How do you remove biopolymers from buttocks?

Question

I had a buttocks injections with unknown substance 5 years ago and a year ago a started getting some reactions in the area .

J. Timothy Katzen, MD, FACS · Answer

Hello, thank you for your question regarding removing an unknown product from your buttocks.  It was probably silicone that was injected into the buttocks.  There can be many reactions to unknown substance injected into the buttocks, especially silicone.  The foreign body causes an inflammatory response.  Buttock scar tissue is created.  Often, the buttock skin reacts and becomes red.  All this scarring can create a granuloma.  Over time, granulomas can turn into cancer.  I would suggest you have this product or silicone removed from your buttock at once.  I use a technique called intra-operative ultra-sound guided VASER assisted liposuction for the removal of buttock silicone and buttock scar tissue.  Another technique for the removal of buttock silicone is direct removal.  These are highly successful procedures.  Before you make any decisions regarding silicone removal from the buttock, I would suggest you seek consultation with an expert. Please seek an experienced, board-certified, plastic surgeon.  Travel out of state if you must to find such a silicone removal  expert. If you have any more questions regarding silicone removal from the buttock, intra-operative ultra-sound guided VASER assisted liposuction or plastic surgery in general, please contact my office.  Sincerely Dr. Katzen. (Certified by the American Board of Plastic Surgery and member of the American Society Plastic Surgeons, International Society of Aesthetic Plastic Surgery, American Academy of Cosmetic Surgery, and Fellow of American College of Surgeons and American Board for Metabolic and Bariatric Surgery)

Carlos Alberto Ríos García, MD · Answer

I understand your concern. Reactions developing years after buttock injections are unfortunately something that can occur with unknown substances, silicone, hydrogels, PMMA, or other biopolymers once chronic inflammation begins developing within the tissues.
One important thing to understand is that biopolymers usually cannot simply be “dissolved” or cleanly suctioned out like temporary fillers. Over time, these materials often become integrated into:
* fat* scar tissue* fascia* lymphatic structures* connective tissue* and sometimes muscle planes
Because of this, removal techniques vary greatly depending on:
* the type of material* extent of migration* tissue involvement* degree of inflammation* fibrosis* skin condition* and whether there are functional symptoms
In many cases, surgeons begin with MRI imaging to understand:
* how diffuse the product is* whether there are localized pockets versus widespread infiltration* involvement of deeper structures* and which areas may safely be approached surgically
Treatment may involve:
* open surgical excision* staged removal procedures* limited debulking* drainage of inflammatory collections* scar revision* reconstructive procedures* or conservative monitoring in selected areas
One of the major controversies in this field is that aggressive liposuction or VASER approaches may sometimes spread inflammatory material, damage lymphatics, worsen fibrosis, or remove large amounts of healthy tissue along with the product. This is why many experienced reconstructive surgeons are very cautious about suction-based techniques in diffuse biopolymer disease.
The goal is usually not simply “getting everything out,” because complete removal is often impossible once the material becomes microscopically integrated into the tissues. Instead, treatment focuses on:
* controlling inflammation* improving symptoms* preserving healthy tissue* protecting circulation and lymphatics* reducing progression* and maintaining long-term function and contour stability as much as possible
Cases involving reactions years later are usually best evaluated by surgeons experienced specifically in silicone and biopolymer complications, because these situations often behave much more like chronic reconstructive disease than routine cosmetic revision surgery.

Jeremy S. Nikfarjam, MD · Answer

Hi Gavinosmom,
I perform hundreds of silicone removal procedures every year, and what I've learned is that open, surgical removal is the safest and most reliable way to remove this foreign body substance. I perform my procedures in two stages- removal followed by reconstruction. 
I urge you to find a board certified plastic surgeon who specializes in this condition. 
Best of luck on your search for treatment!
- Dr. Nik

Raffy Karamanoukian, MD, FACS · Answer

Silicone biopolymers are being used throughout the world for facial and body volume augmentation. Results are longer-lasting that Juvederm or Restylane. 
Bellafill and Artefill are known to cause granulomas and permanent nodules with swelling. This is not the case for everyone. Silicone biopolymers can also cause similar chronic inflammatory conditions. 
In my practice, I specialize in the removal of Bellafill and Artefill injections, in addition to silicone biopolymers, from the face and body. Initially, treatments are non-surgical with corticosteroids and immune modulators. If unable to be corrected, we can also perform surgery in some cases. 
Silicone biopolymers can also be removed from the body if there are signs of migration or inflammation. All of these filler-types should be removed as early as possible. 
Lastly, our office is conducting ongoing studies of plasma-assisted corticosteroid application, which allows for diffusion of the treatment medication in superficial tissue without causing atrophy. 
Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Kenneth Hughes, MD · Answer

Unfortunately, I am having to do more and more of these debulking procedures.  The material is removed in the first stage.  It is rare that over 50% of the material can be removed.  Because the material is typically laden with bacteria means that you run the risk or injection and recurrence of granulomas.   A period of 3 months or so is observed.  A BBL can be performed later to improve the appearance.  Kenneth Hughes, MD, Board Certified Plastic SurgeonLos Angeles, CA

How do you remove biopolymers from buttocks?

Answers (5)

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