Is open surgery the only option for silicone injection removal in the butt?

Hello, Thank you for your question about what to do about illegal, butt silicone injections done eight years ago.  Basically, if you have buttock silicone injections and you want the silicone removed, you have two options. To remove buttock silicone, I recommend either targeted buttock silicone liposuction or excision. I have successfully removed a lot of silicone from the buttock with ultrasound guided, VASER liposuction.  During ultrasound guided, VASER liposuction surgery, the butt silicone is identified and isolated with an intraoperative ultrasound. Then, the VASER is used to melt the silicone.  Then a traditional liposuction cannula is used to remove the silicone.  This is quite successful and avoids making a larger incision.  However, if you have a significant amount of silicone or another foreign body (that the VASER cannot melt), you may need an incision.  Usually, I make the incision at the top of the  buttocks.  After the incision is made at the top of the buttocks, I dissect to the area of silicone. Usually, the illegal, silicone injector places silicone at the superior portion of the buttocks.  Sometimes, the illegal, silicone injector places silicone in the inferior portion of the buttock.  Usually, the silicone at the top of the buttock is easier to remove.  Either way, I try to remove all the silicone safely. Upper buttock skin and fat that is impregnated with silicone is directly removed.  Excess sagging buttock skin is then removed and the buttock is raised.  The incision was then closed.  On another note, I am not sure why you were denied a Brazilian Butt Lift or Augmentation. Indeed, many of my patients need buttock augmentation after buttock silicone is removed. Just because you have had silicone injected in the past, does not mean you cannot have a Brazilian Butt Lift or Augmentation.  The removal of buttock silicone surgery is not an easy surgery. Many plastic surgeons do not perform this procedure.  Before you make any decisions regarding the removal of buttock silicone, 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 buttock silicone removal expert. If you have any more questions regarding removing buttocks silicone with ultrasound guided, VASER liposuction or excision, 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, and American Academy of Cosmetic Surgery.)

Hi Ljd,
I perform hundreds of silicone removal procedures every year, and what I've learned is that open removal is the safest and most reliable way to remove this substance. I see revisionary patients from all over the country who have attempted lipo or laser lipo and not only does it not remove the substance, it often makes the patient's condition much worse.
I perform a BBL as part of the reconstructive phase of my open removals, so you could certainly be a candidate for a BBL in the future! I commend you on your honesty in disclosing this to your surgeon.
I wish you the best of luck in your search for treatment!
- Dr. Nik

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

Open surgery with direct excision is effective as it allows removal of the offending agent without additional or surrounding fat removal or deformity.