Liquid injectable silicone for soft tissue augmentation

Liquid injectable silicone is a unique soft tissue augmenting agent that may be effectively utilized for the correction of specific cutaneous and subcutaneous atrophies. Although historical complications have occurred, resulting likely from the presence of adulterants and impurities, modern purified silicone products approved by the Food and Drug Administration for injection into the human body may be employed with minimal complications when strict protocol is followed. In this article the present authors review the history and controversy regarding silicone as well as describe the appropriate indications, patient selection, instrumentation, treatment protocol, and anticipated complications involved with the use of liquid injectable silicone for soft tissue augmentation. Although its use is controversial, the present authors maintain that liquid injectable silicone is an important and effective augmenting agent for the long-term correction of scars and facial contour defects such as HIV facial lipoatrophy. Furthermore, it is a treatment modality deserving of continued investigation.     

Generalized livedo reticularis induced by silicone implants for soft tissue augmentation

Silicone is one of the most widely used filler for facial cosmetic correction and soft tissue augmentation. Although initially it was considered to be a biologically inert material, many local and generalized adverse effects have been reported after silicone usage for cosmetic purposes. We present a previously healthy woman who developed progressive and persistent generalized livedo reticularis after cosmetic surgery for volume augmentation of buttocks. Histopathologic study demonstrated dermal presence of interstitial vacuoles and cystic spaces of different sizes between the collagen bundles, which corresponded to the silicone particles implanted years ago. These vacuoles were clustered around vascular spaces and surrounded by a few foamy macrophages. General examination and laboratory investigations failed to show any evidence of connective tissue disease or other systemic disorder. Therefore, we believe that the silicone implanted may have induced some kind of blood dermal perturbation resulting in the characteristic violet reticular discoloration of livedo reticularis.     

Soft tissue augmentation--use of hyaluronic acid as dermal filler

Soft tissue augmentation has revolutionized the treatment of the aging face. It is a technique in which a substance is injected under the skin. The concept of utilizing materials for soft tissue augmentation actually began around 1950 with the use of fluid silicone. Today we have a large armamentarium of implant materials to delay the tell tale signs of aging. Filling has replaced conventional surgery in facial rejuvenation. In this article, the emphasis will be on hyaluronic acid as this substance is easily available in India and ranks among the most widely used dermal fillers.     

Granulomatous reaction to liquid injectable silicone for gluteal enhancement: review of management options and success of doxycycline

Liquid injectable silicone (LIS) for cosmetic purposes has been widely available and commonly used for almost half a century. An increase in buttock augmentation procedures because of patients wanting to emulate the look of some celebrities has recently highlighted cases in the media of unsafe administration of liquid silicone injections. Severe complications including death have been reported. In this article, we report a case in which liquid silicone was injected in the patient's gluteal tissue resulting in granulomatous reactions in the surrounding tissues. The patient responded well to doxycycline, presumably because of both its antimicrobial properties and immunomodulatory effects.     

Minocycline for the treatment of cutaneous silicone granulomas: A case report

Silicone oil injections are often used for soft tissue augmentation and local and general adverse effects occurring from a few months to 15 years after injection have been reported. Here, we present a case of delayed granuloma formation due to liquid injectable silicone with large extent of involvement, which precluded surgical removal. Our patient was successfully treated with minocycline, considering its anti-inflammatory, immunomodulating and antigranulomatous properties. This case presents minocycline monotherapy as a useful treatment option for the management of severe granuloma induced by silicone use when surgical excision is not possible.     

Soft Tissue Augmentation With Silicone

Adatosil is a viscous silicone oil which was granted FDA approval in 1994. This designation removes the legal obstacles to usage for soft tissue augmentation. However, physicians are advised to exercise discretion when using this product. There are several caveats which govern its use, including several contraindications, as well as difficult technical application.     

Silicone migration and granuloma formation

The use of liquid injectable silicone for soft tissue augmentation is a controversial practice within the medical community. Injectable silicone has been illegally obtained, adulterated, and abused by nonmedical practitioners for the last five decades. Injection of silicone can result in catastrophic consequences including death, when grossly abused. Opponents of this practice cite the many serious adverse events that have occurred with its use both legally and illegally. Proponents argue that employment of a stringent regimen of use as well as a highly purified medical grade product allow for a safe utilization of the material. Both sides agree that this practice calls for a high degree of knowledge and technical skill. A continued evaluation of the long-term safety of this material is necessary before a consensus can be reached.
Herein, we report a case of illegal administration of injectable silicone resulting in product migration accompanied by a granulomatous response. Further, the literature that both supports and refutes the practice of silicone injection is reviewed.     

