The Complex World of Silicone Injections
Silicone injections have gained a notorious reputation due to fatal incidents and unqualified practitioners. The aesthetics medical field has largely turned away from them. However, a number of respected plastic surgeons and cosmetic dermatologists still employ it in specific cases, maintaining that when properly injected, it serves as a safe and effective permanent filler.
Patients' responses to silicone injections are mixed. Only 40% of RealSelf members consider them "Worth It," reporting issues ranging from misshapen lips and under-eye puffiness to near-fatal complications from unlicensed butt injections. Many view silicone as a "misstep." But there are positive tales too – several patients praise microdroplet silicone for acne scars. One 50-year-old male who struggled with acne as a teenager describes his results as "exceptional and lasting." Another member asserts that "the treatment is effective," finding it "significantly more cost-efficient [and] less invasive" than the multiple rounds of Fraxel they initially attempted for their scars.
So, what's the conclusion? Here, physicians on both sides of the issue offer their perspectives on silicone's risks and benefits.
A Short Account of Silicone and Its Production
Silicones are polymers – groups of hydrophobic (or water-repellent) molecules composed of oxygen, carbon, and hydrogen bonds. These synthetic compounds find application in various items, from medical devices to car parts and hair products. "If you've ever given a blood sample or had an IV catheter, you've been exposed to a small amount of silicone," remarks Dr. Eric Joseph, a facial plastic surgeon in West Orange, New Jersey. "The internal aspect of every syringe manufactured in the U.S. since World War II is coated with a small quantity of silicone grease to facilitate smooth operation." The gel form of silicone is widely utilized in bandages and dressings. In plastic surgery, silicone gives shape to facial, breast, testicle, and pectoral implants.
The Distinction Between Medical-Grade and Other Silicone
The thought of injecting something into your body that is literally used to manufacture electronics and car parts is undoubtedly terrifying – but there is a significant difference between the medical and industrial-grade versions. Notably, the former is a sterile, highly refined liquid.
In the U.S., medical-grade silicone oil is FDA-approved only for treating retinal detachment in the eye. On its website, the FDA explicitly states "that injectable silicone is not approved to enhance or augment the body. Such use can result in ongoing pain, infections, and severe injuries, such as scarring and permanent disfigurement, embolism (blockage of a blood vessel), stroke, and death." Nevertheless, some providers use it off-label as a permanent filler for cosmetic purposes.
Dr. Joseph clarifies that there are two FDA-approved silicone oils available in the U.S.: Silikon 1000, from Alcon Laboratories, and Adato Sil-OL 5000, from Bausch and Lomb. The main difference between these silicone oils lies in their molecular weights. Adato Sil-OL 5000, as the name suggests, has a viscosity of 5000 centistokes (meaning 50 times thicker than water) and requires a 25-gauge needle for injection. Silikon 1000 has a viscosity of 1000 centistokes, or 10 times thicker than water, and can be administered with a smaller, 27-gauge needle. Dr. Joseph states that while both are safe and suitable, he mainly uses Silikon 1000, as the slimmer needle is more tolerable for patients and causes less bruising.
Related: 5 Risky Cosmetic Procedures to Avoid – and What to Choose Instead
The Controversy Surrounding Silicone Injections
The permanence, irreversibility, and risk profile of the oil are among the reasons some doctors avoid using silicone in their practices. "Employing silicone as a cosmetic filler is associated with greater unpredictability, less flexibility, and a loss of the ability to adjust outcomes," says New York City plastic surgeon and RealSelf Chief Medical Editor Dr. Lara Devgan. "Silicone cannot be dissolved or removed without invasive surgery – and for high-risk areas like the under-eyes and nose, this is particularly concerning."
