Brazilian butt lift and traveling
Many of my patients come from other parts of the country and this is a common question they ask. The post operative instructions are as important as the surgery itself. Remember that the fat that has been processed and reinjected into the buttock behaves as a graft for the first two weeks. This means that the fat is nourished by its surrounding soft tissue, and it does not have its own blood supply yet. The fat needs to be handled with care and prolonged pressure by sitting after surgery can have a detrimental effect on the fat survival.
If you have to travel after surgery, I recommend that you stay in the area where you had your surgery for at least 7–10 days. On your way back, make sure that you walk for some time during your flight. In addition, buy a cigar-shaped cushion. You will put it under your thighs to bump you buttock and minimal pressure will be applied to the gluteal area.
If you survive the butt injection with silicone, the first thing you need to do is to thank God. Now, you need to understand that, even if you don’t develop a complication right away, it might happen years after the surgery. There are many ways to manage the complications of silicone Buttock Augmentation.
Surgical treatment of silicone granuloma, as discussed before, is a challenge. It is a challenge to treat because, once you inject the product in the buttock, it disperses to many areas. If the granuloma or product is well localized, then, it can be surgically removed. On the other hand, most of the times this is not the case since multiple injections of the product in different areas makes it difficult to anticipate the extent of the granulomatous reaction. I have personally treated silicone granuloma in the breasts, and it requires a complete removal of the breast tissue (mastectomy) and a reconstruction. Over time the effect of inflammation on the fat and breast tissue distorts the breasts significantly. A similar reaction is common in other parts of the body like the buttocks.
Various factors will determine the extent of the surgical excision and final results:
1. Chronic inflammation resulting in distortion and granuloma
2. Amount of silicone injected
3. Area in the buttock that was injected
4. Purity of the silicone injected
Unfortunately, when silicone is injected, there are not a lot of options, except to wait and see how the body reacts and encapsulates the product. Many times a surgical reconstruction will be necessary to restore the harmony of a deformed area.
There are other options to manage silicone granulomas and complications associated with this product. Painful granulomas have been treated with the following products:
2. Non-steroidal antiinflamatory drugs
4. Immune modulating therapies
Steroids have led to improvement in the symptoms but the effects appear to be transient and the symptoms often relapse upon tapering of the dose. Both injection of the granuloma with steroids and oral steroids have been use in an attempt to control the inflammation with mix results.
Non-steroidal anti-inflamatory agents have also been used and led to symptomatic improvement although also the effects appear to be transient.
Now, tetracycline including family of antibiotics has led to sustained remission in several cases. These antibiotics have intrinsic anti-inflamatory and immune-modulating capabilities but long terms remission is still to be seen.
Finally, some newer medications that control the immune system have also been used in treating silicone granulomas. Medications like etanercept and imiquimid show promosing in managing the pain and the inflammation. Now, most of the studies and report on the literature has been on small granulomas on the lips, cheeks and other part of the face which typically are small amount that what is typically use in buttock augmentation.
Silicone pneumonitis is closely associated with the silicone emboli syndrome discussed in the previous blog. Silicone pneumonitis is an inflammation of the lung. Injections of silicone in the buttocks have been associated with spillage of silicone in the alveolar space after embolization which spreads to the lungs. Patients typically present several symptoms such as shortness of breath, fever, cough, and vomiting blood.
There are two ways (to detect pneumonitis) how pneumonitis presents itself. Most patients present an early response usually a few days after the injections, including shortness of breath, chest pain, cough, and sometimes loss of consciousness. The second response is later after the injection, most typically after 6 months of the injection. Patients present local swelling at the injections’ site and mild respiratory symptoms.
Pathological examination supports the theory that silicone injections result in migration of silicone to the blood stream affecting the lung and causing an inflammatory response resulting in either a lung inflammation or pulmonary vessel blockage.
This blog has explained another reason why silicone should not be injected for butt augmentation.
Severe complications have been documented in different states across the country due to the injection of liquid silicone. In 2007, the North Carolina Division of Public Health performed an investigation of three patients that presented acute renal failure (kidney not working) after an injection of presumably silicone for soft tissue augmentation. All the patients had learned about the facility that was injecting silicone through the Internet. The provider was a radiology technician who was injecting silicone without proper supervision. The importance of this possible complication was posted on the CDC epidemic Information Exchange and distributed to physicians countrywide.
