Adverse Granulomatous Reaction After Cosmetic Dermal Silicone Injection

Oleomas mimicking cutaneous xanthomas following breast augmentation by injection of liquid silicone

“…Although considered biologically inert, this material has been implicated in a variety of adverse reactions including granulomas, disfiguring nodules and lymphoedema, sometimes with latent periods of decades. 4,5 In the 1980s several authors concluded that only minor and transient problems occur if pure silicone is properly used, but more recent reviews suggest that these complications can occur despite good techniques and good quality material. 5 Other authors suggest that cholesterol 271 mg/dl, LDL 154 mg/dl, HDL 55 mg/dl, triglycerides 309 mg/dl.…”

“…This could explain why the onset of granulomatous reactions are unpredictable and may occur many years after injection of liquid silicone. 4,5 Minor complications include pain, erythema, edema, tissue induration, pigmentation, peau d'orange, small skin nodules, cellulitis, ulcerations, local lymph enlargement, migration, tissue destruction and scarring. In addition to these minor reactions, more severe life-threatening systemic complications, such as pneumonitis, granulomatous hepatitis or an increased risk of breast cancer have been reported.…”

“…In addition to these minor reactions, more severe life-threatening systemic complications, such as pneumonitis, granulomatous hepatitis or an increased risk of breast cancer have been reported. 5,6 Breast oleomas may occasionally mimic neoplasms upon physical examination and imaging. 1 Microscopically, there is granulomatous inflammation with multiple clear vacuoles representing injected liquid silicone particles, resulting in the so-called "Swiss cheese".…”

“…The first line of treatment is surgery, but surgical resection of the affected area is difficult because the silicone extends into a much larger area through the subdermal layer and usually a flap reconstruction is required. 2,3,5,6 The diagnosis is challenging because the patient usually does not report to the physician that he received silicone injections, which may result in delayed diagnosis and performing unnecessary tests. …”

Lip Augmentation Dermal Filler Reactions, Histopathologic Features

“…Clear vacuoles of varying size are encountered yielding a bubbly appearance with interposed histiocytes and multinucleated cells. Over time, fibrosis evolves with minimal vacuolar features [13][14][15][16][17]. The nuclei are round, small and monomorphic and immunohistochemical markers depict histiocytic differentiation.…”