But not all are so easily deterred. New York City dermatologist and silicone advocate Dr. Paul Jarrod Frank – who recently filmed an educational IGTV segment on injectable silicone – contends that the problem isn't silicone itself but the misuse and excessive dosing of the substance. In other words, the headline-grabbing fatalities involving silicone typically stem from large quantities of industrial-grade silicone being illegally injected into the body – most commonly the buttocks – by unqualified practitioners. Some of the accounts from RealSelf members are downright terrifying.
"Silicone butt injections are extremely perilous, considering the large area that needs to be injected," states Dr. Lesley Rabach, a facial plastic surgeon in New York City. Repeated high-volume injections are typically necessary for silicone butt augmentation, she adds, increasing the likelihood of vascular occlusions and fatal embolisms, which occur when silicone enters a gluteal blood vessel and travels to the heart or lungs.
Dr. Rabach also warns that over time, the body, in a protective measure, forms scar tissue around the silicone to enclose it. As this scar tissue continues to grow, the silicone can become lumpy and hard. It can also migrate and spread from its original injection site and entwine with the tissue, making it extremely challenging to remove. "Supporters of silicone argue that its small particle size makes it safe, but how it behaves in vitro is not the same as in the human body," says Dr. Devgan. "Many plastic surgeons, myself included, have spent considerable time surgically removing undesirable silicone that is lumpy and irregular from the face and lips."
The process of silicone removal, which involves a surgeon extracting silicone granules and scar tissue from the body with a scalpel, is painstaking, often incomplete, and can lead to deformities. Nevertheless, 83% of RealSelf members who have undergone it say it was "Worth It."
The Microdroplet Technique: The Safe Route for Silicone Injection
To ensure a safe amount of silicone is administered, an experienced board-certified dermatologist or plastic surgeon should employ a multiple-puncture, microdroplet injection technique. Using a very fine needle, they will inject tiny aliquots (or fractions) of silicone oil into the fatty layer, just above the bone or cartilage in the treated area. And we mean truly tiny: On average, a typical treatment requires approximately 0.5cc per area – that's about 1/10th of a teaspoon. Some situations, like permanently correcting a small acne scar, call for only 0.01cc – an extremely small drop. When enhancing a cheek, doctors deposit roughly 0.1cc of silicone with each injection. For fuller lips, around 0.025cc is standard with each puncture.
"The guiding principle is not to fill all at once," says Dr. Robert Kotler, a facial plastic surgeon in Beverly Hills, California. It's best done sequentially – a little at a time, for three rounds, at six-week intervals. "This highly conservative and cautious process of incremental enhancement eliminates the risk of overfilling. Additionally, patients get a sense of what they like as the corrections develop," he adds.
Where Can Silicone Be Injected and What Are the Effects?
It's worth emphasizing: slow and steady microdosing is a crucial safety measure when injecting silicone. Our experts do not recommend using it to augment the buttocks, breasts, or any area that requires more than a few drops of the liquid.
Injectable silicone is commonly used to delicately enhance and shape the lips, cheeks, temples, and nose (for non-surgical nose jobs) and to mask deep wrinkles and acne scars. It can also be used to level out sunken traumatic scars anywhere on the body and to rejuvenate aging hands. "As we age, not only do we lose facial volume, we lose volume in the backs of our hands, which can lead to the unwanted appearance of tendons and veins. Microdroplet Silikon 1000 works particularly well for restoring hand volume for a more youthful look," says Dr. Joseph, noting that complete restoration of the hands typically requires one to three treatments.
Specifically for acne scarring, Dr. Joseph discovers that silicone opens up treatment options for patients with dark skin, who typically aren't suitable candidates for laser or other resurfacing procedures (as they can trigger hyperpigmentation in darker complexions). However, for silicone to be effective, "the acne scars must be pliable and not adhered to the deep tissues, as some chicken pox scars tend to be," he notes.
Dr. Kotler is more specific about where he applies silicone. "I use it only in the nose. To me, it makes perfect sense to use it there because the nose is a non-moving part. When placed in areas subject to external pressure, such as the buttocks, or in an area with movement, there's a higher chance of complications and adverse results," he explains. When there's movement or action against the silicone, he adds, the body may respond by thickening the scar-tissue wall around the substance – which can lead to lumps.
