Silicone injections have become synonymous with fatal butt lifts and fake doctors. And the aesthetics medical community has largely abandoned silicone in practice. But a number of well-respected plastic surgeons and cosmetic dermatologists still use it in select cases, insisting that it’s a safe and effective permanent filler when injected properly.
Patients also have mixed reactions to silicone injections. Only 40% of RealSelf members deem them “Worth It,” reporting everything from misshapen lips and under-eye puffiness to near-fatal complications from butt injections performed by unlicensed providers. Many refer to silicone as a “mistake.” There are positive anecdotes too, however—including several patients praising microdroplet silicone for acne scars. One member, a 50-year-old male who struggled with acne as a teen, describes his results as “excellent and permanent.” Another member says that “the treatment works,” finding it to be “way more cost-effective [and] less invasive” than the multiple rounds of Fraxel she originally tried for her scars.
So what’s the verdict? Here, physicians on both sides of the issue weigh in on silicone’s risks and benefits.
A brief history of silicone and how it’s made
Silicones are polymers—groups of hydrophobic (or water-repelling) molecules made up of oxygen, carbon and hydrogen bonds. These synthetic compounds have been used in everything from medical devices to car parts and hair products. “If you’ve ever given a blood specimen or had an IV catheter, you’ve been exposed to a small amount of silicone,” says Dr. Eric Joseph, a facial plastic surgeon in West Orange, New Jersey. “The internal aspect of every syringe manufactured in the U.S. since WWII is coated with a small amount of silicone grease, to allow smooth action.” The gel form of silicone is widely used in bandages and dressings. In plastic surgery, silicone lends shape to facial, breast, testicle and pectoral implants.
Not all silicone is the same: how medical-grade silicone is different
The idea of injecting something into your body that is literally used to make electronics and car parts is, no doubt, terrifying—but there’s a huge difference between the medical- and industrial-grade versions. Most notably, the former is a sterile, highly purified liquid.
In the U.S., medical-grade silicone oil is FDA-approved only for treating retinal detachment in the eye. On its website, the FDA clearly states “that injectable silicone is not approved to enhance or augment the body. Such use can lead to ongoing pain, infections, and serious injuries, such as scarring and permanent disfigurement, embolism (blockage of a blood vessel), stroke, and death.” Still, some providers use it off label, as a permanent filler for cosmetic purposes.
Dr. Joseph explains that there are two FDA-approved silicone oils sold in the U.S.: Silikon 1000, from Alcon Laboratories, and Adato Sil-OL 5000, from Bausch and Lomb. The major differentiator between silicone oils is their molecular weights. Adato Sil-OL 5000 is, as the name suggests, 5000 centistokes viscosity (meaning 50 times thicker than water) and requires a 25-gauge needle for injection. Silikon 1000 is 1000 centistokes, or 10 times thicker than water, and can be administered with a smaller, 27-gauge needle. Dr. Joseph says that while both are safe and appropriate, he uses mostly Silikon 1000, since the slimmer needle is more tolerable for patients and causes less bruising.
Related: 5 Risky Cosmetic Procedures to Avoid—and What to Get Instead
Why are silicone injections so controversial?
The oil’s permanence, irreversibility and risk profile are just a few of the reasons some doctors avoid silicone in their practices. “Using silicone as a cosmetic filler is associated with more unpredictability, less flexibility and a loss of the ability to adjust outcomes,” says New York City plastic surgeon and RealSelf Chief Medical Editor Dr. Lara Devgan. “Silicone cannot be dissolved or removed without invasive surgery—and for high-risk areas like the under-eyes and nose, in particular, this is quite concerning.”
But not all scare so easily. New York City dermatologist and silicone proponent Dr. Paul Jarrod Frank—who recently filmed an educational IGTV segment on injectable silicone—argues that the problem isn’t silicone itself but the abuse and overdosing of the substance. In other words, the headline-making fatalities involving silicone typically result from large quantities of industrial-grade silicone being illegally pumped into the body—most often the buttocks—by sham doctors. Some of the stories from RealSelf members are downright terrifying.
