Should I remove my silicone butt injections if I am not having any problems?

Question

Could I remove silicone butt injections and get reconstructive surgery at the same time? I see some Doctors stating they lipo suctioned the silicone out and some says it makes it spread and should never be lipo out; which is true and explain.

J. Timothy Katzen, MD, FACS · Answer

Hi Cheerful8557, Thank you very much for your question regarding removing silicone from your buttocks. Silicone can be removed from the buttock either by intra-operative Ultrasound Guided Vaser Assisted Silicone Suction, or direct excision. Liposuction alone can not remove silicone from the buttock. 
  
However, intra-operative Ultrasound Guided Vaser Assisted Silicone Suction does work. I would suggest you have the silicone removed from your buttock as soon as you can. It is only a matter of time before it starts causing problems like pain, excessive scar tissue, and other possible problems. I have had patients who developed electrolyte abnormalities, eventually needing kidney transplant, and even patients who have developed cancer secondary to having silicone injections to the buttock.  Get the silicone removed, NOW!   Silicone removal is not an "easy" surgery.  Please seek an expert in the field of silicone removal.  I have about five surgeries a week for silicone removal.  I hope that I have answered your questions about what to do with the silicone in your buttock. Before you make any decisions regarding silicone removal, I would suggest you seek consultation with a silicone removal 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 either with intra-operative Ultrasound Guided Vaser Assisted Silicone Suction or excision, or plastic surgery in general, please contact my office.  Sincerely, Dr. Katzen. (“Verified” plastic surgeon, 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, Awardee: RealSelf 100.)

Jeremy S. Nikfarjam, MD · Answer

Hi and thank you for your question! I have performed many silicone/biopolymer removals at my private plastic surgery practice and have found that the best way to remove silicone/biopolymer materials is through a staged excision. I perform this technique to meticulously excise any (and only) problematic material including silicone/biopolymer product, compromised surrounding soft tissues (necrotic tissue) and foreign body granulomas. All of which cannot successfully be removed with a liposuction cannula. The overall goal is to surgically excise as much silicone/biopolymer materials within safe limits to help restore normal function and health to the patient in need. The final stage would be a reconstructive BBL (Brazilian Butt Lift). The reconstructive BBL is performed to provide additional cushioning/padding to the areas that may have been thinned out during the excision procedure(s). In addition, the BBL can address contour irregularities from prior silicone/biopolymer injections and/or their removal. I usually recommend that patients undergo this reconstructive component at least 3 months after the silicone removal procedure to ensure that you have recovered sufficiently from the removal. I hope this helps!

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

I am having to do more and more of these debulking procedures before patients can have a BBL. The type of removal depends on the type of substance, the amount of surface area involved, and the patient desires. 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 of injection and recurrence of granulomas.   A period of 3 months or so is observed.  Reconstructive surgery can be performed later to improve the appearance. To help allay fears and eliminate worries of patients who made the previous poor decision to have these substances injected, I recommend that they consult with a board certified PS who has experience in removing silicone.

Syed M. Sayeed, MD · Answer

There are risks associated with any treatments. Regardless of what method is chosen for removal most surgeons who perform this procedure would probably delay placing fat in the form of a BBL for reconstruction until your tissue has healed. This will minimize the risk of infection, improve graft take and allow for a better overall result.
It is unknown how many of these illegal procedures have been performed and what percentage of patients will have complications from this. There are patients who go their whole lives without experiencing negative effects and there are extreme cases of auto immune dysfunction as a result of such. Some surgeons advocate immediate removal if you have had such a procedure even without symptoms and some may suggest an approach where you are educated regarding what to look out for to know you are experiencing complications. Examination and a consultations will help you make a decision you are comfortable with.
It is possible to remove a large portion of involved tissue from your buttocks and to close the wound in one stage. A staged approach may decrease the risk of wound related complications and may allow removal of more of the involved tissue prior to closing the wound. 
I would not say there is only one way to perform these procedures and most surgeons will offer what they feel most comfortable with. Until there is published data comparing liposuction versus excision most of us would advise you based on experience.
The following is a very limited explanation of the options
Debulking procedures 
Single or staged procedure
Scar, asymmetry and need for possibly more than a single session of fat grafting to your buttocks to improve contour as well as revisions to improve scarring
Need for staged procedure if there is a large amount of affected tissue
May be only option is tissue is hard and scarred and there is injured skin
Risk of seromas and wound healing complications
Liposuction
Silicone collections may spread once the capsule around them ruptures
Silicone embolization if a blood vessel in the area of liposuction is injured and silicone travels into your blood stream
Might be possible if tissue is soft and silicone or substrate is in liquid form with less granulomatous tissue
Risk of seromas and wound healing complications

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