations associated with demyelination.

  • Systemic · Mucocutaneous

    Dryness · distant lesions

    Xerostomia (dry mouth), xerophthalmia (dry eyes) — suggesting overlap with Sjögren-like presentation — and cutaneous lesions distant from the infiltration site.

  • Lab · Immunologic

    ESR · autoantibodies · thyroid

    Elevated ESR, appearance of antithyroglobulin antibodies, evolution to subclinical hypothyroidism, elevated IgG/IgM, ANA and other autoantibodies in subgroups.

Ch. 04 · Proposed mechanism of TPE in biopolymer-ASIA

What plasma exchange acts on — and what it does not

Therapeutic plasma exchange acts on systemic circulation: clearing soluble mediators, autoantibodies and plasma microparticulate. This is why it is discussed as an adjunct in ASIA. What TPE does not do is remove the biopolymer from tissue — that remains exclusive to specialized surgical extraction.

  • Cytokine clearance

    TNF-α · IL-1 · IL-6 · IL-8

    The in vitro studies reported in the Montealegre paper document sustained elevation of pro-inflammatory cytokines (TNF-α, IL-1, IL-6, IL-8) in response to modelling material. TPE removes soluble mediators from plasma — one of the classic rationales for plasma exchange.

  • Autoantibody removal

    ANA · antithyroglobulin · IgG

    When the adaptive immune system mounts an autoantibody response — as occurs in evolution toward autoimmune thyroiditis or Sjögren-like presentations — TPE can transiently reduce the circulating titer of those autoantibodies.

  • Plasma microparticulate

    Circulating fragments

    The literature documents macrophage phagocytosis of microspheres and microparticles from modelling material. The portion that reaches systemic circulation — small fragments, not tissue deposits — may be modulated by plasma exchange.

  • Integrated immune modulation

    Th1/Th2 · Th17 · inflammaging

    ASIA mechanisms described by Shoenfeld and reviewed by Perricone (2013) include Th1/Th2 imbalance, Th17 activation and innate immunity dysregulation. TPE acts as a transient reset of the circulating inflammatory milieu.

What we do · what we don't

Wellness Care does not perform biopolymer extraction surgery. If you have biopolymers and consider removing them from tissue, the clinical recommendation is evaluation by specialized plastic surgery — surgery remains the only documented way to remove the deposited modelling material. The literature describes techniques such as the Butterfly Wings Technique (Montealegre et al.) and extensive resections with reconstruction.

What we do: evaluate patients with systemic ASIA-type manifestations through advanced inflammatory and autoimmune biomarker panels — ESR, CRP, autoantibody profile, inflammaging, complete thyroid autoimmune panel, hepato-renal markers — and design individualized protocols of inflammatory modulation. These protocols may or may not include therapeutic plasma exchange depending on the case, immunologic profile, and evidence available for that specific patient.

TPE is not an alternative to extraction surgery — it is a complementary strategy acting on systemic inflammatory and autoimmune response. We confuse this in marketing, we respect it in clinic.
Ch. 06 · Clinical scenarios where TPE may be considered

Pre-surgical · Post-surgical · Standalone

None of these scenarios is a regulatory-approved indication. They are individualized compassionate-use approaches under strict medical criterion, communicated with transparency about what the evidence supports and what it does not.

  • Scenario 1 · Pre-surgical

    Before extraction

    In patients with planned major extraction surgery, TPE is evaluated to reduce systemic inflammatory burden prior to the procedure — attempting to improve the surgical field, modulate perioperative inflammatory response and favor post-surgical recovery. Decision made jointly with the treating plastic surgeon.

  • Scenario 2 · Post-surgical

    Residual ASIA

    Patients who persist with ASIA-type manifestations — chronic fatigue, arthralgias, brain fog, circulating autoantibodies — after adequate surgical extraction. Hypothesis: systemic inflammation can self-sustain via circulating mediators and autoantibodies even after removing the tissue deposit.

  • Scenario 3 · Standalone

    Surgery not possible / not desired

    Patients with systemic manifestations who, for clinical, anatomical or personal reasons, cannot or will not undergo extraction surgery. TPE does not extract the material — it modulates systemic inflammatory response as adjunct. Transparent communication: the cause remains, the effect is modulated.

Regulatory framework · INVIMA · International

Biopolymer-induced ASIA is not a regulatory-approved indication

Therapeutic plasma exchange is approved by INVIMA in Colombia for hematologic, immune-mediated neurologic (Guillain-Barré, myasthenia gravis, chronic inflammatory demyelinating polyneuropathy) and specific nephrologic indications. Biopolymer-induced ASIA syndrome does not appear as an approved indication in any regulatory jurisdiction — neither Colombian nor international.

