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The High Cost Of "Free" Silicone
These days, you can find silicone almost anywhere, from the hot pads used for cooking to the industrial lubricants used in construction. Silicone is versatile and ubiquitous, but there's one place it doesn't belong: hanging out free in the human body. One reason why silicone has been so widely adopted within the medical community is that it's long been thought the human body doesn't react to it, thus making it safe as an implant material. If the body didn’t react to it, then the rate of inflammation and infection would be low, and complications would rarely occur. Unfortunately, after decades of use, this concept is now being called into question. Even if you assume there's no reactivity to silicone, some forms are more problematic than others. When we think of silicone for medical use, breast implants are the first thing to come to mind. But there are many other forms silicone can take and many other places it can end up. From eyelids to buttocks, in the form of liquid or solid, silicone injections have been making an appearance in multiple places here and abroad, often with dire consequences. So, why is silicone such a problem? And why are we using it if it causes us so much trouble? Let’s try to demystify this issue once and for all.
Solid silicone is a block with a specific shape. This type of silicone is used to make things like chin or cheekbone implants. The product remains hard and is therefore used to mimic bone. Like any foreign material that enters the body, a scar shell called a capsule forms around it, which contains the implant and serves as a barrier between the silicone and the rest of the body. Because solid silicone has no liquid or gel component, it can't run free around the body even if the implant cracks. This means removing it is usually pretty easy. Even if the silicone sticks to the capsule, it can be removed with the capsule shell all in one go. The problem with solid silicone is that it's very firm, making it less desirable for areas that are not meant to be solid like rock.
When you want something softer that can also be contained fairly easily, silicone gel is the answer. Silicone gel has semi-solid consistency, but it also has a softness and fluidity that makes it ideal for simulating human tissue. The degree of “cohesiveness” in the gel refers to how linked the molecules are, or how solid it feels and how much it holds its shape. At this point, technology allows us to dial up or down on the softness, depending on what the implants are for. Silicone gel can be found in calf or buttock implants. Often, these implants also consist of a thin, pliable shell that contains the silicone and a capsule that forms around it like in the case of solid silicone. The problem with silicone gel is that if the implants burst, the insides can leak out, depending on the level of fluidity. Once silicone gel is no longer contained within its shell, it's considered free silicone and can come in full contact with the human tissues. That’s where things get hairy. The gel is sticky and sometimes even taffy-like, making it incredibly difficult to clean up. It sticks to everything it touches, irritating tissues and causing inflammation. Most of the time, in order to get it out, you have to remove the sticky gel, the shell, the capsule, and any affected tissues. It can become a huge mess, which is why many surgeons in the Unites States don't perform silicone injections in the first place.
Here's where things get really sticky. Liquid silicone was also long thought to be inert. As a filler material, it offered the option of being clear, malleable, and easy to inject. It also had the appeal of being able to fill every nook and cranny evenly. This was very tempting to practitioners who were looking to add bulk without making an incision and inserting a solid block of silicone. But the same thing that makes liquid silicone so good as a filler material also creates a medical nightmare when it comes to removing it. Imagine wiping up liquid Jell-O with a sponge and then putting it in the fridge to set. Now, take the sponge out and try removing the Jell-O from it. It’s totally impossible. That's what happens when liquid silicone is injected into the buttocks, for example. The stuff sets into the fat and muscle, never to be retrieved again. If it has the misfortune of getting inflamed or infected, then the misery has just begun.
Whether or not you believe it's inert, silicone gel is still a foreign material to the human body. It can get covered in bacteria and become infected. It can also cause an inflammatory response without any infection present, stimulating your immune system to attack it. When this happens, your body will produce a lot of scar tissue, causing tight and painful areas where the battle has taken place. In many cases, these infections and/or inflammations can make the patient sick and they can strike at any time, frequently. What's worse is that there's no specific medical treatment for this condition and no way to predict the severity of it. Whether in small or large amounts, free silicone can easily turn into a lifelong problem. Any tissues that have to be taken out to remove free silicone ultimately need to be replaced. This means treatment can be long and require multiple surgeries, often resulting in disfiguring scars. Patients who have large amounts of free silicone injected, usually in other countries, will find it difficult to receive treatment here because removing it is an arduous search-and-destroy mission, one that many surgeons shy away from performing. And unfortunately, the alternative is living with chronic pain and deformity as the granulomas become hard and lumpy.
The Bottom Line
Thousands of people get lured every year into having silicone injected into everything from their buttocks to their labia, often with the promise of lasting results with no surgery or downtime. But if you think about it, silicone injections would have replaced surgery long ago if it was the real answer. There’s a reason it hasn’t. The best litmus test is this: If a board certified plastic surgeon won’t do it, and you rarely see or hear success stories, you probably don’t want to chance it yourself. In aesthetics, as in life, you often get what you pay for, and short cuts often lead you right off the cliff. There’s no buying your way out of that freefall, and it’s not a pretty one at that.
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