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Abtahi‐naeini B, Faghihi G, Shahmoradi Z, Saffaei A. Filler migration and extensive lesions after lip augmentation: Adverse effects of polydimethylsiloxane filler. J Cosmet Dermatol 2018; 17:996-999. [DOI: 10.1111/jocd.12476] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Bahareh Abtahi‐naeini
- Skin diseases and Leishmaniasis Research Center Isfahan University of Medical Sciences Isfahan Iran
| | - Gita Faghihi
- Department of Dermatology Skin Diseases and Leishmaniasis Research Center Isfahan University of Medical Sciences Isfahan Iran
| | - Zabihollah Shahmoradi
- Department of Dermatology Skin Diseases and Leishmaniasis Research Center Isfahan University of Medical Sciences Isfahan Iran
| | - Ali Saffaei
- Department of Clinical Pharmacy School of Pharmacy and Pharmaceutical Sciences Research Center Shahid Beheshti University of Medical Sciences Tehran Iran
- Pharmacy Students' Research Committee School of Pharmacy Isfahan University of Medical sciences Isfahan Iran
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2
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Nakahori R, Takahashi R, Akashi M, Tsutsui K, Harada S, Matsubayashi RN, Nakagawa S, Momosaki S, Akagi Y. Breast carcinoma originating from a silicone granuloma: a case report. World J Surg Oncol 2015; 13:72. [PMID: 25888835 PMCID: PMC4350903 DOI: 10.1186/s12957-015-0509-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 02/09/2015] [Indexed: 11/17/2022] Open
Abstract
Breast carcinoma rarely occurs in cases of foreign body granulomas following liquid silicone injection. Although the Food and Drug Administration (FDA) banned the use of all silicone injection products in 1992, liquid silicone injection for breast augmentation continues to be performed illegally. We herein report a case of breast carcinoma following liquid silicone injection in a 67-year-old female. A total of 45 years after liquid silicone injection, the patient had felt a breast mass in the right breast. Mammography showed a smooth mass that retracted the right nipple. Due to the presence of a marked acoustic shadow caused by the granulomas, evaluating the mass on ultrasonography was difficult. However, magnetic resonance imaging (MRI) showed a lobulated mass under the right nipple. The mass exhibited low signal intensity (SI) on T1-weighted images and intermingled high and low SI on T2-weighted images. Heterogeneous early enhancement with central low intensity was noted on dynamic contrast-enhanced MRI. Several oval-shaped low SI structures in the adipose tissue and disruption of the pectoralis major muscle were also observed. We diagnosed the patient with invasive ductal carcinoma based on a stereotactic-guided Mammotome® (a vacuum-assisted biopsy system manufactured by DEVICOR MEDICAL JAPAN, Tokyo, Japan) biopsy and subsequently performed mastectomy and axillary lymph node dissection (with a positive result for the sentinel node biopsy). Histologically, invasive ductal carcinoma was observed in the silicone granuloma. The development of foreign body granulomas following breast augmentation usually makes it difficult to detect breast cancer; thus, various devices are required to confirm the histological diagnosis of breast lesions. The stereotactic-guided Mammotome® biopsy system may be an effective device for diagnosing breast cancer developing in the augmented breast.
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Affiliation(s)
- Ryoichi Nakahori
- Department of Breast Care Center, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuou-ku, Fukuoka, Japan. .,Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 1-8-1 Chigyouhama, Chuou-ku, Fukuoka, Japan.
| | - Ryuji Takahashi
- Department of Breast Care Center, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuou-ku, Fukuoka, Japan. .,Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 1-8-1 Chigyouhama, Chuou-ku, Fukuoka, Japan.
| | - Momoko Akashi
- Department of Breast Care Center, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuou-ku, Fukuoka, Japan. .,Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 1-8-1 Chigyouhama, Chuou-ku, Fukuoka, Japan.
| | - Kana Tsutsui
- Department of Breast Care Center, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuou-ku, Fukuoka, Japan. .,Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 1-8-1 Chigyouhama, Chuou-ku, Fukuoka, Japan.
| | - Shino Harada
- Department of Breast Care Center, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuou-ku, Fukuoka, Japan. .,Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 1-8-1 Chigyouhama, Chuou-ku, Fukuoka, Japan.
| | - Roka Namoto Matsubayashi
- Department of Breast Care Center, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuou-ku, Fukuoka, Japan. .,Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 1-8-1 Chigyouhama, Chuou-ku, Fukuoka, Japan.
| | - Shino Nakagawa
- Department of Breast Care Center, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuou-ku, Fukuoka, Japan. .,Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 1-8-1 Chigyouhama, Chuou-ku, Fukuoka, Japan.
| | - Seiya Momosaki
- Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 1-8-1 Chigyouhama, Chuou-ku, Fukuoka, Japan. .,Department of Pathology, National Hospital Organization Kyushu Medical Center, 1-8-1 Chigyouhama, Chuou-ku, Fukuoka, Japan.
| | - Yoshito Akagi
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Kurume, Japan.