The literature does not explicitly report that silicone causes kidney failure directly, but some reports indicate that often silicone is either mixed with other products intentionally that stimulate an acute inflammation to avoid silicone migration or is not sterile and has been adulterated unintentionally with other products.
Practitioners implicated in injecting these products have been convicted of serious offences up to third degree murder in the practice of medicine without a license.
Suppose you want to have your butt done and you have heard of a new product on the street… Such product supposedly requires minimal down time and you don’t need to have surgery. You contact an individual that you found online or through email and schedule an appointment. During you appointment you are told that the best way to increase the volume of your butt is by injecting silicone. The person gives you a quote for $2,000.00 and the procedure will be done in a hotel room without major anesthesia. All excited, you show up the day of the procedure. The provider starts injecting a liquid with no color or smell. Everything is going well and your butt starts having a better shape. There is minimal pain. All of a sudden, you lose consciousness and wake up in an emergency room. You can barely breathe, your heart is pounding rapidly, and after a while everything goes dark and the beep of your heart becomes silent. What a terrible situation!
Injecting silicone into the buttocks can cause what is called the silicone emboli syndrome. This is a condition where clots block the blood supply to the lungs preventing oxygen from getting into the blood stream and essentially you suffocate and can even die. This typically occurs within the first 72 hrs after silicone injection. There are two main ways of presenting this syndrome. First, the patient can be present with respiratory distress and low oxygen levels within the first 72 hrs. There is fever, chest pain, cough, vomiting blood, and shortness of breath. Other patients present an altered mental status, including coma. If this is the case, your chances of dying is 100%.
The silicone emboli syndrome is the most serious complication of buttock augmentation with silicone. I don’t recommend injecting this product in the buttock area. If you survive this injection, most likely you will have additional problems in the future as discussed previously.
Silicone granuloma (painful nodes) is the most common complication of liquid injectable silicone. Granuloma is a medical and pathological term used to describe the formation of a mass of immune cells, inflammatory cells and scar tissue that forms when the immune system attempts to wall off substances that perceives as foreign but is unable to eliminate. When silicone is injected into the buttocks or any other area of the body, a similar response occurs. The reaction of liquid silicone injected to the buttocks vary considerably and depends on the amount and type of silicone injected. There are two general clinical presentations. In the first one, the patient presents painful multicystic lumps on the buttock area. This can occur in the early years or as long as 10 -15 years after the injection.the second presentation is characterized by skin inflammation and breakdown as the silicone migrates close to the skin. Also, these lesions manifest as recurrent infections with pain and hardening of the buttocks.
The exact mechanism is not fully understood but multiple theories exits. It is known that silicone is not completely biologically inert. Silicone undergoes a biological oxidation to silica. This product is incorporated in some cells called reticular endothelial cells. It is speculated that this oxidation into silica sets the stage for the painful granulomas manifested.
The reaction of liquid silicone can be presented in different ways. For example, we know that not all the patients that have silicone injection have developed significant complications. It seems that when a high amount of silicone is injected, almost all of the patients will develop palpable nodules. The average time of presentation is nine years. It can take decades for some of the complications to manifest. So, just because nothing happens right away, it does not mean that you will not have a problem in the future. You might be lucky to survive a high volume of silicone in your buttocks.
Some of the complications could be the following:
1. Multiple and painful lumps
2. Skin inflammation
3. Skin breakdown
5. Recurrent Cellulitis (Infections)
6. Silicone migration
7. Acute pneumonitis (Lung inflammation)
8. Blood Clots
9. Kidney failure
Now, remember I am referring to large amounts of silicone, which is necessary to augment the buttock. I don’t recommend the use of industrial or medical silicone in large amounts for soft tissue augmentation. Typically, when I use fat transfer to sculpt the buttocks, I inject between 500 cc – 1000 cc (1 Liter). I have found that this is the best option to improve butts with minor complications.
To understand the complications of silicone injection to the butt for augmentation we need to understand the history of silicone injection in the breast.
