12/29/2024
Hello all!
As this year comes to an end, I’m bringing some cases for you all to see, if you’d like and can make time for it.
Couple days ago I just saw another case of “Silikon micro-droplets injections treatment” that came to me as a complication and, like most of the times, there’s very limited resources for me to use and not much that I can do to try and improve – let alone resolve - the aesthetics of these patients, and to bring awareness, I’m sharing a few silicone injection complication cases I saw this year – 4 among others that I can’t share - and explaining the whys of my current approach to that.
The intention is to share my experience and some information, as to keep you all from falling on this trap.
There is no personal judgement here – neither to the clinicians that performed the injections on the patients in the past, nor the ones that still do, because despite knowing that most of you share my opinion about this and other permanent materials, we also know that there are still clinicians out there that swear by the benefits they believe silicone injections might bring. As a matter of fact, one of the cases below had the injections performed not long ago.
Many colleagues ask me to evaluate patients if they consider surgical removal of lesions in the peri-oral area caused by permanent fillers, but that depends on many factors to be weighted during an extensive assessment, like number of lesions, size, location, anatomical structures involved, functionality, psychological status of patient, expectations - and others.
Honestly, the aesthetics improvement is the least of my concerns, when it comes to a complicated lesion originated out of a permanent material – and this is a frustrating point in the conversation with patients, as their expectations are uneducated, naive and unrealistic - most of the times.
Patient #3 came to me this week recommended by a colleague, looking for any solutions that could soften the tissue and regain normal movement of her lower lip, also decrease the asymmetry of lower face, that has been progressing and is by now noticeable.
She stated that she had “Silikon micro-droplets injections treatment” some 25 years ago, on lips and NLFs, and that over the last few years she’s noticed the hardening of the lips, to the point that now her smile is crooked and that she needs to speak out of one side of her mouth. She’s also had fat transfer injections performed all over her face about a year ago, trying to compensate for some weight loss sagginess and the asymmetry she doesn’t like, among other treatments she’s had in between, and was pretty swollen when I saw her.
Just like all cases of free silicone oil injections I’ve seen before, she is inoperable – in my opinion, and I’ll soon tell you all why.
Patient #1 is a similar case, but she’s had silicone injected all over her face, and it’s affected – and partially compromised – masseter and mylohyoid muscles significantly as well. She also has other permanent fillers in areas of her face, several surgical interventions performed over several decades – mostly aesthetics and plastics in the past - but more recently she’s had bilat hip rep. given her osteoporosis and rheumatoid arthritis, has constant multiple joints swelling and pain, and by now she is ok on being on symptomatic palliative managed care, as she too wanted some solution for the facial tissue hardening she also struggles with.
Patient #4 had silicone oil injected on her lower lids and tear throughs in 2022 – she says she was unaware that it was a silicone based product - and the picture you see (4a) is her first bad flare up.
If you look at the MRI picture (4b) you’ll see how invasive silicone oil is, as it reached her upper lids and glabellar area.
Every time I look at imaging tests that give me some idea of the silicone oil spread it shocks me, as it always goes beyond the target area and shows up where it’s not expected to be.
Patient #2 presents clear atypical hyper-vascular growth. I see this on maybe half the cases of silicone oil injection patients, and this is due the extra effort the body is deploying to build an isolation capsule around the foreign material.
Because it is not absorbed or metabolized, silicone oil triggers a forever effort of the immune system that keeps trying to isolate it through its foreign body reaction, but in the case of free silicone oil injections, it can never succeed. Its spread can’t be predicted or contained, but that does not mean that the immune system will stop trying.
The sclerosing feature of the granulomatosis caused by silicone oils leads to recurrent hypercalcemia, causing progressive proximal muscle weakness and consequent hardening of any tissue affected. The harder it gets, the less it moves – that’s the decrease in dynamics of affected muscles, and mid to long term it can become pretty bad.
This is what Patient #3 is complaining the most about now, as Orb Oris, DAOs, Mentalis’ are stiff and thick.
With all that said:
– Imagine that silicone oil is like bubblegum on fur. It invades and spreads, from dermis to periosteum, soaking all layers and triggering immune local response that keeps trying non-stop, but can never isolate it.
- There’s no such thing as removal of the oil from the tissue – if surgical removal is required, it means literal resection of the tissue affected, which many times require grafts and are procedures not focused on aesthetics.
- Silikon 1000 is thick as heck! I got ahold of a vial of it a couple months ago, so I asked my dear friend and genius Rachel Polazzi to come to meet me at the Craniofacial RSC Lab in Miami and we injected it into cadavers, while we watched it spread all over the place on the ultrasound screen.
- Nothing smaller than an 18G could have that buttery oil go through – it is thick! That makes it obvious that the “microdroplet injections treatment” can’t be so micro - nor precise.
- Hypercalcemia is predictable and expected, as it is a byproduct of the sclerosing granulomatosis caused by the weird foreign body reaction of the immune system to silicone oils.
- Fibrotic atrophic hardening of the muscles is a common consequence in areas soaked by silicone oils. It is progressive and might get to the point where patients present dynamic limitations, like the Patients 1 and 3 do.
- Injecting areas that are already soaked on silicone oils or that contain any previous permanent filler might create risks of cross contamination by rupture of biofilm – so please, make sure there is no permanent material already present where you plan to inject.
I sincerely hope this info serves as a heads up, to help avoid as many colleagues and clinicians blindly re-inject patients that come seeking aesthetic improvement and symmetry corrections on top of permanent fillers.
Patients underestimate the risks of everything and are unaware of the correlations and the impact that procedures of the past might have in their quality of life in the future.
Wishing you all a wonderful and Happy New Year – and hit me up if I can be of any help or if you'd like to come visit us at the Craniofacial RSC in Miami!
