These days you can find silicone almost anywhere. It’s in the hot pads we use for cooking, the gel we use for scar healing, and the industrial lubricants that the contractor uses for some of his building projects. Silicone is versatile and ubiquitous, but there is one place where you can find it that it does not belong: hanging out free in the human body.
One of the reasons why silicone has been so widely adopted is that it has long been considered inert, meaning that the body does not react to it. As more and more silicone products were developed, the medical community supported their use with the belief that the human immune system had no reaction to the material, making it safe as an implant product. If the body didn’t react to it, then the rate of inflammation and infection would be low, and therefore problems would rarely occur. Unfortunately, after decades of use, this concept is now being called into question. But even if you assume that there is reactivity to silicone, some forms are more problematic that 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 that silicone can take, and many other places it can end up. From eyelids to buttocks, in the form of liquid or solid, silicone has been making an appearance in multiple places here and abroad, often with dire consequences. So why is this such a problem? And why are we using so much silicone if it causes us so much trouble? Let’s try to demystify this issue once and for all.
1. Solid silicone implants
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 often used to substitute things like bone. Like any foreign body, a scar shell called a capsule forms around it, and this contains the implant and serves as a barrier to the rest of the body.
Because solid silicone has no liquid or gel component, even if the implant cracks, there is nothing in it that can run around the body. This means that removing it is usually pretty easy. Even if it is stuck to the capsule, it can be removed with the capsule shell and this takes everything out in one go. The problem with the solid state is that it is very firm, and this makes it less desirable for areas that are not meant to be solid like rock.
2. Silicone gel
When you want something semi-solid for softness but that also remains contained fairly easily, gel is the answer. Silicone gel has a relatively solid consistency, but it also has a softness and fluidity that make 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 we are using the implants for.
Some of the other places that silicone gel can be found is in calf or buttock implants. Often, these implants also have a thin, pliable, solid shell and the gel is used to fill the shape. The solid shell contains all of the product, and a capsule forms around it as usual. The problem with these implants is that, depending on the level of fluidity of the gel, if they burst, the insides come out. Therein lies the main issue.
Once silicone gel is no longer contained within its shell, it is basically free, in full contact with the human tissues. That’s where things get hairy. The gel is sticky, taffy-like even. This makes it incredibly difficult to clean up. It sticks to everything it touches, irritating tissues and causing inflammation. Removing it becomes a huge problem, and this is where the real trouble starts. Most of the time, in order to really get it out, you have to remove the sticky gel, the shell, the capsule, and any tissues that came into contact with it. What a mess. This is one reason why many surgeons in the Unites States do not perform these procedures. When it goes bad, it’s bad, and very hard to cope with.
3. Liquid silicone
Here is 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 property of infiltrating the tissues like gelatin into a sponge, by filling every nook and cranny evenly. This was very tempting to practitioners who were looking for some bulk without having to make an incision and insert a block of construction material. But the same thing that makes liquid silicone so good as a filler material also creates a medical nightmare when things are less than fantastic: it cannot be removed from those tissues.
Imagine wiping up liquid Jell-o with a sponge and then putting that sponge in the fridge and letting the Jell-o set. Now take the sponge out and try to remove the Jell-o from it. It’s totally impossible. This is what happens when liquid silicone is injected into a buttocks. The stuff sets into the fat and muscle, never to be retrievable again. If it has the misfortune of getting inflamed or infected, then the misery has just begun.
Whether or not you believe it is inert, silicone gel is still a foreign body to the human body. It can get covered in bacteria and become infected. If it is not inert, then it can cause an inflammatory response without any infection present, stimulating your immune system to fight it off and attack. When this happens, your body will make 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 person sick; and they can strike at any time and with any degree of frequency. What is worse is that, not only is there no specific medical treatment for this condition, there is no way to predict how bad it will get nor how often it will get there. This is where the black hole of misery begins.
One area where liquid silicone sometimes makes an appearance if the eyelid. People looking to fill in the divots under their eyes will sometimes get persuaded to go for a permanent solution. While some forms of liquid silicone are approved for human injection, these are intended for use in ophthalmology procedures, not for cosmetics. Injectable medical-grade silicone only comes in these small amounts in the U.S., but it is not made for wrinkle repair. When it sits quietly, all is well; and the results can be terrific. But if it decides to get upset, it too cannot be removed without removing a large piece of that same eyelid. The other thing is that the inflammatory response is usually so great that a different kind of scar tissue forms, called a granuloma. This too must come out for treatment to be complete, because it harbors small amounts of the silicone that the immune cells were not able to destroy. All in all, this can become a true disaster right in the middle of your face.
Whether in small or large amounts, free silicone can unpredictably become a life-long problem. Any tissues taken out in order to take out the problem silicone will ultimately need to be replaced. This means that treatment can be long and require multiple stages or surgeries, and end with disfiguring scars. Patients who get large amounts of free silicone injected, usually in other countries, will find it difficult to get any kind of treatment once seeking care here, because the interventions required are often dramatic and with unpleasant outcomes. The alternative is living with chronic pain and deformity, as the granulomas become hard and lumpy, the opposite of what you wanted for either look or feel.
Consider as well that once the gel gets out of that shell, it essentially becomes the free silicone that no one wanted to inject in the first place, whether or not there is a capsule barrier present. This is the big problem with breast implants, when silent ruptures mean free silicone without the patient even knowing it. What started as a contained soft addition becomes a clumpy mess of gel and granuloma, often with small bits traveling around the chest wall. Removing it becomes an arduous search and destroy mission, one that many surgeons shirk away from performing. While this situation is usually not as bad as the buttock epidemic currently under way, it can be just as miserable for its bearer.
FREE SILICONE – The VERDICT
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 and no downtime. It takes very little time, costs very little money, and seems to hold the answer. But if you stop to consider this for a moment, it may occur to you that if this were the real easier and cheaper answer, it would have replaced surgery long ago. It hasn’t. Also consider that most of the time, free silicone injections are occurring in motel rooms rather than credentialed physicians’ offices, and payments are in cash only. This too should set off all of the alarms.
In the end, there is usually a reason why certain things are not done very often. Sometimes it is because they are difficult and require expertise. Other times, and more usually, it is because somewhere along the way the community figured out that it probably wasn’t such a great idea, and people stopped doing it. The best litmus test is this: If a Board Certified plastic surgeon won’t do it, and you rarely see successful before and after stories about it, you probably don’t want to chance it yourself.If it were such a good idea, there would be more of it going around, and you would have at least a handful of friends who could show you how happy they were with their results ten years later; as opposed to the horror stories you find online and in blogs. In aesthetics, as in life, you often get what you pay for; and short cuts often lead you right off the cliff. There is no buying your way out of that freefall, and it’s no