Dow Coming Corporation created the first medical grade silicone in the early 1960’s. There were three early silicone products: Dow Corning 200 fluid, Dow Corning 360 Medical Fluids and Dow Corning MDX 4-4011. The misuse of silicone is clearly documented in the docks of Yokohama Japan were the Dow Corning 200 was being stolen and injected into prostitutes who wanted to have bigger breasts to cater United States Service men who prefer women with larger breasts than the Asians. This product was never intended for use for industrial purposes. Subsequently, Dow Corning 200 was purified and became known as Dow Corning 360 with a higher purity but not design for injection. This product was branded as Dermagen and for the purpose of a dressing for burn patients. This product became used by physicians in Las Vegas for breast augmentation and subsequently because of severe complications the State of Nevada declares the injection of silicone a felony and ban silicone injection.
Significant complications started to resurface causing the FDA to investigate this product as a new drug. It is at this point in 1965 that Dow Corning under FDA issue a “notice of claim investigational exception for a new drugs no 2702”. The product for these studies was named Dow Corning MDX 4-4011. It was basically a higher purified Dow Corning 360. Years later, due to problems with the studies protocols the company elected not to pursue a formal premarket approval application.
By the 1990, thousands of patients have received facial and body injection of silicone to the point that FDA forbid the sell of liquid silicone for aesthetics purposes until standardized studies can verify the safeness of the product. To this date there is no long term study published in the literature under FDA guidelines. Remember this was early 1990’s and it was not until 1994 that the first medical liquid silicone was approved by the FDA. Not good at all. Certainly it has not approved the silicone for cosmetic indications to this date. Regardless of the warning silicone in the decade of the 1990’s was easily accessible in clinics and the problems continue. If you want to know what were the common problems read the next blog.
Silicone does have a role in the medical field. Silicone is used in surgical dressing, implants, and ointments for scar treatment. In addition, the FDA approved liquid silicone in 1994 for the management of retinal detachment caused by a cytomegalovirus in patients suffering of AIDS. In 1997, the first commercial formulation using liquid silicone was approved by the FDA under the name of Silikon 1000 ( Alcon, USA). Subsequently, in 2001, the FDA approved another commercial formulation called Adatosil 5000 (Baush and Lamb) for the same ophthalmologic indications.
If the FDA approved the liquid silicone, it must me safe to use it anywhere? Sign me on! Not so fast. According to Alcon USA, Silikon 1000 and Adatosil are indicated for use as a prolonged retinal tamponade in selected cases of complicated retinal detachments where other interventions are not appropriate for patient management. In addition, even for this specific indication, the silicone oil is intended to be removed after maintenance of retinal reattachment in order to minimize significant eye complications.
Silicone is not even approved for cosmetics purposes including butt, breasts, or any soft tissue augmentation. Really? Yes, really… So why do some license practitioners use silicone for facial augmentation and wrinkle reductions and don’t get into trouble? The FDA allows the use off label of any product for any condition as described in the Food and Drug Administration Modernization Act Amendment of 1997:
FOOD AND DRUG ADMINISTRATION MODERIZATION ACT OF 1997 SEC. 214. PRACTICE OF MEDICINE. Chapter IX is amended by adding at the end the following: <<NOTE: 21 USC 396.>> “SEC. 906. PRACTICE OF MEDICINE.
“Nothing in this Act shall be construed to limit or interfere with the authority of a health care practitioner to prescribe or administer any legally marketed device to a patient for any condition or disease within a legitimate health care practitioner-patient relationship. This section shall not limit any existing authority of the Secretary to establish and enforce restrictions on the sale or distribution, or in the labeling, of a device that is part of a determination of substantial equivalence, established as a condition of approval, or promulgated through regulations. Further, this section shall not change any existing prohibition on the promotion of unapproved uses of legally marketed devices.”
In simple words, it is legal for any license practitioner to use silicone if he or she believes this will be beneficial to you for the treatment or management of your condition. The FDA has no power directly over the practice of medicine.
This is why I am writing these blogs about liquid silicone injection. Because there is a loop hole that allows silicone to be used off label (meaning the use of a product FDA cleared for one indication for a total different application) Scary, doesn’t it? Wait until you read the next few blogs about silicone injection complications.