When removing silicone liquid from the buttocks with liposuction or Vaser, can the surgeon avoid removing too much fat? (photos)

Question

I see some videos where surgeons remove too much fat while trying to remove liquid silicone. I was scam injected only a few weeks ago and small silicone spheres are floating around in my fat. I am very concerned because most surgeons are not able to selectively lipo the liquid from the fat. Is un-vasered or cold fat dense enough to somewhat avoid getting lipoed indiscriminately with the silicone? I don’t see real scar tissue in the MRI. I don’t have much fat on my body to graft.

Raffy Karamanoukian, MD, FACS · Answer

You are in a very difficult position because of the injections placed into the subcutaneous fat of the buttocks. Since this is very early, we are already seeing the silicone in the fatty tissue and it is likely that without immediate or early treatment, you will see dissipation of the fat and silicone in a wider plane.

I begin consultations with an examination and ultrasound in 4D to examine the extent of muscle or fatty involvement. An MRi is excellent but does less to map the areas of concern. Using a small incision approach, I prefer to not use VASER or laser lipo because I want to create as little scar tissue and inflammation as possible during the surgery.

Removal of silicone is possible and our options have helped a lot of people with silicone biopolymer injections in the buttocks. I am the surgical director of Kare Plastic Surgery in Los Angeles and our center is a National Center of Excellence in Biopolymer removal. Silicone biopolymers are difficult to treat and no cookie cutter answers by surgeons can give you any credible solution. These treatments should be individualized and perfected.

Start with a consultation in my office to examine the tissue and provide you with personalized answers to your problem. We strive to remove as little fat as possible and we constantly assess the area for lipo to silicone ratios. The approach uses similar techniques as lipo but is different.

Best, 
Dr. Karamanoukian
Realself100 Surgeon

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding how to selectively remove silicone from the buttocks using liposuction or Vaser without removing too much fat. Thank you for your question regarding how to remove silicone from the buttock with the closed technique or the suction technique. In your case, since the injections were only a few weeks ago, scar tissue will not show on the MRI. It probably takes about 12 to 24 months for scar tissue to develop around the silicone spheres in your body. After that, the scar tissue becomes thicker and thicker. To more accurately suction the injected silicone from your buttocks, I use an ultrasound during the surgery. During the surgery, the ultrasound can selectively target pockets of silicone and thus minimize the extraction of fat. This is highly selective. I have tried using a traditional suction technique without VASER for silicone removal from the buttocks. Silicone removal from the body without the VASER is not as accurate nor does it remove as much silicone as traditional liposuction. In addition, cold fat makes no difference. In fact, I would definitely not suggest using cold fat liposuction techniques since you state you do not have much fat to graft on the buttocks. After suction, your other alternatives would include Sculptra (an FDA-approved injection product) or an FDA-approved silicone butt implant. Please seek an experienced board-certified plastic surgeon who has performed many silicone injections removal procedures.

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.)

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.)

Jeremy S. Nikfarjam, MD · Answer

Hi and thank you for your question! Ive performed many silicone/biopolymer removals in my private plastic surgery practice and have found that the best way to remove silicone/biopolymer is through a staged excision. I perform this technique to meticulously excise any (and only) problematic material including silicone/biopolymer product, compromised surrounding soft tissues (necrotic tissue) and foreign body granulomas. All of which cannot be successfully removed with a liposuction cannula. 
Unfortunately, it is difficult to properly evaluate MRI images through photographs, but it is great that you have already taken the first step! Silicone/biopolymer foreign body removal surgery is becoming a very common and, in my opinion, medically necessary surgery that not every surgeon truly understands or is comfortable performing. I would encourage you to schedule an in-person or virtual consultation with board certified plastic surgeons who specialize in silicone disease and these highly complex removal procedures. I hope this helps!

Praful Ramineni, MD · Answer

Unfortunately, there is no way to selectively remove silicone (or all the silicone) after injections.  Generally liposuction is done to debulk the area and to avoid over resection.  If a patient has enough fat, a second stage can be performed to add fat if needed.

Darryl J. Blinski, MD · Answer

Thanks for the question/s. This is a prefect example of the foolishness of allowing a non medical individual to preform a medical procedure upon you with an illegal substance. Calling it a scam being preformed on you is no excuse! Plus the scan demonstrates how dangerous the injections of industrial grade silicone are. It has inter dispersed into all the tissues. So that it is IMPOSSIBLE to remove each "sphere" individually. Small cannulae liposuction of a layer or so of the damaged tissue in the buttock with re injecting fat grafts as a sub dermal layering protection has been my technique. The results are very good. Fee $6,500. Please do not have a deforming total excision of all the injected sub dermal buttock tissue. You will result in a severe deformity of your buttock.

When removing silicone liquid from the buttocks with liposuction or Vaser, can the surgeon avoid removing too much fat? (photos)

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