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Severe granulomatous reaction associated with hypercalcemia occurring after silicone soft tissue augmentation of the buttocks: a case report. Aesthetic Plast Surg 2014; 38:95-99. [PMID: 24281899 DOI: 10.1007/s00266-013-0167-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Accepted: 05/26/2013] [Indexed: 10/26/2022]
Abstract
UNLABELLED Liquid silicone is a permanent filler. Its use to augment soft tissues for aesthetic purposes was widespread worldwide in the 1960s. Although initially considered to be biologically inert, this substance may cause, after its injection, an inflammatory granulomatous effect of variable severity and, in very rare cases, a severe hypercalcemia, which can be life threatening. The reported case highlights the well-known physiopathology of hypercalcemia, and the various therapeutic options are discussed. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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de Vries CGJCA, Geertsma RE. Clinical data on injectable tissue fillers: a review. Expert Rev Med Devices 2013; 10:835-53. [PMID: 24164663 DOI: 10.1586/17434440.2013.839211] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Treatment with injectable tissue fillers for aesthetic purposes is increasingly popular. In parallel with this success, questions related to the safety of these treatments and the products involved are being raised more prominently. To gain insight in the safety aspects of injectable tissue fillers, we performed a literature review to collect studies reporting clinical data of injectable tissue fillers. We found several case reports where serious complications after more than three years are described. However, there are only a limited number of well-defined prospective clinical studies available with follow-up periods longer than three years. Furthermore, causes of complications, that is, treatment or product related, are often not specified in literature. Considering the intended functional period of fillers in combination with the known occurrence of long-term complications, there is a need for well-defined prospective clinical studies. In order to be able to discriminate between product failure (a product safety issue) or application methodology (a physician expertise or training issue), better identification of observed complications and whether they are product or treatment related, is needed. For the safe use of the fillers it is important that treatment with injectable tissue fillers is performed by a trained physician, who knows the product specifications and its applications.
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Affiliation(s)
- Claudette G J C A de Vries
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, NL-3720 BA Bilthoven, The Netherlands
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Ginat DT, Schatz CJ. Imaging features of midface injectable fillers and associated complications. AJNR Am J Neuroradiol 2013; 34:1488-95. [PMID: 22837310 DOI: 10.3174/ajnr.a3161] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Injectable fillers are increasingly used for midface augmentation, which can be performed for facial rejuvenation and treatment of HIV facial lipoatrophy. A variety of temporary and permanent filler agents has been developed, including calcium hydroxylapatite, collagen, liquid silicone, polytetrafluoroethylene, hyaluronic acid, poly-l-lactic acid, and polyacrylamide gel. Facial fillers are sometimes encountered on radiologic imaging incidentally and should not be mistaken for pathology. Alternatively, patients with facial fillers may undergo imaging specifically to evaluate associated complications, such as infection, overfilling, migration, foreign-body reaction, and scarring. Therefore, it is important to be familiar with the imaging appearances of the various filler materials and their complications.
