The use of silicone oil for aesthetic facial injection treatments has a long and checkered history. Besides the fact that it is not FDA-approved for this type of treatment (can be used off label based on the physician’s discretion), the general perception amongst physicians is that it is unsafe and associated with a high rate of irreversible complications. One only has to Google search the term ‘silicone oil injections’ and look at the images section to see how and why it is so perceived.
Many of the perception problems with silicone oil injection stem from the use of large amounts of impure formulations for indications that exceed it’s biologic capabilities. Silicone oil works for soft tissue augmentation by not only occupying a space in the soft tissues (permanently) but by also causing a collagenous deposition around the material. (soft tissue reaction) There is a fine balance between causing non-reactive scar formation around the material and that of an ‘over response’ to it resulting in nodules, granulomas and even chronic inflammation. That balance is highly determined by the load of the material to the tissue surface area.
In the September 2013 issue of the American Academy of Dermatology, an article was published on this topic entitled ‘HIV-associated facial lipoatrophy treated with injectable silicone oil: A pilot study’. In this paper, twenty HIV positive patients with varying degrees of facial lipoatrophy were treated with highly purified medical-grade injectable silicone using the serial microdroplet injection technique. (the authors state that their droplet size is 1/100 of a cc) Each treatment session was no greater than 2 ccs and patients had up to six treatment sessions. They reported no complications or adverse reactions seen in any of the patients. They found that the vast majority of the patients obtained complete correction of their HIV-associated facial lipoatrophy after six treatments and maintained this correction up to the eighteen month follow-up period. (which was the conclusion of the study)
While the use of silicone oil injection for facial soft tissue augmentation remains off-label with medical-grade products(e.g., Silikon 1000), numerous studies such as this one proves that it can be safely used. The key is that it is used completely differently than any other injectable filler. This applies not only to how it is injected but also to patient indications and expectations.
One fundamental difference is that one needs patience and should not expect an immediately gratifying result. Hence the small droplet and multiple treatment approach to achieving the final result. It is a sheer function of not overloading the tissues and generating too great of a reactive response. Secondly, medical-grade silicone oil is not a high volume injectable filler augmentation method and has no role in body contouring procedures such as breast and buttock augmentation. Lastly, it is important to not create overdone or large facial augmentations results. Since the material can not be easily reversed (or not reversed at all), one should take a conservative approach to the use of this filler material and advise patients accordingly.
Dr. Barry Eppley