Carbon Dioxide Laser Vaporization of Facial Siliconomas: Flash in the Pan or Way of the Future?

Delayed hypersensitivity reaction from microneedling twenty years after silicone fillers

Skin rejuvenation procedures have increasingly flooded the aesthetic market, one of which includes microneedling. In microneedling, multiple fine punctures of the skin are performed with a needle to induce neocollagenesis. Microneedling has increasingly been used to treat inflammatory acne, acne scarring, photodamaged skin, and even radiation dermatitis. We present a patient with a stable history of liquid injectable silicone (LIS) given 20 years prior who developed chronic periocular and facial hypersensitivity after undergoing microneedling at a medi-spa. Long-term steroids and immunosuppressants were needed for control. The patient's severe reaction and resistance to treatment highlights the potential complications of microneedling administered by a non-medical professional in the setting of prior injectable silicone.

Gluteal Augmentation With Liquid Silicone of Unknown Purity Causes Granulomas in an Adult Female

Background:

A 39-year-old woman presented with a history of relapsing painful erythema and progressive fibrosis of the lower back. Upon questioning, the patient admitted to receiving liquid silicone (LS) injections for gluteal augmentation abroad and was diagnosed with silicone migration, granulomatous reaction, and fibrosis of the lower back.

Objective:

To review the history of LS injections for cosmetic soft tissue augmentation (STA) as well as its complications and potential treatments.

Methods:

The author reviewed articles that involved the use of LS for STA and summarized their findings.

Results:

The author summarizes the various treatments that have been described for inflammatory reactions following LS injection.

Conclusion:

The growth of cosmetic medical tourism and its inherent lack of after-care as well as patients’ ability to obtain restricted products at home raise the likelihood of encountering granulomatous or fibrotic reactions to fillers during consultations. Physicians should have a structured approach to these patients.

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.

Local complications after industrial liquid silicone injection: case series

OBJECTIVE

To analyze a case series of patients who underwent injection of industrial liquid silicone in a clandestine manner and by unauthorized persons.

METHODS

We conducted a retrospective analysis of medical records of patients treated between September 2003 and December 2010. Data regarding gender, age, location and volume of silicone injected, time between application and clinical manifestations, complications, treatment and outcome were collected. Early manifestations were defined as occurring within 30 days of injection and late manifestations, the ones arising after this period.

RESULTS

We treated 12 patients, eight were male, seven transsexuals. The volume injected ranged from 5 ml to 2000 ml, being unknown in three cases. The most often used injected sites were the thighs and buttocks. Eight patients had early manifestations, with inflammation and/or infection. Surgical debridement was necessary in five cases. Three patients with a history of injection in the breast region underwent adenomastectomy. There was one death due to refractory septic shock.

CONCLUSION

The use of industrial liquid silicone should be completely contraindicated as a filling material and modification of body contouring, and may have serious complications, even death.

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.

Neck lymphadenitis due to silicone granuloma after mammary implants

INTRODUCTION

A foreign body reaction due to silicone where it is infiltrated or at the places to which it can migrate is known as siliconoma. The use of silicone in breast augmentation procedures can provoke this reaction at the neck level in cases of leakage from mammary implants.

METHODS

We reviewed the cases of patients with increased size neck lymph nodes who had previously undergone plastic surgery of the breast with highly cohesive silicone gel implants.

RESULTS

In a 10-year period, we identified 12 cases with silicone-infiltrated neck lymphadenopathies, histologically confirmed by fine needle aspiration. They represented 3.5% of patients attended for neck lymph node study. We removed those detected by physical examination and CT in 5 cases, due to pathological characteristics of the node or a previous malignant history. In 2 of these nodes recurred, and node size also increased in 2 of the other 7 non-operated cases. After implant removal, silicone leakage was observed in only 7 cases.

CONCLUSIONS

Cohesive gel silicone used for mammary implants can generate increased neck lymphadenopathies as a secondary effect due to systemic reactions against the silicone when it migrates in cases of implant failure. Surgical options for involved nodes usually do not offer good long-term results.