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Affiliation(s)
- D T Ginat
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Herink C, Zwaka P, Schön M, Mempel M, Seitz C. Schwere Komplikationen nach glutealer Silikoninjektion. Hautarzt 2013; 64:599-602. [DOI: 10.1007/s00105-013-2573-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Carlos-Fabuel L, Marzal-Gamarra C, Martí-Álamo S, Mancheño-Franch A. Foreign body granulomatous reactions to cosmetic fillers. J Clin Exp Dent 2012; 4:e244-7. [PMID: 24558563 PMCID: PMC3917632 DOI: 10.4317/jced.50868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 05/04/2012] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION The use of different facial cosmetic fillers has increased in recent years. The introduction of apparently inert substances in the epidermis can give rise to foreign body granulomatous reactions. Objetives: A literature review is made of the foreign body granulomatous reactions to cosmetic fillers. MATERIAL AND METHODS A PubMed-Medline search was made using the following keywords: "granulomatous reactions", "foreign body reactions", "esthetic fillers", "cosmetic fillers". The search was limited to articles published in English and Spanish during the last 10 years. A total of 22 articles were reviewed. RESULTS A great variety of substances have been found to give rise to foreign body granulomatous reactions. The most common locations are the upper and lower lip and the nasogenian sulcus. The clinical presentation is variable and can range from single or multiple nodules to diffuse facial swelling of hard-elastic consistency, accompanied by reddening. Most lesions are asymptomatic or cause only mild discomfort. The literature describes different treatments, including systemic corticosteroids, local tacrolimus infiltrations, minocycline, retinoids, allopurinol, 5% imiquimod, and surgical removal. CONCLUSIONS In view of the current demand for esthetic treatments, the use of cosmetic fillers can be expected to increase in future, together with the incidence of complications. Key words:Esthetic fillers, granulomatous reactions, foreign body reactions, cosmetic fillers.
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Affiliation(s)
- Laura Carlos-Fabuel
- DDS. Master in Oral Medicine and Surgery. University of Valencia. Valencia (Spain)
| | | | - Silvia Martí-Álamo
- DDS. Master in Oral Medicine and Surgery. University of Valencia. Valencia (Spain)
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9
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Park YJ, Park TH. Comments on an article by Ginat and Schatz. AJNR Am J Neuroradiol 2012; 33:E122-3. [PMID: 22954740 PMCID: PMC7964746 DOI: 10.3174/ajnr.a3331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abstract
Silicone, a synthetic polymer considered to be a biologically inert substance, is used in a multitude of medical products, the most publicly recognized of which are breast implants. Silicone breast implants have been in use since the early 1960s for cosmetic and reconstructive purposes, and reports of autoimmune disease-like syndromes began appearing in the medical literature soon thereafter. Over the previous year, silicone implants have been suggested as playing a role in a new syndrome that encompasses a wide array of immune-related manifestations, termed ASIA ('Autoimmune Syndrome Induced by Adjuvant'). Scleroderma, a relatively rare connective tissue disease with skin manifestations and systemic effects, has also been described in association with silicone implantation and rupture. However, epidemiological studies and meta-analyses have failed to corroborate the clinical impression of silicone-induced scleroderma. The following review describes the mechanisms by which silicone may mediate autoimmunity in general, as well as the evidence for causal associations with more specific autoimmune syndromes in general, and scleroderma in particular.
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Affiliation(s)
- M Lidar
- Rheumatology Unit, The Chaim Sheba Medical Center, Tel Hashomer, Israel.
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11
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Camacho D, Machan S, Pilesanski U, Revelles JM, Martín L, Requena L. Generalized Livedo Reticularis Induced by Silicone Implants for Soft Tissue Augmentation. Am J Dermatopathol 2012; 34:203-7. [DOI: 10.1097/dad.0b013e31821cb3c5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Peters W, Fornasier V. Complications from injectable materials used for breast augmentation. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2011; 17:89-96. [PMID: 20808751 DOI: 10.1177/229255030901700305] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Fewer surgical procedures have a history as fascinating and as terrifying as breast augmentation. Initial efforts at augmentation involved injection of substances such as paraffin or oil into the breast tissue, or the implantation of substances including ivory or glass balls, or rubber. More recent efforts have included the injection of liquid silicone or polyacrylamide hydrogel. The current paper reviews four distinct eras of breast augmentation, and provides the current status of these injection materials. A case report is presented on a woman whose breasts were injected with polyacrylamide hydrogel in Iran. The current status of this group of materials is also presented. During the past 110 years, history has repeated itself during each of the four eras of injection.
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Abstract
BACKGROUND Since the 1960s, silicone implants have been successfully used for breast augmentation and reconstruction. However, safety issues regarding the use of silicone have led to a moratorium by the US Food and Drug Administration between 1992 and 2006. DESIGN To date, although the moratorium has been removed and women overwhelmingly prefer silicone over saline implants, local and systemic adverse effects still remain a concern. RESULTS Silicone-elicited inflammatory fibro-proliferative response and capsular contracture is irrefutable. Studies on silicone breast implants have not supported a relationship to carcinogenesis, whereas that to autoimmunity mainly to nondefined autoimmune phenomena seems very plausible. These silicone-related autoimmune adverse events termed 'siliconosis' are probably limited to a small minority of implanted patients. CONCLUSIONS Risk factors, such as characteristic environmental exposure and/or genetic predisposition, still require further elucidation. Similarly to antibacterial agents, texturized implants and Zafirlukast that were found to be beneficial in inhibiting fibro-proliferative response and capsular contracture, elucidating autoimmune-related risk factors might subsequently enable physicians to accurately predict long-term health status of silicone implant recipients.
