What type of scan would silicone injections be visible with?

Question

Do they need to have granulomas for them to be seen or could you see the liquid silicone in the body without lumps yet?

J. Timothy Katzen, MD, FACS · Answer

Hello, that you for your question about what type of scan is best to evaluate silicone injections. The best radiographic study for silicone injections is a MRI. The MRI should be performed with and without contrast. This allows your plastic surgeon to see where the silicone, scar tissue, and granulomas exactly are located. I specialized in biopolymer and silicone removal and subsequent reconstruction. Since removing biopolymer and silicone is a big procedure, please seek an experienced, board certified plastic surgeon with significant experience in removing silicone from the buttock. Do your research. Make sure they have performed at least 100 biopolymer and 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, buttock silicone removal surgeon in your neighborhood, consider traveling out of state if you must. Sincerely, Dr. Katzen. (“Verified” Plastic Surgeon, President of the American Society of Bariatric Plastic Surgeons, 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 Mamallama94, and thank you for your question!As a board-certified plastic and reconstructive surgeon who specializes in silicone/biopolymer disease and its complex removal procedures, all silicone injection patients that are seen at my private practice are sent for an MRI (with and without IV contrast) to determine and locate foreign body (free silicone/biopolymer). From that point, we discuss the staged excision technique I perform to effectively remove as much of the free silicone/biopolymer material and associated granulomas and scar tissue in the hopes of relieving some, if not all of the patient’s symptoms.

Kenneth Hughes, MD · Answer

Though silicone can be seen via ultrasound and MRI, frequently, the patient does not know if the injector has any credentials at all. In addition, they do not know exactly what was injected or how much was injected. This usually leads to a concern about the danger of having this substance within the body. Unfortunately, many surgeons will refuse such patients because there is more intrinsic risk in operating on a patient who has non-sterile injections of unknown material present.

Daniel Barrett, MD · Answer

Dear mamallama94,
it is hard to tell for sure without an examination. Generally speaking, MRI can detect the presence of silicone in different tissues. I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Praful Ramineni, MD · Answer

The best test for silicone/biopolymers is MRI and will show liquid silicone.  This can show soft tissue changes as well.

What type of scan would silicone injections be visible with?

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