Scleroderma following augmentation mammoplasty. Report of a case and review of the literature

A 46-year-old woman developed localized scleroderma after surgical manipulation of her silicone gel-filled breast prostheses. She developed firm, shiny plaques on her legs that progressed to involve the thighs. Histopathologic examination of a deep-skin biopsy specimen confirmed the diagnosis of scleroderma. On surgical removal of the silicone implants, and their replacement with saline-filled implants, the scleroderma gradually resolved. Histopathologic examination of the removed implant capsules revealed evidence of silicone leakage. All new female patients with scleroderma should be questioned and examined regarding augmentation mammoplasty. Until prospective studies are completed on the possible association between scleroderma and silicone breast implants, it would seem prudent to use the saline-filled, elastomeric envelope-type breast implant for augmentation mammoplasty rather than the silicone gel-filled implant.     

Penis swelling due to foreign body reaction after injection of silicone

A 19‐year‐old man presented with phimosis and painful swelling of the penis four weeks after augmentation with silicone in Thailand. Histology revealed a foreign body reaction to silicone. Infectious causes were ruled out. Granulomatous foreign body reactions to silicone are common, but there are few case reports on reactions following silicone injection for penis enlargement. Foreign body reactions should be included in the differential diagnosis of penis swelling.     

Foreign body granuloma formation secondary to silicone injection

Injectable silicone has been used extensively over the last 40 years for soft tissue augmentation. Although considered biologically inert, this material has been implicated in a variety of adverse reactions including granulomas, disfiguring nodules, and lymphedema, sometimes with latent periods of decades. Often these complications are a result of the use of industrial grade products injected by unlicensed or unskilled practitioners. Here we report a case of foreign body granuloma in the thigh secondary to silicone injection in the buttocks. Initially the patient did not disclose a cosmetic contouring procedure administered by a nonprofessional nine months earlier, making diagnosis difficult. We remind clinicians to include foreign body granulomas in the differential diagnosis of apparent cellulitis and to question patients about the use of injectable fillers.     

Dermal fillers: Facts and controversies

Dermal fillers have been used for decades in soft tissue augmentation. Currently, filler implementation is among the most common minimally invasive procedures for rejuvenation and body sculpturing. There is a broad variety of filler materials and products. Despite immense experience, a number of controversies in this topic exist. Some of these controversies are addressed in this review, for example, who should perform filler injections, the difference between permanent and nonpermanent fillers, the off-label use of liquid silicone, and the role of pain reduction. Implementation of guidelines and restriction of filler use by trained physicians can improve safety for patients.     

Polyacrylamide gel in cosmetic procedures: experience with Aquamid

Polyacrylamides have been used in tissue augmentation since 1980. AQUAMID injections amounting to 40,000 have been done for facial and body corrections in cosmetic and reconstructive medicine and surgery. Possible neurotoxic and carcinologic effects of acrylamide and their stability are reported. The most important complications are infection, granuloma, and migration. All actual studies and results are reported. Main indications are lips, nasolabial fold, and malar area.     

The use of injectable collagens for aesthetic rejuvenation

Bovine collagen was approved by the Food and Drug Administration in 1982 and since that time has remained a primary filler of choice for soft-tissue augmentation of dermal defects. During the past decade, however, perhaps mirroring the growth and overwhelming acceptance of botulinum toxin for wrinkle reduction, there has been an increase in demand and availability of new injectable filler products. A partial list includes the ever-expanding class of hyaluronans (hyaluronic acids), calcium hydroxylapatite, polymethylmethacrylate, poly-L-lactic acid, and silicone oil. There are many more on the immediate horizon that are under investigation both abroad and in the United States. Nevertheless, the collagen family of agents, regardless of their source of derivation, remain a reliable and useful alternative. They have an unparalleled record of safety and efficacy; they have different formulations, which makes them amenable to many indications and user friendly for the physician. And, for patient, the admixture of local anesthesia reduces the discomfort of the injection procedure.     

Inflammatory Nodules Following Soft Tissue Filler Use: A Review of Causative Agents, Pathology and Treatment Options

Nodule development is a common complication following the use of fillers for soft tissue augmentation and is commonly categorized as inflammatory or non-inflammatory in nature. Inflammatory nodules may appear anywhere from days to years after treatment, whereas non-inflammatory nodules are typically seen immediately following implantation and are usually secondary to improper placement of the filler. Although inflammatory nodules are more common with permanent fillers such as silicone, inflammatory nodule development following administration of temporary fillers such as hyaluronic acid and collagen has also been reported. Treated many times with corticosteroids due to their anti-inflammatory properties, inflammatory nodules may be secondary to infection or biofilm formation, warranting the use of alternative agents. Appropriate and prompt diagnosis is important in avoiding delay of treatment or long-term complications for the patient. This paper addresses the etiology, development, and studied treatment options available for inflammatory nodules secondary to each of the major classes of fillers. With this knowledge, practitioners may expeditiously recognize and manage this common side effect and thus maximize functional and aesthetic benefit.     