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Affiliation(s)
- Steven D Hajdu
- The Zabludowicz Center for Autoimmune Diseases and Department of Medicine B, The Chaim Sheba Medical Center, Tel Hashomer, Israel
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14
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Adverse reactions to injectable soft tissue fillers. J Am Acad Dermatol 2011; 64:1-34; quiz 35-6. [DOI: 10.1016/j.jaad.2010.02.064] [Citation(s) in RCA: 210] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2009] [Revised: 01/29/2010] [Accepted: 02/02/2010] [Indexed: 11/23/2022]
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HEVIA OSCAR. Six-Year Experience Using 1,000-Centistoke Silicone Oil in 916 Patients for Soft-Tissue Augmentation in a Private Practice Setting. Dermatol Surg 2009; 35 Suppl 2:1646-52. [DOI: 10.1111/j.1524-4725.2009.01343.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Granulomatous foreign-body reaction involving oral and perioral tissues after injection of biomaterials: a series of 7 cases and review of the literature. J Oral Maxillofac Surg 2009; 67:280-5. [PMID: 19138600 DOI: 10.1016/j.joms.2008.01.052] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2007] [Accepted: 01/04/2008] [Indexed: 11/23/2022]
Abstract
PURPOSE Injectable implants used for soft-tissue augmentation may lead to a granulomatous foreign-body reaction. The aim of this report is to present 7 new cases of foreign-body granulomas involving the oral and perioral tissues, after injection of biomaterials to achieve soft-tissue augmentation. In addition, the clinical and epidemiological profile of this condition is summarized, based on a review of the English-language literature of all previously described cases. PATIENTS AND METHODS We report on 7 new cases of granulomatous foreign-body reaction involving the oral and perioral tissues after the injection of biomaterials. A comprehensive literature review is also presented. RESULTS The literature search revealed 49 cases of this condition affecting the oral and perioral tissues. Our 7 patients were female, with a mean age of 52.8 years (range, 34 to 70 years). The lower lip was affected in 4 cases, 1 case was located in the upper lip, 1 case in the buccal mucosa, while 1 case involved 2 different sites (upper lip and buccal mucosa). Histopathologic examination revealed numerous cells with clear, often multiple, cytoplasmic vacuoles, bearing a resemblance to lipoblasts. Immunohistochemistry revealed diffuse positivity for the histiocytic marker CD68. CONCLUSIONS The diagnosis of granulomatous foreign-body reactions may be challenging because of their microscopic resemblance to liposarcoma, and because of the occasional reluctance of patients to report the previously performed esthetic procedure. A clinical history, histopathologic examination, and immunohistochemical analysis (as needed) are essential in achieving an accurate diagnosis.
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González-García R, Rodríguez-Campo FJ, Román-Romero L, Sastre-Pérez J, Gamallo C, Fernández-Herrera J, Muñoz-Guerra MF, Naval-Gías L. Migration of aluminum silicate from the oral cavity to the submandibular region, with foreign body granuloma formation: report of a case. ACTA ACUST UNITED AC 2007; 104:e45-9. [PMID: 17683961 DOI: 10.1016/j.tripleo.2007.04.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2007] [Revised: 04/12/2007] [Accepted: 04/15/2007] [Indexed: 11/25/2022]
Abstract
We present the first case of foreign body granuloma in the cervical (submandibular) region as a result of migration of noninjected aluminium silicate particles from the oral mucosa. This migration can be explained by macrophage phagocytosis and transport through the local lymphatic network and surgical disruption of fascial layers. The appearance of foreign body granulomas in distant sites may appear several weeks after the local event in a specific disposition according with the migration route. This entity must be born in mind in differential diagnosis of multiple nodules, pigmentation, or persistent swelling in the cervical-orofacial region.
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Affiliation(s)
- Raul González-García
- Department of Oral and Maxillofacial-Head and Neck Surgery, University Hospital La Princesa, Madrid, Spain.