The international ASFA guidelines (Connelly-Smith et al., Journal of Clinical Apheresis 2023) — the canonical framework for therapeutic apheresis — classify 92+ indications across four evidence categories (I–IV) and six recommendation grades (1A–2C). Biopolymer-ASIA does not appear in that classification.

Any discussion of TPE in this context is educational, individualized compassionate use under medical criterion, and must be communicated to the patient with full transparency about regulatory status. This page is educational editorial content — it does not constitute treatment offering or efficacy promise.

Go deeper into the science

Related categories

Biopolymer-ASIA intersects several library categories: the science of plasma exchange, advanced autoimmune and inflammatory biomarkers, ASFA apheresis guidelines, and the toxins category. Each deepens a different angle.

Therapeutic Plasma Exchange

TPE as the parent category — plasma exchange mechanisms, the Buck Institute biological age study, evidence in Long COVID and elimination of persistent synthetic chemicals (PFAS).

Explore →

ASFA Apheresis Guidelines

American Society for Apheresis — Ninth Special Issue (Connelly-Smith et al. 2023). 92+ indications classified across four evidence categories. The canonical international framework.

Explore →

Advanced Biomarkers

Inflammaging, ESR-CRP, autoantibodies, autoimmune thyroid profile, hepato-renal markers. How we evaluate a biopolymer patient with ASIA suspicion before proposing any protocol.

Explore →

Toxins & Detoxification

Heavy metals, mycotoxins, microplastics, PFAS. The broader conversation of chronic exogenous load — adjacent category to biopolymer management from a systemic modulation standpoint.

Explore →
Featured evidence

The papers that anchor
the biopolymer-ASIA conversation

Three publications defining the state of the art linking modelling material infiltration to autoimmune/inflammatory syndrome induced by adjuvants.

"All the patients in the present case-series with foreign body modelling reaction developed ASIA syndrome. Foreign body modelling reaction should be considered a precursor to ASIA syndrome."
13/13 patients · 2-year follow-up · FUCS-Bogotá
Montealegre, Rojas-Villarraga et al.
Toxicology Reports · 2021
"ASIA is a syndrome induced by exposure to adjuvants — silicone, biopolymers, mineral oil — that triggers widespread immune activation through both innate and adaptive pathways."
Diagnostic criteria · conceptual basis · 2011
Shoenfeld & Agmon-Levin
Journal of Autoimmunity · 2011
"Silicone breast implants are associated with a 45% increased risk of autoimmune/rheumatic disorders — a real-world signal consistent across multiple populations."
+45% autoimmune risk · real-world · 2018
Watad et al.
Int J Epidemiology · 2018

Frequently asked questions about biopolymers, ASIA and plasma

The questions we receive most often about biopolymers — what they are, why they cause harm, how they relate to ASIA syndrome, what plasma exchange does and does not do, and where the regulatory limits sit in Colombia. Answers aligned with indexed literature — including the Colombian-authored reference paper (FUCS-Hospital San José Bogotá).

01

What are biopolymers and why do they cause damage in the body?

Biopolymers used for aesthetic purposes are injectable modelling substances — mineral oil, liquid silicone, methacrylate, paraffin, collagen, polyacrylamide, Biogel — most of them not approved by regulatory agencies for that use. In the clinical literature this entity is termed iatrogenic allogenosis (Coiffman) or foreign body modelling reaction.

The body recognizes them as permanent foreign bodies and mounts a chronic inflammatory response that can persist for months or years. The FUCS-Hospital San José case-series in Bogotá reported a mean latency of 27.8 months between infiltration and the first documented clinical manifestations.

Montealegre, Rojas-Villarraga et al. · Toxicology Reports · 2021
02

What is ASIA syndrome and how does it relate to biopolymers?

ASIA (Autoimmune/Inflammatory Syndrome Induced by Adjuvants) — also called Shoenfeld's syndrome — was described by Shoenfeld and Agmon-Levin in Journal of Autoimmunity (2011). It is a systemic autoimmune and inflammatory condition triggered by exposure to adjuvants: silicones, biopolymers, mineral oils and other materials recognized as foreign bodies.

The FUCS-Bogotá study demonstrated that 13 of 13 patients with foreign body modelling reaction from gluteal biopolymers met ASIA criteria during follow-up. Cohen Tervaert (2018) reported that ~50% of patients with silicone incompatibility develop an established systemic autoimmune disease.

03

Does plasma exchange remove biopolymers from the body?

No. Therapeutic plasma exchange does not remove the modelling material deposited in tissue. For that, there is specialized plastic surgery for biopolymer extraction — techniques such as the Butterfly Wings Technique described by Montealegre or extensive resections with reconstruction.

