Silicone Injections and Hydrogell Injections.Samir Shureih MD. FACS.Baltimore, Maryland.Buttock enlargement is becoming a very popular cosmetic surgery procedure. There are several well established surgical procedures that can safely accomplish that. These include the Brazilian Buttock lift, Dermis Fat graft, and Buttock Implants.Some people have taken advantage of this trend and use illegal, unsafe injections of non medical grade Silicone, silicone oil and gel, Hydrogell, polyacrylamide, Macrolane and many other unusual substances.Silicone injection to the buttocks and other areas in the body are common underground illegal procedures. The silicone used is industrial grade silicone oil bought from hardware store or silicone oil used as a lubricant. This type of silicone is not pure and contains many other substances. It is not a Medical Grade Silicone, if medical grade silicone was to be used for buttock enhancement; it will be very expensive and still not medically approved. The body reacts to the foreign material by forming chronic inflammatory reactions called SILICONE GRANULOMAS; these granulomas can be felt as hard lumps, sometimes very painful. When injected near vital structures like nerves. The granulomas entrap the nerve and cause pain, burning sensations, swelling, migration, blockage of the lymphatic channels and skin color changes. The foreign injected material can not be removed completelt. Granulomas can be removed in most cases but one can not remove the entire injected material. Surgical removal will leave a deformity that will have to be repaired at a later stage.Silicone can MIGRATE beyond the injection site, and can migrate to involve regional lymph nodes. This will cause long term swelling. If the reaction is intense and causing problems, then diluted steroid injection can decrease the inflammatory process. However the steroid injections can carry a certain amount of risks as well. The steroid injections can dissolve the normal fat. Treatment of silicone granulomas is very difficult and complex. Silicone can spread in the surrounding tissue, which makes it impossible to be totally removed. Silicone oil can cause oil cysts with severe inflammatory reaction by the body.Removing the silicone granulomas leaves scars and deformities. When attempts are made to remove it from the buttocks, it is never a complete removal and will lead to major DEFORMITIES. If the granulomas are near or engulfing a major nerve or blood vessel it can be very hazardous and complex surgery with potential for major risks.The UNDERGROUND silicone injectors have graduated to injecting HYDROGEL.It is as hazardous as Silicone injections and gives a similar granuloma reaction. All these materials when injected (PUMPING PARTIES) lead to disastrous long term complications. Most of the time the injections are above the muscle and are under the skin or within the fat. It is rare to be injected deep into the muscle. In the face it is much common for the silicone to be in the muscles of the face because of the closeness of the muscles to the skin. The major nerves are also very close and the silicone can wrap around the nerves. This makes the surgical removal very risky to impossible.Liposuction can remove some of the oil cysts but will not remove the granulomas. Silicone granulomas have to be removed surgically. Even laser liposuction, ultrasound liposuction will not remove silicone granulomas.It is very difficult to know what material was injected before any attempt to remove it.Plastic surgeons are familiar with the reaction to silicone injections and the difficulty in removing it and the subsequent major deformity left behind. That is why patients and surgeons are reluctant to take on these cases. When silicone is injected close to the skin, the skin will look like an orange peel appearance and attempts to remove it will jeopardize the skin vascular supply and can cause the skin to die. Removing large deep lumps ( Hard granulomas) will cause depressions and deformities that is very difficult to repair and may require long surgeries. These deformities are very difficult to repair and may require multiple surgeries. That is why these surgeries are very expensive. Not because of greedy plastic surgeons. When the lymph nodes are invaded by silicone the lymph nodes are blocked and cause chronic edema. One cannot remove lymph nodes. Chronic reaction to the injected silicone can cause hyper pigmentation changes in the skin that is irreversible, and impossible to treat.