Liposuction Not the Procedure of Choice for Silicone Removal with Dr. Kenneth Hughes

Dr. Kenneth Hughes, Los Angeles plastic surgeon, sees at least 2 to 3 patients a week who have had injections of one or more foreign substances including silicone, PMMA, hydrogel, and biopolymers into the buttocks, hips, lips, face, and many other areas of the body for volume improvement.  Black market injection of foreign substances into the buttocks has become big and dangerous business throughout the US and in other countries. This is an unregulated practice as it is not performed by plastic surgeons and the substances are not FDA approved for injection. There are significant risks associated with these injections including skin death, skin changes, chronic pain, cosmetic deformity, infection that can become severe and lead to death.

However, the desire for larger buttocks and hips at a low cost is attractive to many. Frequently, the individual performing the injections has performed the injections for a friend or family member and that is how the process propagates. Under no circumstances are these injections a good idea, nor should they be performed.

With the deluge of black market injection patients to plastic surgeons for removal of these materials, all sorts of removal techniques have been recommended. Having performed many of these primary removals and an even greater number of revisions of attempts at removal,  Dr. Kenneth Hughes can tell you that in almost every case the materials must be removed by literally excising them, or cutting them out directly. The reason for this is the simple reason of density. The density of these foreign materials or the secondary fibrosis that they produce  is greater than the surrounding fat and thus liposuction removes fat without really addressing the substance, scar, and tissue changes.  Even when the substance is of similar density a blind liposuction approach causes much more removal of native fat than would removal of the material itself, assuming that tissue response to the injected material is minimal or none (which is frequently not the case).   Ultrasound guided liposuction can be considered when larger volumetric amounts of silicone or foreign material have pooled into a smaller area.

In fact the goal should be removal of as little native or intrinsic tissue as possible to reduce the chance for deformities or the need for further revision procedures.

Though the bad practice of black market injections is unlikely to cease, the removal of these substances should be done in precise fashion to limit the potential damage.

Dr. Kenneth Hughes, MD
Board Certified Plastic Surgeon