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Narins RS, Beer K. Liquid Injectable Silicone: A Review of Its History, Immunology, Technical Considerations, Complications, and Potential. Plast Reconstr Surg 2006; 118:77S-84S. [PMID: 16936547 DOI: 10.1097/01.prs.0000234919.25096.67] [Citation(s) in RCA: 164] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
For over five decades, liquid injectable silicone has been used for soft-tissue augmentation. Its use has engendered polarized reactions from the public and from physicians. Adherents of this product tout its inert chemical structure, ease of use, and low cost. Opponents of silicone cite the many reports of complications, including granulomas, pneumonitis, and disfiguring nodules that are usually the result of large-volume injection and/or industrial grade or adulterated material. Unfortunately, as recently as 2006, reports in The New England Journal of Medicine and The New York Times failed to distinguish between the use of medical grade silicone injected by physicians trained in the microdroplet technique and the use of large volumes of industrial grade products injected by unlicensed or unskilled practitioners. This review separates these two markedly different procedures. In addition, it provides an overview of the chemical structure of liquid injectable silicone, the immunology of silicone reactions within the body, treatment for cosmetic improvement including human immunodeficiency virus lipoatrophy, technical considerations for its injection, complications seen following injections, and some considerations of the future for silicone soft-tissue augmentation.
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Affiliation(s)
- Rhoda S Narins
- Dermatology Surgery and Laser Center, Department of Dermatology, New York University Medical School, White Plains 10604, USA.
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Balkin SW. Injectable Silicone and the Foot: A 41-Year Clinical and Histologic History. Dermatol Surg 2006; 31:1555-9; discussion 1560. [PMID: 16416638 DOI: 10.2310/6350.2005.31241] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Since 1964, the author has investigated injectable liquid silicone as a soft tissue substitute for the loss of plantar fat. This form of fatty tissue depletion over the sole is closely linked to a common painful weight-bearing foot disorder, metatarsalgia, and to painless diabetic foot ulcers. OBJECTIVES To present the history of injectable silicone, corporate interest, individuals who helped pursue approval, its misuses, and events that have delayed its availability. MATERIALS AND METHODS Dow Corning Corporation's 360 Medical Fluid of 350 centistoke was injected beneath corns and calluses in 1585 patients. Diabetic neuropathic foot ulcers were injected after healing in an effort to prevent their recurrence. Surgical and postmortem specimens were gathered for histologic analysis. RESULTS There was no evidence of significant adverse response in long-term clinical follow-up. Silicone specimens studied by two departments of pathology found no inflammation, infection, allergy, or granulomas. CONCLUSIONS Medical Fluid silicone appears to be safe, effective, and stable biomaterial for treating weight-bearing loss of plantar fat. Trademarked PodiSil (Richard-James Inc., Peabody, MA, USA), a 350-centistoke injectable silicone has been approved for marketing in Europe for the prevention of diabetic foot ulcers.
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Affiliation(s)
- Sol W Balkin
- Department of Orthopaedics, Podiatry Section, Los Angeles County, University of Southern California Medical Center, Glendale, California, USA.
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21
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Barnett JG, Barnett CR. Treatment of acne scars with liquid silicone injections: 30-year perspective. Dermatol Surg 2006; 31:1542-9. [PMID: 16416636 DOI: 10.2310/6350.2005.31239] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
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
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Affiliation(s)
- Jay G Barnett
- Dermatology Clinical Research Unit, Columbia University Medical Center, New York, New York, USA
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22
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Abstract
The histological aspects of resorbable heterologous fillers (bovine collagen, acid hyaluronique), autologous fillers (lipofilling, dermis-fat graft), biodegradable fillers (New-Fill), and permanent fillers (silicone, Artecoll, Evolution, Aquamid, DermaLive, DermaDeep, Bioplastique, Paraffin) are described. This article relates the morphological aspect of these materials, the normal tissue reaction after injection, and its chronological evolution as the morphological aspects from the different side effects, more frequently observed for the permanent fillers. They mainly consist of granulomatous reactions which may appear long after injection.
