By John Compogins, M.D., F.A.C.S
The injection of liquid silicone for cosmetic augmentation has a history of both legal as well as illicit practice in the United States and worldwide.
The American Society of Plastic Surgeons has previously launched a public awareness campaigns through patient stories and various statements in response to the rise in deaths related to this illicit practice. Free injectable silicone has unfortunately been used for decades to augment the human body- faces, breasts, butts and extremities. It is, however, different from the silicone contained within FDA approved breast implants, because the breast implant shell keeps the silicone from migrating into the body. Injectable silicone is currently only approved by the FDA for use inside the eye. Free silicone injection for body contouring and augmentation is not FDA approved and is illegal- many medical tourists outside the US seeking less expensive dermal fillers actually end up injected with silicone.
Patients need to be aware that injectable liquid silicone used for body contouring can cause serious side effects including chronic pain, skin death, muscle death, permanent disfigurement or even death. The silicone tends to migrate beyond the injection site with time and can cause an embolism, stroke, and infections. Serious complications may occur right away or could develop weeks, months, or years later.
The second concern is that free silicone injections for body contouring is often performed by unlicensed and non-medical practitioners in non-clinical settings such as residential homes or hotels and garages. The FDA does not know the true extent of these injuries caused by these procedures because unlicensed practitioners do not report injuries incurred from their illegal practice and patients who are harmed may not know to alert the FDA.
The FDA has participated in a number of criminal enforcement actions in recent years that resulted in the arrest and sentencing of unlicensed practitioners who illegally used these unapproved injections on patients. We encourage patients who may have received injectable silicone to seek medical attention immediately. For those who are considering a body contouring procedure, talk with a Board Certified Plastic Surgeon about appropriate treatment options and the risks associated those. Patients who have been offered or have received injectable silicone for body contouring from an unlicensed provider are urged to use the FDA website to report these activities. The images below demonstrate an example of some potential outcomes from free silicone injection. Most require surgical excision.
The patient seen here is a transgender 35-year old who had repeated injections of free silicone into the breasts and buttock. The breasts became indurated and discolored and the skin overlying the right buttock died requiring multiple debridement and skin grafts.
Spotlight on Plastic Surgery – Why Do Some Ears Stick Out?
by Juris Bunkis, M.D., F.A.C.S.
Just as some people are tall, others short, some people are born with ears that appear more protuberant than others. This is genetic and is unrelated to anything the mother may have done during pregnancy. This is a normal variant, but at the far right side of the Bell Curve. The very outside of the ear is called the helical rim. The ridge just in front of the helical rim is called the antihelical fold. The vast majority of people are in the middle of the Bell Curve and have a well-defined antihelical fold. People with protruding ears do not have a visible antihelical fold, giving the ear a cupped look. These people can hear normally and do not have any health issues but often feel insecure about their appearance because of prior episodes of teasing, having been called “Dumbo” or “Mickey Mouse” as a child.
As with all aesthetic surgery, I insist that the patient understands the procedure and really wants the procedure. Parents will sometimes bring in an infant for repair of protruding ears but I will not do such a procedure before a child is 5 or 6 years old. Rarely are children teased about their ears before school age and rarely does this become a problem for a child or result in a desire to have a repair before then. When parents do bring in a school-aged child, I ask the child if the ears bother them and if they would like them repaired. If the answer to either question is “No”, I ask the parents to bring the child back when the child perceives that they have a problem and want it repaired.
Fortunately, there is a relatively simple surgical correction for a protruding ear deformity. Patients who choose to have this corrected undergo a 1 ½ hour outpatient procedure under sedation or light general anesthesia. Through an incision behind the ear, which is usually barely perceptible after healing is complete, the skin is dissected off the cartilage and the cartilage scored to create an antihelical fold. The fold position of the fold is maintained with sutures until the cartilage has healed. Patients go home with a bulky cotton head dressing in place. There is little discomfort and by the next day, patients can answer e-mails and do light activities, and most return to play, school or work after the dressings come off in about five days.
This is a one and done procedure, and once healed, the patient will have a normal looking ear for the rest of their lives. I have done a number of ear setbacks over the years in facelift patients with protruding ears, who knowing that I will be making an incision behind their ears for the facelift, ask if I could pin ears back at the same time. From children to older adults, patient satisfaction with this procedure is very high.