Lethal silicone embolization syndrome complicating penile, scrotal and breast self-augmentation

Injectable Penile Enhancement Procedures: A Review of Agents, Risks, and Complications

Penile dysmorphophobic disorder describes men who feel their normal penile size is inadequate. Penile fillers have been used to address penile size dissatisfaction. However, unpredictability of these procedures can yield unfavorable outcomes. Reactions to these foreign bodies are inherently uncertain, owing to an array of materials, concentrations, and biocompatibility. Management of complications also varies. As fillers are more commonly used in cosmetic procedures to augment facial features, most genitourinary surgeons are unfamiliar with these therapies. This review seeks to describe the available materials, techniques, and risk profiles of the various types of fillers used for penile augmentation.

Female genital mutilation - An overview for forensic practitioners

Female genital mutilation (FGM) refers to all procedures that partially or totally remove the external female genitalia, or to all other deliberate injuries to the female genital organs for non-medical reasons. It is thought that over 200 million girls and women have had some form of FGM, with more than three million girls being at risk annually. The procedure varies in severity from partial or complete removal of the clitoris (Type 1) to oversewing of the vaginal opening, so-called infibulation (Type 3). There are no medical benefits from FGM, with complications increasing with the amount of tissue damage that has been inflicted. Side effects may be psychological and physical including excessive scarring, pain, infections, sexual dysfunction with significant obstetrical complications such as fistulas and increased risks of stillbirth, as well as increased neonatal and maternal morbidity and mortality. Although primarily originating in countries in Africa, the Middle East and Asia, mass migrations in recent years have made FGM a feature in most societies. For this reason, forensic practitioners and pathologists should be aware of the anatomical features of FGM and the potential medical and psychological side effects. Accurate recording of cases is required to enable appropriate resources to be allocated for instituting preventive measures.

Filler-induced non-thrombotic pulmonary embolism after genital aesthetic injection

Genital aesthetic procedures have increased in popularity among women and men. Many clinicians tried to expand the application of fill injection by using it for genital aesthetic injection. However, this procedure is not so safe as imagined and may lead to a fatal complication of pulmonary embolism. This article summarizes the clinical manifestations and proposed mechanism of the filler-induced non-thrombotic pulmonary embolism (FINTPE) cases. A literature review was performed with the search keywords including "genital aesthetic injection, vaginal injection, vaginoplasty, vaginal tightening, penile augmentation, penis injection, hyaluronic acid, fat grafting, pulmonary embolism, alveolar hemorrhage, hypoxemia, and dyspnea." Among the 14 cases from 11 articles enrolled, 12 patients were female, and two were male. Eight patients received silicone injection, followed by two received fat grafting and hyaluronic acid injection, respectively. All the female patients had one single injection site, including 11 cases for the vaginal wall and one for G-spot, while all the male patients received injections into the penis and scrotum. The main symptoms were dyspnea and chest pain. Almost 60% of FINTPE patients presented respiratory disorders within 12 hours post-operation. Treatment includes oxygen therapy, corticosteroids, and anticoagulation. Five patients improved with an average of 14.6-day treatment, and seven died due to organ failures. Genital aesthetic filler injections are experimental procedures without being strictly reviewed or approved. As a severe complication following these procedures, FINTPE requires cautious performance, careful prevention, timely identification, and treatment to decrease its incidence and mortality.

Recurrent Silicone Embolism Syndrome requiring VA ECMO

The illegal use of liquid silicone in injectable procedures has been on the rise for the last few years. While originally thought to be an inert material, today, silicone is associated with several inflammatory complications-including Silicone Embolism Syndrome (SES). SES is the most dreaded complication of unlicensed liquid silicone injections. It is characterized by pneumonitis, diffuse alveolar and silicone pulmonary emboli leading to acute respiratory distress syndrome and cardiopulmonary failure. We present a case of a patient who was diagnosed with SES after she received unlicensed liquid silicone injections for gluteal augmentation. Her disease necessitated treatment with veno-arterial extracorporeal membrane oxygenation. Her neurological status remained poor. Our patient was also treated for SES status-post illicit silicone injections several years prior to the current episode. To our knowledge, this is the only reported instance of the same patient experiencing SES status-post illicit silicone injections on two separate occasions.

Our patient's case suggests that robust education is needed for patients and the general public regarding the dangers of illicit body modifications. Given the widespread availability of counterfeit “medical grade” silicone, it is likely that the number of SES cases will continue to increase. Physicians must to be able to recognize the symptoms of SES, and not discount the possibility that patients will continue to receive illicit injections-even if they experienced devastating consequences the first time.

Liquid silicone embolism syndrome (SES) in lungs and liver - A case report

Silicone embolism syndrome (SES) is a well known complication after injection of silicone gel as well as liquid silicone. Rarely, men use physiologic salt solution or liquid silicone injected into the subcutaneous tissue of the scrotum, the penis, the upper genital or the inguinal region. Those men, who call themselves "siliconers", want to get a larger penis and scrotum, also visible when wearing clothes. Injections of liquid silicone in the mentioned regions can lead to liquid silicone embolism in the lungs and also the liver, sometimes eventually leading to death via right heart failure as in the present case. Autopsy revealed "frog spawn"-like vacuoles in the subcutaneous tissue of the genital region and liquid silicone embolism in lungs and liver. Additionally, toxicological analyses revealed different liquid silicones. Smaller oligomers were transported into lung and liver, larger ones showed local enrichment at the injection site. The seized Polydimethylsiloxane (PDMS) could not be detected in abdominal fat, blood or urine, potentially due to low perfusion of fat tissue, the aqueous character of blood and urine or the time span between last injection and death.

Nonsurgical Methods for Penile Augmentation: A Systematic Review

BACKGROUND

There is no standardized approach for nonsurgical techniques for penile augmentation despite the increase of demand for this intervention.

OBJECTIVE

To compare the efficacy and safety between different injection techniques.

MATERIALS AND METHODS

On October 8, 2019, a literature search was performed on PubMed, Embase, Ovid, and Cochrane database. All articles describing penile augmentation were included.

RESULTS

Thirteen studies were included in this article with a total of 1,311 patients. Five studies were prospective cohort. The most commonly described technique was hyaluronic acid fillers with a total of 4 articles and 205 patients. The mean injected volume ranged from 20 to 40 mL. In all included studies, a minority of patients had side effects, but some had disabling complications.

CONCLUSION

There are no defined clinical guidelines for penile augmentation techniques implemented yet. Hyaluronic acid seems to be safe, efficient, and with a high satisfaction score. Further randomized control trials are warranted.

EBM LEVEL OF EVIDENCEBASED MEDICINE

2a.