What TPE does is act on circulation: clearing pro-inflammatory cytokines (TNF-α, IL-1, IL-6, IL-8), autoantibodies generated as adaptive immune response, and any microparticulate material that has migrated into the bloodstream.

TPE is not an alternative to surgical extraction — it is a complementary strategy acting on the systemic inflammatory and autoimmune response.

04

In what clinical scenarios might TPE be considered for biopolymer patients?

Three main scenarios — all individualized under strict medical criterion:

· Pre-surgical: reducing systemic inflammatory burden before major extraction surgery, attempting to improve the operative field and post-surgical recovery.
· Post-surgical: patients who persist with ASIA-type manifestations — chronic fatigue, arthralgias, brain fog — after adequate surgical extraction.
· Standalone: patients with systemic manifestations who, for clinical, anatomical or personal reasons, cannot or will not undergo extraction surgery and require inflammatory modulation.

None of these scenarios is a regulatory-approved indication — all are individualized compassionate-use approaches under medical criterion.

05

Is TPE approved for biopolymer-related complications in Colombia or internationally?

No. Therapeutic plasma exchange is approved by INVIMA in Colombia for hematologic, immune-mediated neurologic (Guillain-Barré, myasthenia gravis, chronic inflammatory demyelinating polyneuropathy) and specific nephrologic indications.

ASIA syndrome induced by biopolymers is NOT a regulatory-approved indication in Colombia or any other jurisdiction. The international ASFA guidelines (Connelly-Smith et al. 2023) do not include biopolymer-ASIA as a classified category I-IV indication either.

Any discussion of TPE in this context is educational and individualized compassionate use — never a menu-style treatment offering.

06

What symptoms should I watch for if I have biopolymers?

Local manifestations: tissue induration, tender nodules, edema, panniculitis, progressive hyperpigmentation, ulceration, fistulization, migration of material to adjacent regions (low back, groin, thigh).

Systemic ASIA-type manifestations: arthralgias and arthritis, myalgias and muscle weakness, chronic fatigue, sleep disturbances, brain fog and cognitive impairment, persistent low-grade fever, dry mouth and dry eyes, distant skin lesions.

The Watad et al. study (Int J Epidemiol 2018) reported +45% risk of autoimmune disease in women exposed to modelling materials with silicone implants — extrapolable conceptually to the biopolymer-liquid clinical picture.

07

Why is there such a high concentration of biopolymer complications in Latin America?

The Montealegre, Rojas-Villarraga et al. paper (Toxicology Reports 2021), published by physicians from Fundación Universitaria de Ciencias de la Salud (FUCS) and Hospital San José in Bogotá, states it explicitly: the authors cite other experts characterizing the problem as having reached "epidemic proportions, especially in Latin America."

Colombia ranks 6th globally in cosmetic procedures. A significant proportion of infiltrations occurred in "clandestine clinics" by unqualified personnel, without regulatory approval, using prohibited or untraceable substances. It is a documented public health problem with Colombian medical authorship.

FUCS-Hospital San José Bogotá · 2021
08

Does Wellness Care extract biopolymers or treat them?

Wellness Care does NOT perform biopolymer extraction surgery. If you have biopolymers and consider removing them from tissue, you must be evaluated by a specialized plastic surgeon — surgery remains the only documented way to remove the deposited modelling material.

What we do at Wellness Care: evaluate patients with systemic ASIA-type manifestations through advanced inflammatory and autoimmune biomarker panels, and design individualized inflammatory-modulation protocols — which may or may not include therapeutic plasma exchange depending on the case.

The decision is always medical, individualized, and communicated with full transparency about what the evidence supports and what it does not.

The real promise

Biopolymers were injected in silence. The inflammation they cause lives in silence for years. The serious clinical conversation also starts in silence — with an honest assessment, the right biomarkers, and a protocol that doesn't promise what it cannot deliver.

Assess systemic manifestations, quantify inflammaging and autoimmunity, decide with you what makes sense and what does not — that's what we do. Biopolymer extraction is performed by your trusted plastic surgeon. Modulating the systemic response is where longevity medicine can contribute — with judgment, transparency and within the regulatory framework.

Have biopolymers and systemic symptoms?

Book an inflammatory and autoimmune biomarker assessment

We evaluate complete clinical history, systemic manifestations, inflammatory profile (ESR, CRP, cytokines), autoantibodies, autoimmune thyroid panel and inflammaging markers. If you have biopolymers and recognize ASIA-type symptoms — chronic fatigue, arthralgias, brain fog, mucocutaneous dryness — this is what we do before proposing any protocol.

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