“Silicone butt injections are incredibly dangerous, given the large area required to inject,” says Dr. Lesley Rabach, a facial plastic surgeon in New York City. Repeated high-volume injections are usually needed for silicone butt augmentation, she adds, increasing the likelihood of vascular occlusions and deadly embolisms, which occur when silicone enters a gluteal blood vessel and travels to the heart or lungs.
Dr. Rabach also warns that over time, the body, in a protective move, forms scar tissue around the silicone in order to wall it off. As this scar tissue continues to grow, the silicone can turn lumpy and hard. It can also migrate and spread from its original injection site and entwine itself with the tissue, making it extremely difficult to remove. “Proponents of silicone argue that its small particle size makes it safe, but how it acts in vitro is not the same as how it behaves in the human body,” says Dr. Devgan. “Many plastic surgeons, myself included, have spent serious time surgically removing undesirable silicone that is lumpy and irregular from the face and lips.”
The silicone removal process, which involves a surgeon’s excavating silicone granules and scar tissue from the body with a scalpel, is painstaking, often incomplete, and can lead to deformities. Still, 83% of RealSelf members who’ve had it done say it was “Worth It.”
The microdroplet technique: the only safe way to inject silicone
To ensure that a safe amount of silicone is doled out, an experienced board-certified dermatologist or plastic surgeon should use a multiple-puncture, microdroplet injection technique. With a very fine needle, they’ll inject tiny aliquots (or fractions) of silicone oil into the fatty layer, just above the bone or cartilage in the area being treated. And we do mean tiny: If you figure, on average, a typical treatment requires around 0.5cc per area—that’s about 1/10th of a teaspoon. Some situations, like permanently correcting a small acne scar, call for only 0.01cc—a miniscule drop. When plumping a cheek, doctors deposit roughly 0.1cc of silicone with each jab. For fuller lips, somewhere around 0.025cc is standard with each puncture.
“The guiding strategy is not filling all at once,” says Dr. Robert Kotler, a facial plastic surgeon in Beverly Hills, California. It’s best done sequentially—a little bit at a time, for three rounds, at six-week intervals. “This very conservative and prudent process of incremental plumping eliminates the chance of overfilling. Also, patients get a sense of what they like as the corrections emerge,” he adds.
Where can silicone be injected, and to what effect?
It’s worth repeating: slow and steady microdosing is a crucial safety measure when injecting silicone. Our experts do not recommend using it to augment the buttocks, the breasts or any area that demands more than a few drops of the liquid.
Injectable silicone is most commonly used to subtly plump and shape the lips, cheeks, temples and nose (for nonsurgical nose job) and to camouflage deep wrinkles and acne scars. It can also be used to level out sunken traumatic scars anywhere on the body and to rejuvenate aging hands. “As we age, not only do we lose facial volume, we lose volume in the backs of our hands, which can lead to the unwanted appearance of tendons and veins. Microdroplet Silikon 1000 works particularly well for replacing hand volume for a more youthful appearance,” says Dr. Joseph, noting that complete restoration of the hands typically requires one to three treatments.
Specifically for acne scarring, Dr. Joseph finds that silicone opens up treatment avenues for patients with dark skin, who typically aren’t candidates for laser or other resurfacing procedures (they can trigger hyperpigmentation in deep complexions). However, for silicone to work well, “the acne scars must be pliable and not stuck to the deep tissues, as some chicken pox scars tend to be,” he notes.
Dr. Kotler is more particular about where he places silicone. “I use it only in the nose. To me, it makes perfect sense to use it there, because the nose is a nonmoving part. When placed into areas that are subject to external pressure, such as the buttocks, or into an area where there is movement, there’s a greater probability of complications and untoward results,” he explains. When there’s movement or action against the silicone, he adds, the body may rebel by thickening the scar-tissue wall around the substance—which can lead to lumps.
