Silicone fluid, attractive and dangerous: Collective review and summary of experience

Rare Complication of Silicone Fluid Injection Presenting as Multiple Calcification and Skin Defect in Both Legs

In the past, many materials have been injected for soft tissue augmentation including paraffin (mineral oil) and other non–biocompatible products. Liquid silicone as one of these materials has a long and notorious history as an injectable material for soft tissue augmentation. However, complications, including cellulitis, ulcerations, migration, and nodule formation, have also been reported with silicone injections. This article aims to demonstrate the diagnosis and treatment of multiple calcification and skin defect after silicone fluid injection for soft tissue augmentation. A 65-year-old female presented with skin defect and calcifications had been steadily increasing in size over a 3-month period. Examination confirmed pain, swelling, induration, and 5 × 5 cm sized skin defect with marginal and adjacent calcification in the left lateral malleolar area. She had been injected silicone fluid for soft tissue of lower extremity augmentation and contouring 30 years ago. Serial surgical debridement of this entire zone of calcification and ulceration was undertaken. The defect was closed by a split thickness skin graft. She was satisfied with the aesthetic appearance of the lateral malleolar area, relieving the symptoms of cellulitis.

Synthetic facial implants

This article presents a range of synthetic implant materials for use in facial plastic surgery. The authors discuss alternatives to autogenous tissue transfer in terms of biocompatibility, technique, complications, controversies, and cautions. The reader is presented information about a range of synthetic implant materials such as silicone, polyester fiber, polyamide mesh, metal, polyethylene, polyacrylamide gel, hydroxyapatite, polylactic acid, collagen, and others.

Treatment of acne scars with liquid silicone injections: 30-year perspective

BACKGROUND

This article addresses the use of liquid injectable silicone as both an immediate and long-lasting treatment for broad-based, depressed acne scars. The only filler substance that maintains precision and permanence in improving and/or correcting these types of acne scar defects is medical-grade liquid silicone.

OBJECTIVE

We describe five patients with a history of acne scarring who showed improvements from injections of liquid silicone at the initial treatment session and lasting over a 10-, 15-, and 30-year follow-up period.

METHODS

Monthly liquid silicone injections using a technique known as the microdroplet, multiple-injection approach.

RESULTS

This article documents the safety, effectiveness, and precision of silicone in addition to highlighting the fact that its permanence is what distinguishes it from other filler materials.

CONCLUSION

As a precise and permanent filling substance used for soft tissue augmentation, liquid injectable silicone can improve and/or eliminate depressed, broad-based acne scars through a technique known as the microdroplet, multiple-injection

An unusual complication from esthetic injection of liquid silicone into the forehead

PURPOSE

To report a case of migration of liquid silicone into the upper eyelid.

DESIGN

Interventional case report.

METHODS

A 32-year-old woman had an injection of liquid silicone into the subcutaneous tissue of the forehead. She developed a cystic mass in the upper eyelid 2 days postinjection. An excisional biopsy was performed.

RESULTS

The mass lay in the Müller's muscle, and its base adhered to the tarsus. The mass ruptured during dissection, revealing a yellowish turbid fluid. Histopathologic findings showed lipogranulomatous reaction.

CONCLUSIONS

Liquid silicone injection to the forehead may promote formation of a cystic mass in the upper eyelid.

Alloplastic implantation

LEARNING OBJECTIVES

After studying this article, the participant should be able to: 1. Define an alloplastic material and know the differences between an alloplast and other types of implants available for surgical use. 2. Determine the biologic response to alloplastic implantation and the material and host characteristics that contribute to long-term reconstruction success with their use. 3. Review the criteria for choosing a specific alloplastic material for a reconstruction site and the principles of surgical technique for its proper placement. 4. Evaluate the various alloplastic material types that are currently available for surgical use and be able to discuss several physical properties of each as they relate to handling and clinical implantation. 5. Discuss the complication of alloplastic infection, its pathogenesis, preoperative and intraoperative measures for its avoidance, and the postoperative management of its occurrence.

Grafts amd implants in rhinoplasty and nasal reconstruction

The quest for nasal symmetry and balance with the face often mandates the need for implantable materials to sculpt and rebuild the nasal skeleton and the overlying tissues. A suitable implant must be biocompatible, strong, and elastic. Implant materials that may be used in the nose can be divided into four groups: autografts, homografts, xenografts, and alloplasts. Each type of implant is reviewed and discussed in the context of rhinoplasty and nasal reconstruction.

