Revision to Remove silicone?

Question

Hello, I had a surgery to remove to remove liquid silicone that is completely mixed with my tissue on my face last year. I have some nerve damage. What can be done to smooth out even out cheeks and chin? I still have blue bump as well. Can retraction radio frequency laser under the skin smooth out all of the uneveness? What are my options without risk of disfigurement? I was told silicone moves and that is why my chin is disfigured now after the surgery. Would appreciate answers?

Jeremy S. Nikfarjam, MD · Answer

Hi there — thank you for sharing your story. I'm really sorry you're dealing with this. Complications from liquid silicone injections can be incredibly frustrating, both emotionally and physically. I’ll walk you through some potential options, based on current standards and techniques.

What You May Be Experiencing:
1. Nerve damage - This can occur when the silicone is deeply mixed with tissue, and surgery disturbs nerves while trying to remove it.

2.Blue Bumps - This is likely a silicone granuloma, residual silicone pooling, or scar tissue that’s visible under thin skin.

3. Facial Asymmetry & Retraction - If silicone has moved or been removed, the surrounding tissue can scar, or tether—especially around the chin and cheeks.

Liquid silicone binds to tissue and moves over time. Surgical removal often leaves gaps, irregularities, and tethering (scarred or hollowed-out areas). Aggressive correction can risk more disfigurement if not carefully planned.

These are common options used by specialists (plastic surgeons, dermatologic surgeons) with experience in post-silicone correction:

1. Subcision + Injectable Filler or Fat. 
What it does: Releases tethered/scarred tissue under the skin;  Fillers (such as hyaluronic acid or long-lasting like Radiesse) can restore volume and smoothness. This option will provide minimal downtime. Please note - results are temporary when using fillers.

2. Radiofrequency Microneedling (stimulates collagen, mildly tightens, improves texture). This option is good for fine irregularities and texture but won’t fix deep retractions or replace lost volume.

3. Surgical Revision (with or without tissue grafting). Sometimes, this is the only route to real improvement if non-surgical options are limited. When to consider: If deformities are severe or persistent blue bumps/granulomas are painful or visible. This option can involve scar tissue excision, dermal fat grafts, revision of chin contour surgically.

The next step would be to consult with a Board-Certified Plastic & Reconstructive surgeon experienced in silicone removal and complex facial revision who can order imaging (like and MRI with and without contrast, if not contraindicated) to map where remaining silicone or fibrosis is. I am a board-certified plastic and reconstructive surgeon with a specialized focus on silicone and biopolymer removal. Over the years, I have dedicated my practice to safely addressing complications arising from these materials. Recognizing the unique challenges they pose, I developed a meticulous surgical excision process with a reconstructive phase. This approach is designed to ensure the most complete removal possible while minimizing risks and optimizing patient outcomes. I'd be happy to see you for a clinical evaluation whether it be a complimentary virtual consultation or an in-office appointment to discuss your options. Please give us a call to see how we can help (516) 279-2616

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

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding the options for managing complications from liquid silicone injections in your face. It's unfortunate that you are experiencing these issues, but you are right to seek thorough and safe treatment options.

Liquid silicone injections to the face are generally considered unwise and unsafe due to the numerous risks they pose. These injections can provoke inflammatory reactions, create excessive scar tissue, and potentially trigger autoimmune diseases. Conditions linked to silicone injections include Hashimoto’s thyroiditis, Rheumatoid arthritis, sarcoidosis, and ulcerative colitis, among others. Moreover, silicone can cause significant metabolic issues such as hypercalcemia, which may lead to kidney stones, kidney failure, and even the need for a kidney transplant. Additionally, silicone can migrate and cause severe granulomas and disfigurement.

Regarding the removal of silicone and associated scar tissue from the face, there are generally two approaches:

Direct Approach: This involves making an incision over the area where the silicone and scar tissue are concentrated. However, making incisions on the face can lead to significant disfigurement, though sometimes such measures are necessary.
Facelift Incision Approach: More commonly, an incision similar to that used in facelifts is made in front of the ear. This type of incision allows extensive access to the face and has the benefit of hiding the scar effectively. Additionally, by using this facelift approach, any tissue removed can coincide with tightening the skin, which may improve the overall aesthetic outcome.
As for the return of nerve function, regrettably, this is unlikely if the damage is extensive. Concerning your question about the use of radiofrequency laser treatments, while these can help break up scar tissue, they will not eliminate the silicone. Furthermore, the heat from the laser could potentially cause the silicone to spread further, worsening the problem. Most plastic surgeons advise against using laser treatment for silicone injections due to these risks.

This is indeed a challenging problem, but there are specialists who focus on the removal of silicone from the face. I recommend consulting with a plastic surgeon who has specific experience in this area to discuss the most appropriate and safe treatment options.

Good luck, and I hope this information helps you in finding a resolution to your concerns.

Sincerely,

J. Timothy Katzen, MD, FASMBS, FICS
Plastic and Aesthetic Surgeon

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