Silicone injections have been performed for nearly ½ century and popularized the ability to affordably enlarge your buttocks in the comfort of your home with minimal discomfort. Silicone injections were often performed by non medical professionals who had no formal training in injections. Although early results were often satisfactory, a high level of complications were observed. Complications were observed early within hours to days after injection, in delayed fashion over weeks to months, and long term over years to decades following injection.
Various free silicone brands
|Generic Name||Brand Name|
|Silicone||Adatol-sil oil 500, bioplastique, biopolimeros, dermagen, silokon 1000, slices|
|Polyacrylamide||Amazingel, Aquamid, Argiform, Bioform, acyl, Evolution, Outline|
|Polyetacrilate||PMMA, Metacril, line safe|
Early complications following silicone injections involve formation of clots in small vessels of the skin resulting in overlying skin necrosis, infections resulting from non-sterile silicone, as well as embolization of silicone polymers that can be propagated to end organs that rarely may result in pulmonary emboli and death.
Delayed complications from silicone injections can result in early rashes, hypersensitivity reaction, delayed infections, and overlying skin discoloration.
Late complications from silicone injections include scar contraction resulting from granuloma formation around the silicone beads and inevitably gel migration to the superficial skin resulting in skin ulcerations, infections, and ultimate contour deformity. Unfortunately, the migration of silicone molecules to the periphery is unavoidable and will occur in almost all cases. The delay of silicone beads up to and through the skin is determined by the debt of free silicone injections. The deeper the injection, the longer it will take for the silicone to extrude through your skin. Skin ulcerations will typically be observed 5 to 10 years following injection based on the debt of silicone injection. It is this devastating complication and deformity that led the FDA to finally make free silicone injections illegal in 1991. Despite this FDA action, free silicone injections are still being performed.
Treatment for free silicone injections include a comprehensive and customized surgical plan based on physical examination and imaging. Physical examination is required to document areas of skin discoloration, areas of firmness and palpable granulomas, areas of skin ulcerations, and severity of buttock deformity. These findings must then be correlated with the actual location of silicone bead positions throughout the buttock cheek which can be documented with an MRI without contrast. The goal of surgical treatment of silicone injections should be to eliminate as many silicone beads as feasible, to replace lost volume with fat transfer, and to excise any and all ulcerations.
MRI image demonstrates injection of free silicone in the subcutaneous fat as well as the muscle courtesy of Dr. Cesar Vellila
The mainstay of treating free silicone injections to the buttocks is removal of the silicone and scar that has formed around them. Elimination of both the silicone as well as scar tissue must be prioritized when considering appropriate treatment. Direct injection of firm areas can be considered with 5-FU which will inhibit fibroblast proliferation and scar tissue deposition. Removal of silicone beads that can be large in size and stuck in scar tissue is another consideration. The use of 5mm sized basket cannulas is necessary to ensure that the diameter of cannula holes will assist in removal of larger sized beads. Additionally, dexamethasone injections of 16mg IV per day for 3 days at one week prior to surgery can also be considered to help scar tissue mobilization prior to surgery.
Removal of silicone beads throughout the buttock cheek is achieved using suction assisted liposuction. The MRI must be used to guide removal of silicone beads throughout the buttock cheek’s soft tissues. Priority for removal of silicone beads is focused on the most superficial silicone beads. This is because the superficial beads are most vulnerable to extrusion. In general, it has been observed that removing 30-40% of silicone material is possible during each session of SAL. When scar tissue is prominent, ultrasound assistance may be necessary to remove both silicone beads and scar tissue effectively. Fat transfer for replacement of lost volume from silicone removal is necessary universally. When planning fat transfer, you must consider fat harvest. It is critical to ensure that fat harvests used to replace the lost volume are not taken from areas that are prone to silicone embolization. These areas include the sacral area, inguinal area, and throughout the legs. Another critical precaution is to use separate collection canisters for the liposuction of the silicone beads and the fat harvested for volume replacement.
Another important consideration is elimination of skin ulcerations and scar tissue. Any areas of skin deformity must be excised. When a larger area of damaged skin is observed, then enblock excision of the area can be considered. This can be performed as a lateral thigh and buttock tuck. The lateral thigh and buttock tuck will not only eliminate skin redundancy of the buttock cheek but also allow for elimination of buttock cheek sagging and lower buttock check cellulitis. A final consideration in silicone buttock treatment is the use of carboxypenumaticdissection which can help any skin discoloration.
In order to help design your customized free silicone injections revision, a consultation with a Surgisculpt surgeon is necessary.