Silicone breast implant rupture presenting as bilateral leg nodules

Gross migration of silicone gel from ruptured breast implants is a rare event. It is associated with extravasation of gel into the breast parenchyma, and to distant locations such as the abdominal wall and inguinal areas. This silicone deposits present as subcutaneous nodules and cause a local reaction known as siliconoma. We evaluated a 56-year-old woman who presented with a 2-year history of painful, firm and ill-defined subcutaneous nodules on the medial aspect of the shins and ankles. Her medical history was notable for bilateral breast augmentation with silicone implants 30 years before presentation. Although there were no signs or symptoms on breast examination, ultrasonography and magnetic resonance imaging confirmed that both implants had ruptured. Histological examination of a punch biopsy from a nodule on the shin found lobular granulomatous panniculitis. An excisional biopsy of the lesion was analysed by scanning electron microscopy and was found to contain silicone. This is a rare case of gross migration of silicone to the shins, originating from ruptured breast implants. To our knowledge, there is no previous report of silicone migration to such a distant location. We discuss the common presentation of silicone migration and highlight the importance of awareness among dermatologists and plastic surgeons about this unusual occurrence.     

Eosinophilic pustular folliculitis (Ofuji's disease) in a patient with silicone tissue augmentation

Eosinophilic pustular folliculitis (EPF) (Ofuji's disease) is a rare dermatosis of unknown etiology. We describe a 45-year-old Chinese woman who developed EPF on her face seven years after having nose and chin augmentation with subcutaneous silicone injections.     

Human adjuvant disease following augmentation mammoplasty

Two patients are described in whom a progressive systemic sclerosis-like illness developed several years after silicone augmentation mammoplasty. Both had removal of breast implants, followed by marked-to-complete recovery from clinical abnormalities. This entity is increasingly recognized and has become known as human adjuvant disease.     

Soft tissue augmentation 2006: filler fantasy

As an increasing number of patients seek esthetic improvement through minimally invasive procedures, interest in soft tissue augmentation and filling agents is at an all-time high. One reason for this interest is the availability of botulinum toxin type A, which works superbly in the upper face. The rejuvenation of the upper face has created much interest in injectable filling agents and implant techniques that work equally well in the restoration of the lower face. One of the central tenets of soft tissue augmentation is the concept of the three-dimensional face. The youthful face has a soft, full appearance, as opposed to the flat, pulled, two-dimensional look often achieved by more traditional surgical approaches. Injectable filling agents can augment and even at times, replace pulling. Additionally, with the lip as the focal center of the lower face, subtle lip enhancement is here to stay, and is in fact, the number one indication for injectable fillers. Moreover, minimally invasive soft tissue augmentation offers cosmetic enhancement without the cost and recovery time associated with more invasive procedures. As more and more physicians take interest in minimally invasive surgery, courses in cosmetic surgery techniques are becoming increasingly popular at the medical meetings of many specialties. Today, physicians have a much larger armamentarium of techniques and materials with which to improve facial contours, ameliorate wrinkles, and provide esthetic rejuvenation to the face. For a substance or device to be amenable for soft tissue augmentation in the medical community, it must meet certain criteria. It must have both a high "use" potential, producing cosmetically pleasing results with a minimum undesirable reactions, and have a low abuse potential in that widespread or incorrect or indiscriminate use would not result in significant morbidity. It must be nonteratogenic, noncarcinogenic, and nonmigratory. In addition, the agent must provide predictable, persistent correction through reproducible implantation techniques. Finally, the substance, agent or device must be approved by the U.S. Food and Drug Administration, which assures purity, safety, and accessibility, as well as much-needed information regarding use. Having a thorough understanding of the filling agents available, their indications and contraindications, as well as having thorough knowledge of implant technique are vital in providing the patient with an esthetically pleasing result.     

Collagen uses in dermatology - an update

Collagen-derived materials have been used in medicine for many decades. Sutures, hemostatic devices and matrices which stimulate cell growth and soft tissue augmentation are the major applications. In this update, we discuss the two major applications for collagen in dermatology: tissue augmentation and wound healing. Copyright (R) 2000 S.Karger AG, Basel     

The use of poly-L-lactic acid in the management of soft-tissue augmentation: a five-year experience

Poly-L-lactic acid (PLA) New-Fill* is one of the latest implants commercialized among bioresorbable fillers. This synthetic polymer is biocompatible, biodegradable, immunologically inert, and free from toxicity. All these necessary properties provide theoretical safety. New-Fill* has to be injected deeply into the dermis or into the subcutaneous tissue, so the main indications of New-Fill* are the correction of important wrinkles and furrows from face (Nasolabial folds, "Marionette" lines), and especially spread tissue augmentation for "face modeling" as for cheeks lipoatrophies in HIV patients receiving an antiprotease treatment. After two or three sessions, results are appreciable and equivalent to other resorbable fillers, but seem to last longer. On the other hand, the cost of this material is widely cheaper than others. However, we do not lose sight that the practitioner fee related to a series of two to three sessions of injections compensates for this material economy. Superficial injections should be avoided. They may increase the risk of persistent granulomas, which will be difficult to manage. Even if severe complications are rare, they must be revealed to the patient to obtain his informed consent before injecting.