How to tell if I've had silicone injected into my cheeks?

Question

How would I know if a nurse injected me with silicone instead of "Radiesse" in the cheeks? Are there any visual ways of telling? Does silicone feel different from Radiesse? Sometimes my cheeks become hot and I need to ice them is that a side effect of something? Could I feel the difference in the touch? Help. Also would an MRI or x-ray scan be able to tell me whether or not it is Radiesse or if it's not? Thanks.

J. Timothy Katzen, MD, FACS · Answer

Hello, I am sorry you had "something" injected into your cheeks and that now you are having problems, like "hotness to touch".  The BEST person to ask is the "nurse" who injected you.  Your nurse should honestly tell you.  Also, ask your nurse if any other patients are experiencing the same problems.  Radiesse is made up of hydroxyapatite microspheres whereas silicone is silicone.  Both Radiesse and silicone stimulate natural collagen synthesis.  Radiesse and silicone start to work immediately.  There is no "reversal" agent for Radiesse or silicone.  However, that is where the similarities end.  Radiesse is a FDA approved filler for the face and hands.  Whereas, silicone is illegal and NOT FDA approved.  The FDA has warned that injected liquid silicone may move throughout the body and can cause serious health consequences, including death. Liquid silicone may block blood vessels in parts of the body like the brain, heart, lymph nodes, or lungs, leading to an extremely dangerous situation. Radiesse lasts for up to two years.  Silicone is PERMANENT.  Early on, there is no way to visually tell the difference between Radiesse and silicone.  There is no way to tell the difference between Radiesse and silicone by touch either.  However, Radiesse should dissolve by about 18 -24 months.  If you still are having problems in your cheeks after 18 -24 months, what was injected was probably not Radiesse.  Radiessse and silicone feel the same.  However, over time, facial cheek silicone becomes firm and hard.  The "hot to touch cheeks" is NOT uncommon for Radiessse and silicone.   X-ray would NOT help.  X-rays are for fractures.  An MRI would show product, but usually cannot tell the difference between Radiesse and silicone.  
Bottom line: I would suggest you wait for about 18 months after your injections.  If these areas still bother you after 18 months, I would suggest surgical removal.  If you can NOT wait 18 months and since there is no reversal agent for either Radiesse or silicone, I would suggest surgical removal.  I specialize in foreign body and silicone removal and subsequent reconstruction with fat grafting and/or implants.  I am the lead investigator and founder of the Silicone Removal Institute. Since removing silicone is a big procedure, please seek an experienced, board certified plastic surgeon with significant experience in removing silicone.  Do your research.  Make sure they have performed many silicone removal surgeries and have the before and after pictures to prove it.  Carefully examine their before and after pictures and check their reviews on RealSelf.   If you cannot find an experienced, silicone removal surgeon in your neighborhood, consider traveling out of state if you must. GOOD LUCK!! Sincerely, Dr. Katzen. (“Verified” Plastic Surgeon, Certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)

Raffy Karamanoukian, MD, FACS · Answer

Silicone biopolymers are commonly used in the face and body. They may sometimes cause noticeable symptoms that we gauge using the Karamanoukian Soft Tissue Reaction Grading Scale from I to V. The severity of your complications dictates the interventions needed, ranging from itching and burning to severe necrosis of the soft tissue. Nerve pain and symptomatic swelling is also possible. Insurance may cover your surgery, but that is a discussion that requires you to contact and appeal to your insurance carrier. Options for removal are complex and depend on whether you have the material in your face or body. We reverse BBL with silicone commonly and remove silicone from the lips very commonly. Diffuse silicone in the face is not likely to respond to removal. Filler migration, swelling, and granulomas can cause significant discomfort and cosmetic ramifications. Our office specializes in the use of enzymes and filler reversal techniques without hyaluronidase to help improve the results of botched cosmetic fillers, whether caused by Juvederm, Restylane, or foreign fillers. We can also test for the material to determine the likelihood of silicone granulomas and silicone reaction.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Jeremy S. Nikfarjam, MD · Answer

Hi Evangeline, and thank you for your question. In order to determine the substance that was injected, I’ve found the best imaging would be an MRI. As a board certified plastic and reconstructive surgeon who specializes in silicone removal in New York, I require an MRI for all of my silicone patients. The MRI will determine if in fact, the product was that of illicit free-standing silicone/biopolymer injections (that are a non-FDA regulated and non-FDA approved injectable material) and determine their location along with the extent in which the product has migrated. If this is the case (a true silicone/biopolymer injection), I then discuss a customized surgical plan tailored to the patient’s specific needs in order to effectively remove the product. Please keep in mind, silicone/biopolymer injections are not in a capsule (like an implant) therefore, cannot be removed 100%.

Luis Lopez Tallaj, MD · Answer

The difference between real dermalfillers as hyaluronic acid or calcium hydroxiapatite is that they stay were we inject it and do not move, and of coirse it will absorb within a period of no more than 12 to 16 months dependind on the case and area. Alloplastic material such silicone and PMMA the invade the cells citoplasma and integrate with the closer tissues, also they migarte and causes deformitis with compromise of the micro circulation, a real nightmare. In some cases we can remove part of it, neve all of it, trying to recreate a temporal normality in the lips or someother areas of the face with the risk of severe deformities. It’s so important that prior to do cosmetic facial injections you verify the doctor choosen by you, and search about the brand of the product that this professional is pffering to you. Recently we posted a documentary in our youtube channel Lopeztallaj, Besos de plástico explaining everything involved with those ilegal injections for a real prevention. It has english subtitles.

How to tell if I've had silicone injected into my cheeks?

Answers (4)

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