Fifty-four patients with problems following "medical grade" silicone injections into the face and legs were seen from 1974 until 1995. Complications consisted of chronic cellulitis, nodules, foreign body reactions, and movement of material to near and distant parts of the body. These difficulties usually demonstrated themselves many years after injection. It is suggested that problems occur despite good technique, good material, and small amounts injected. Because the side effects are unpredictable and often uncorrectable, further studies must be performed to insure silicone's safety.

No abstract

Dimethylsulfoxide (DMSO) has been in clinical use since the early 1960s. In 1967 the discovery that DMSO can greatly reduce ischemia in experimental pedicle flaps stimulated its use in plastic surgery by the authors since 1976. In 1987 its ability to soften collagen, thus permitting degrees of immediate intraoperative tissue expansion hitherto unknown, was applied clinically for the first time. Evolving use of topical 70% DMSO alone, in combination with intravenous DMSO, and intravenous DMSO alone with greater efficacy is discussed. Cases of intraoperative tissue expansion for large lesion excision and use in abdominoplasty to maximize skin resection are discussed. In breast reconstruction, maximal tissue expansion in minutes with immediate placement of large permanent prostheses ends the delay of reconstruction and problems of chronic tissue expander capsule formation and gives this technique a clear advantage over other reconstructive techniques.

The author describes extensive use of diazepam (Valium) with ketamine as a safe and efficacious technique of dissociative local anesthesia in an ambulatory plastic surgery facility. He finds these agents helpful in rhinoplasty, facial surgery, and breast augmentations as well as all other aesthetic and most reconstructive procedures.