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Lai CS, Lin TM, Lee SS, Yang CC, Lin SD. Surgical Treatment of Facial Siliconoma Involving the Temporal Area. Plast Reconstr Surg 2005; 115:553-8. [PMID: 15692362 DOI: 10.1097/01.prs.0000149483.70678.c9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Chung-Sheng Lai
- Department of Plastic and Reconstractive Surgery, Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Wong TW, Tsai YM, Lee JYY, Hsu ST, Sheu HM. Eosinophilic pustular folliculitis (Ofuji's disease) in a patient with silicone tissue augmentation. J Dermatol 2005; 31:727-30. [PMID: 15628318 DOI: 10.1111/j.1346-8138.2004.tb00585.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- Tak-Wah Wong
- Department of Dermatology, National Cheng-Kung University Hospital, 138 Sheng-Li Road, 704 Tainan, Taiwan
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25
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Christensen L, Breiting V, Janssen M, Vuust J, Hogdall E. Adverse reactions to injectable soft tissue permanent fillers. Aesthetic Plast Surg 2005; 29:34-48. [PMID: 15759096 DOI: 10.1007/s00266-004-0113-6] [Citation(s) in RCA: 200] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2004] [Accepted: 10/01/2004] [Indexed: 02/06/2023]
Abstract
BACKGROUND Synthetic injectable facial fillers with a permanent effect are widely atoxic and nonimmunogenic, but they differ with respect to composition and in chemical and biologic characteristics. Yet, they all act as foreign bodies in the tissues eliciting a host response that try to remove the gel. Inflammatory nodules may develop at the sites of injection-for some fillers, many years later, for others, not. Why is that? METHODS Biopsies were contributed by various plastic surgeons from Europe and Australia after requests were made at international congresses and workshops. The study was based on (a) 5 biopsies from unreactive tissue obtained at different times after injection of polyacrylamide hydrogel (Aquamid); (b) 28 biopsies from intermediate or late inflammatory nodules after injection of polyacrylamide hydrogel (Aquamid) (20 cases), a hyaluronic acid-polyhydroxyethylmethacrylate/ethylmethacrylate gel (Dermalive) (2 cases), and a gel consisting of polylactic acid in mannitol/carbomethoxycellulose (New-Fill) (6 cases); and (c) a review of the literature on adverse reactions after injection with permanent fillers. RESULTS Clinically unreactive tissues after injection with Aquamid showed modest or no host reaction. Inflammatory nodules showed an increased foreign body reaction and a bacterial infection after injection with Aquamid, and a combination of moderate foreign body reaction, fibrosis, and in some cases also bacterial infection after injection with Dermalive and New-Fill. According to the literature, inflammatory nodules occur no later than 1 year after injection with polyacrylamide hydrogel, but up to 6 years after injection of combination gels (Artecol), and up to 28 years after injection of silicone gel. CONCLUSIONS Inflammatory nodules are likely to be caused by a low-grade infection maintained within a biogfilm surrounding the hydrophobic silicone gel and the combination gels. Aquamid gel may prevent formation of a biofilm through its high water-binding capacity, explaining why late inflammatory nodules are not seen after injection of this polyacrylamide hydrogel product.
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Affiliation(s)
- Lise Christensen
- Department of Pathology, Rigshospitalet Fred., Copenhagen, Denmark.
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Injecting 1000 Centistoke Liquid Silicone With Ease and Precision. Dermatol Surg 2003. [DOI: 10.1097/00042728-200303000-00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
BACKGROUND Since the Food and Drug Administration approved the use of the 1000 centistoke liquid silicone, Silikon 1000, for intraocular injection, the off-label use of this injectable silicone oil as a permanent soft-tissue filler for facial rejuvenation has increased in the United States. Injecting liquid silicone by the microdroplet technique is the most important preventive measure that one can use to avoid the adverse sequelae of silicone migration and granuloma formation, especially when injecting silicone to improve small facial defects resulting from acne scars, surgical procedures, or photoaging. OBJECTIVE To introduce an easy method for injecting a viscous silicone oil by the microdroplet technique, using an inexpensive syringe and needle that currently is available from distributors of medical supplies in the United States. METHOD We suggest the use of a Becton Dickinson 3/10 cc insulin U-100 syringe to inject Silikon 1000. This syringe contains up to 0.3 mL of fluid, and its barrel is clearly marked with an easy-to-read scale of large cross-hatches. Each cross-hatch marking represents either a unit value of 0.01 mL or a half-unit value of 0.005 mL of fluid, which is the approximate volume preferred when injecting liquid silicone into facial defects. Because not enough negative pressure can be generated in this needle and syringe to draw up the viscous silicone oil, we describe a convenient and easy method for filling this 3/10 cc diabetic syringe with Silikon 1000. RESULTS We have found that by using the Becton Dickinson 3/10 cc insulin U-100 syringe, our technique of injecting minute amounts of Silikon 1000 is facilitated because each widely spaced cross-hatch on the side of the syringe barrel is easy to read and measures exact amounts of the silicone oil. These lines of the scale on the syringe barrel are so large and clearly marked that it is virtually impossible to overinject the most minute amount of silicone. CONCLUSION Sequential microdroplets of 0.01 cc or less of Silikon 1000 can be measured and injected with the greatest ease and precision so that inadvertent overdosing and complications can be avoided.