Beyond tweaking born-this-way nasal imperfections, Dr. Kotler also uses silicone to obscure telltale signs of nose jobs gone wrong: “When too much bone or cartilage has been removed, the nose looks overdone and unnatural. Silicone can compensate for the overzealous sculpting.”
It would be irresponsible of us not to mention that many rhinoplasty specialists advise using only temporary and dissolvable hyaluronic acid (HA) fillers for nonsurgical nose jobs—and some doctors outright refuse to inject the nose with any type of filler, due to the potential for vascular complications, like blindness and skin necrosis (tissue death).
Defending his position, Dr. Kotler explains, “We have stories like that from the temporary fillers, but I am not aware of such reports coming from experienced, highly specialized injectors of silicone. It is easier and safer to use, in my opinion, but not all injectors are the same. And technique is very important”—a slow build over several appointments.
The case for safe silicone injections
Pro-silicone physicians insist that medical-grade silicone, when properly dosed and injected into the skin, has unique benefits. “Liquid injectable silicone offers patients versatility, precision and permanence over other types of fillers,” Dr. Joseph says.
Dr. Rabach, who does not inject silicone, acknowledges the material’s most sought-after advantage: “Unlike FDA-approved fillers, like hyaluronic acid gels, Sculptra, and Radiesse—all of which dissipate over varying time frames, [requiring] patients to return for future treatments—silicone is completely permanent.” In her opinion, however, this quality can be a double-edged sword, since it leaves unhappy patients with little recourse.
Dr. Frank contends that while no medical treatment is without some level of risk, he has not seen one negative reaction to sterile, medical-grade silicone (when used properly) in more than 20 years of practicing cosmetic dermatology.
While he also injects HA fillers all day long and appreciates their value, he says they actually have “a much higher risk of vascular events.” Meanwhile, there are no documented vascular occlusive events associated with microdroplet silicone, Dr. Frank adds, primarily “because if injected into a blood vessel, the oil would just go right through it—it wouldn’t clog it.”
There’s no reliable way to confirm this comparison, however, since “there’s not a great body of literature comparing silicone injections to other injections,” says Vancouver, British Columbia, dermatologist Dr. Katie Beleznay, who uses silicone to treat acne scarring and HIV lipoatrophy (facial wasting associated with the disease). While she hasn’t had any patients experience negative side effects, she still cautions that “silicone oil may be less forgiving than temporary and reversible fillers, and granulomatous reactions [inflammatory nodules] and other side effects can be seen from silicone oil, so it is not typically used for routine facial volumizing or contouring.”
Related: 7 Unexpected Areas Where Filler Injections Can Have a Big Impact
What happens to silicone as we age?
Dr. Frank notes that silicone oil, when placed under the skin, actually helps stimulate the body’s own production of collagen and elastic tissue. It can be used at various levels of the skin, from deeper down to more superficial fine lines on the surface, for significant lifting, he says.
According to Dr. Joseph, microdroplets of silicone seem to hold up well over time. “Liquid silicone becomes part of your soft tissue, and as you age, it does not change in appearance—nor does it preclude [patients from having] surgical procedures, like facelifts or rhinoplasty.”
Unfortunately, not everyone fares so well. One RealSelf member, who had a series of silicone injections 20 years ago, says: “It looked great for 10 years, [but now] all the silicone is sagging, leaving me looking 10 years older than my age. My cheeks are sagging into jowls. My chin is sagging. The injections seem to have swollen with time. My face feels heavy and looks abnormally large.”
The bottom line
While silicone injections are vilified by many in the aesthetics medical community, they can be administered safely in super-small doses by board-certified dermatologists and plastic surgeons who have extensive experience injecting medical-grade liquid silicone via the microdroplet technique. Keep in mind, though, that silicone requires commitment. Unlike most other fillers that break down over time, silicone is there to stay. Best-case scenario: it offers a forever solution, without the need for repeat treatments. Worst case: it’s a lifelong problem, necessitating costly and potentially risky repair work. Be sure to discuss all the pros and cons with several trusted medical professionals before moving ahead with silicone injections.
