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Liquid injectable silicone a safe, long-lasting correction for facial defects

Article-Liquid injectable silicone a safe, long-lasting correction for facial defects

Key iconKey Points

  • Two liquid injectable silicone products, Silikon 1000 (Alcon) and AdatoSil 5000 (Bausch & Lomb) are FDA-approved in the U.S.
  • Procedure performed under topical anesthesia, and material must be delivered with microdroplet serial puncture technique

Liquid injectable silicone offers safe, precise and long-lasting correction for a range of facial and extrafacial defects when used with proper injection technique and regard for its permanent nature, says Jay G. Barnett, M.D.

Dr. Barnett
Speaking at the 26th annual scientific meeting of the American Academy of Cosmetic Surgery, Dr. Barnett told attendees that he has 40 years of personal experience using medical-grade liquid injectable silicone off-label as a filler material. During this time, he has treated many thousands of patients with excellent results, few adverse events and no serious complications, he says.

"Currently, there are more than 100 fillers available on the worldwide market, but I would encourage anyone who performs soft-tissue augmentation procedures to know about liquid injectable silicone," says Dr. Barnett, a private practitioner in New York City.

In the United States, there are currently two commercially available FDA-approved liquid injectable silicone products — Silikon 1000 (purified polydimethylsiloxane, Alcon) and AdatoSil 5000 (purified polydimethylsiloxane, Bausch & Lomb), both of which are approved only for intraocular use as a prolonged retinal tamponade in eyes with complicated retinal detachments.

Silikon 1000 is the less viscous of the two products (1,000 cs) and can be injected with a 27-gauge needle. AdatoSil has a viscosity of 5,000 cs and must be delivered with a 25-gauge needle. Dr. Barnett says he uses a 1 cc, glass Luer-Lok syringe for the injections. When performing silicone injections, the consent form should state the material is being used off-label, he notes.

TECHNIQUE After the physician marks the areas to be injected, the injections are performed under topical anesthesia, usually with the patient sitting in a comfortable upright position.

The material must be delivered using a microdroplet serial puncture technique in which small volumes of the liquid silicone, between 1/10th to 1/40th cc, are deposited at non-overlapping sites spaced about 0.5 cm apart. The depth of injection ranges from the superficial dermis to the subcutaneous level, depending on the nature of the defect being corrected.

"For most treatments, the total volume delivered at one treatment session is less than 1 cc, and often just half of that amount. A small volume of liquid injectable silicone provides tremendous improvement, and situations where a greater amount of silicone is used would involve multiple treatments of the scars or augmentation for facial rejuvenation involving both sides of the face," Dr. Barnett says.

"Most patients are surprised and pleased by the ease of the treatment and its success. However, as with most procedures, the results are technique-dependent. The microdroplet serial puncture technique is different from any other technique used in filler injections, and it is important to learn the difference," he says.

CONSERVATISM COUNTS The permanency of liquid injectable silicone is both an advantage and a drawback if this feature is not respected. Therefore, Dr. Barnett cautions to never try to fix a "10-foot hole in a single session" and to counsel patients about the value of serial treatments and of being conservative in the amount of correction.

"When using silicone, surgeons have to be a little ornery at times in resisting patients who want larger-volume corrections, especially when augmenting the lips or cheeks. Since the effects are permanent, be careful to do only what you think is indicated," he says.

Treatment is usually done in a series of two to five sessions at least one month apart, depending upon what is being corrected or augmented. This approach helps to avoid overcorrection and has the advantage of helping to minimize the total volume of silicone used, because sequential treatments enable more patient input about the amount of correction desired.

Dr. Barnett highlighted the excellent results achieved using liquid injectable silicone for treatment of various types of scars, including atrophic and depressed traumatic and surgical scars, acne scars, and postsurgical external nasal defects.

"Various lasers can be used to treat depressed scars, but even after multiple sessions, the results they produce do not come anywhere close to the improvement readily and permanently achieved with liquid injectable silicone," Dr. Barnett says. "Knowing what can be achieved with liquid injectable silicone, it seems unfair to patients not to offer this treatment option or refer them to someone who does perform this procedure."

OTHER INDICATIONS Other uses of liquid injectable silicone include lip augmentation procedures (filling linear creases and increasing fullness) and filling eyelid grooves, tear trough deformities, aging facial grooves and facial volume loss (including volume loss due to HIV-related lipoatrophy). In addition, Dr. Barnett reports that he has used medical-grade injectable silicone safely and effectively as a filler in the ears, neck and hands.

Dr. Barnett says that to his knowledge, no patient he has treated with liquid injectable silicone has developed serious complications such as blindness, ulceration or significant overcorrection. Fewer than 10 of his patients have developed an idiosyncratic reaction manifested primarily by swelling, although he has seen a small number of other such cases on referral. When these reactions occur in patients who have been injected with medical-grade silicone, resolution with no permanent sequelae has been achieved in all cases with triamcinolone acetonide injections, he says.

DISCLOSURES: Dr. Barnett reports no relevant financial interests.

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