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Affiliation(s)
- Anthony V Benedetto
- Department of Dermatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Ficarra G, Mosqueda-Taylor A, Carlos R. Silicone granuloma of the facial tissues: a report of seven cases. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2002; 94:65-73. [PMID: 12193896 DOI: 10.1067/moe.2002.124459] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The liquid form of silicone, called dimethicone (dimethylpolysiloxane), has been used extensively in some countries during the past 4 decades for soft tissue augmentation. Although considered biologically inert, this material has been reported as potentially inducing, after tissue injection, a granulomatous inflammatory response of variable severity. Interestingly, a remarkable paucity of reports exists about the development of complications after injections of liquid silicone into the facial tissues, especially considering its high frequency of use. The purpose of this article is to describe the clinical and microscopic features of 7 cases of silicone-induced granulomas that developed after injection of the facial tissues for cosmetic purposes and to discuss the differential diagnosis and management of this condition.
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Affiliation(s)
- Giuseppe Ficarra
- Section of Oral Pathology and Medicine, Dept of Odontology and Stomatology, Azienda Ospedaliera Careggi and University of Florence, Via Morgagni 85, 50234 Florence, Italy.
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Adverse Granulomatous Reaction After Cosmetic Dermal Silicone Injection. Dermatol Surg 2001. [DOI: 10.1097/00042728-200102000-00021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bigatà X, Ribera M, Bielsa I, Ferrándiz C. Adverse granulomatous reaction after cosmetic dermal silicone injection. Dermatol Surg 2001; 27:198-200. [PMID: 11207699 DOI: 10.1046/j.1524-4725.2001.00020.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Various alloplastic injectable implants have been developed for soft tissue augmentation without surgery, but different local or systemic adverse reactions have limited their use for cosmetic purposes. OBJECTIVE To examine the problems associated with silicone injection. METHODS Case report and literature review. RESULTS We describe an adverse granulomatous reaction after the injection of liquid silicone for lip augmentation, causing facial disfigurement. Although the initial response to steroids was poor, after 3 years of follow-up the nodules have almost disappeared spontaneously. CONCLUSION We advise that silicone injection be performed solely by trained physicians using medical-grade silicone or consider other injectable materials.
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Affiliation(s)
- X Bigatà
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
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Haycox CL, Leach-Scampavia D, Olerud JE, Ratner BD. Quantitative detection of silicone in skin by means of electron spectroscopy for chemical analysis (ESCA). J Am Acad Dermatol 1999; 40:719-25. [PMID: 10321600 DOI: 10.1016/s0190-9622(99)70153-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Evaluation of silicone-induced morbidity in skin has been hampered by the difficulty of detecting silicone in tissue because conventional methods are nonquantitative and insensitive. OBJECTIVE We attempted to determine whether silicone could be identified and quantitated in skin by means of electron spectroscopy for chemical analysis (ESCA). METHODS Skin biopsy specimens were obtained from the nose, chin, malar region, and inner arm of a patient who had received injections of silicone gel in his nose and chin. Frozen sections were dried under vacuum and examined by means of ESCA. Contiguous sections were examined by light microscopy. RESULTS The surface concentrations of silicone were as follows: chin, 20.6% +/- 3.6%; nose, 19.0%; malar region, 2.6% +/- 1.6%; inner arm, 0.0% +/- 0.0%. Light microscopy revealed homogeneous "globules" consistent with silicone in the chin and nose sections only; the malar region and inner arm sections showed no evidence of silicone. CONCLUSION ESCA can be used to detect silicone in skin in a specific, highly sensitive, and quantitative manner. This is the first report of quantification of silicone in skin by means of ESCA.
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Affiliation(s)
- C L Haycox
- Department of Medicine (Dermatology), University of Washington, Seattle 98195-6524, USA.
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DUFFY DAVIDM. Commentary. Dermatol Surg 1997. [DOI: 10.1111/j.1524-4725.1997.tb00739.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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