Dermal and subdermal tissue filling with fetal connective tissue and cartilage, collagen, and silicone: experimental study in the pig compared with clinical results. A new technique of dermis mini-autograft injections

The early reaction to the injection of silicone, collagen, and lyophilized heterologous fetal connective and cartilage tissues into the limiting zone deep dermis-superficial subcutaneous tissue was histologically examined in the pig and compared with clinical results. The inflammatory reaction to lyophilized heterologous fetal tissue is considerably more intense than that to collagen and silicone and lasts for several weeks. Therefore, it is not recommended for soft tissue filling in the face. Admitting an inferior antigenicity of fetal tissues, the authors suggest that enzymatically denaturalized collagen should be manufactured from heterologous fetal connective tissue, to be then further tested. The reaction of tissue to silicone and collagen is minimal. Silicone is preferred for dermal injections since in clinical experience it remains in the site of injection much longer. For subdermal injections, however, collagen is preferred. Based on experience with over 600 patients since 1958, the first author continues using liquid silicone. The lack of complications is probably a result of the fact that only small amounts (milliliters) of silicone were used in wrinkles or small depressions in the dermal layer and that from the beginning injection into the subcutaneous tissue was avoided. Since 1988 a new technique for the treatment of wrinkles and skin depressions with injections of dermal miniautografts has been used with satisfactory results.

Immediate breast reconstruction with subpectoral implantation after transaxillary subcutaneous mastectomy for siliconoma

Immediate breast reconstruction on 14 patients suffering from breast hardening after augmentation mammaplasty by injection of silicone gel was performed. Transaxillary subcutaneous mastectomy was done followed by insertion of a double-lumen prosthesis into the subpectoralis plane. The result was greatly influenced by the amount of injected silicone gel. The patient was carefully observed after surgery, and the prosthesis was immediately removed when abnormal skin changes became apparent. Seven cases had no hardening on either side and 1 case had hardening on one side, 3 cases had hardening on both sides and 1 case on one side, 2 cases had the prosthesis removed from both sides and 2 cases from one side. All other cases with hardening or prosthesis removal, except one with removal from both sides, were subsequently reconstructed after more than three months.

Treatment of depressed cutaneous scars with gelatin matrix implant: a multicenter study

Twenty-two centers participated in a study to determine the efficacy and safety of gelatin matrix implant (GMI; Fibrel) in the elevation of depressed cutaneous scars. Gelatin matrix implant is an implant consisting of absorbable gelatin powder and epsilon-aminocaproic acid, which is reconstituted with the patient's plasma before being injected intradermally beneath the scar. A total of 321 patients were evaluated after a skin sensitivity test; six of the patients (1.9%) had a positive response. After a skin test with negative results, 27 patients dropped out of the study for unrelated reasons. The remaining 288 patients were treated with the implant (total of 840 scars), many of whom have been followed up for more than 1 year. Preliminary results show that approximately half of the treated scars showed improvement of greater than 65%. The current data suggest that the improvement lasts at least up to 1 year. Adverse reactions to gelatin matrix implant injections were local and transient, and none of the patients developed major hypersensitivity responses to the treatment. The data indicate that intradermal injections of gelatin matrix implant are safe and effective in correcting the depressed scars selected for this study.

The history of injectable biomaterials and the biology of collagen

The authors discuss the history and use of injections of paraffin, silicone, and collagen for soft-tissue contouring. The structure and uses of collagen are described with particular reference to Zyderm Collagen Implant, a highly purified bovine collagen.

Substances for soft tissue augmentation: collagen and silicone

Zyderm injectable collagen and silicone are both used for soft tissue augmentation. Neither is perfect. Critical factors associated with their use include lesion selection and injection technique. Both may have immediate and delayed adverse reactions.

Complications after silicone injection therapy in aesthetic plastic surgery

Silicone injection therapy plays a significant, but limited, role in soft tissue augmentation. It is confined only to a tissue defect, folds, and deep wrinkles of the face. It is important to use only a small amount of injectable silicone (1-2 ml) in one area of the face at a time. Massage is applied over the injected area for 5-6 minutes. The following side effects and complications are observed: diminished volume, descending of silicone fluid due to the gravity, and silicone granuloma formation. Liquid silicone should be available, for the time being, only to surgeons for experimental purposes, because of the danger of complications and abuse. In this experimental study, the author applied 1,677 silicone injections (only in the face).