Beyond correcting inherent nasal imperfections, Dr. Kotler also uses silicone to conceal telltale signs of unsuccessful nose jobs: "When too much bone or cartilage has been removed, the nose appears overly done and unnatural. Silicone can compensate for the overly aggressive sculpting."
It would be irresponsible of us not to mention that many rhinoplasty specialists recommend using only temporary and dissolvable hyaluronic acid (HA) fillers for non-surgical nose jobs – and some doctors outright refuse to inject the nose with any type of filler due to the potential for vascular complications, such as blindness and skin necrosis (tissue death).
Defending his stance, Dr. Kotler explains, "We have such stories from the temporary fillers, but I am not aware of such reports from experienced, highly specialized injectors of silicone. In my opinion, it is easier and safer to use, but not all injectors are the same. And technique is extremely important" – a gradual build over several appointments.
The Case for Safe Silicone Injections
Physicians in favor of silicone insist that medical-grade silicone, when properly dosed and injected into the skin, has unique advantages. "Liquid injectable silicone offers patients flexibility, precision, and permanence compared to other types of fillers," Dr. Joseph says.
Dr. Rabach, who does not administer silicone, recognizes the material's most sought-after benefit: "Unlike FDA-approved fillers, such as hyaluronic acid gels, Sculptra, and Radiesse – all of which dissipate over varying timeframes, [requiring] patients to return for future treatments – silicone is completely permanent." However, in her opinion, this quality can be a double-edged sword, as it leaves dissatisfied patients with limited options.
Dr. Frank argues that while no medical treatment is without some degree of risk, he has not witnessed a single negative reaction to sterile, medical-grade silicone (when used correctly) in over 20 years of practicing cosmetic dermatology.
While he also injects HA fillers throughout the day and values their benefits, he claims they actually have "a much higher risk of vascular incidents." Meanwhile, there are no documented vascular occlusive events associated with microdroplet silicone, Dr. Frank adds, mainly "because if injected into a blood vessel, the oil would simply pass through it – it wouldn't clog it."
There's no reliable way to confirm this comparison, however, since "there isn't a substantial body of literature comparing silicone injections to other injections," says Vancouver, British Columbia, dermatologist Dr. Katie Beleznay, who uses silicone to treat acne scarring and HIV lipoatrophy (facial wasting associated with the disease). While she hasn't had any patients experience negative side effects, she still cautions that "silicone oil may be less forgiving than temporary and reversible fillers, and granulomatous reactions [inflammatory nodules] and other side effects can result from silicone oil, so it is not typically used for routine facial volumizing or contouring."
Related: 7 Unexpected Areas Where Filler Injections Can Have a Significant Impact
The Effects of Silicone as We Age
Dr. Frank notes that when silicone oil is placed beneath the skin, it actually stimulates the body's own production of collagen and elastic tissue. It can be used at various levels of the skin, from deeper layers to more superficial fine lines on the surface, for significant lifting, he says.
According to Dr. Joseph, microdroplets of silicone appear to hold up well over time. "Liquid silicone becomes part of your soft tissue, and as you age, it does not change in appearance – nor does it prevent [patients from having] surgical procedures, such as facelifts or rhinoplasty."
Unfortunately, not everyone has a positive experience. One RealSelf member, who had a series of silicone injections 20 years ago, states: "It looked great for 10 years, [but now] all the silicone is sagging, making me look 10 years older than my age. My cheeks are sagging into jowls. My chin is sagging. The injections seem to have swollen over time. My face feels heavy and looks abnormally large."
The Final Verdict
While silicone injections are maligned by many in the aesthetics medical community, they can be administered safely in extremely small doses by board-certified dermatologists and plastic surgeons with extensive experience injecting medical-grade liquid silicone using the microdroplet technique. Keep in mind, though, that silicone requires commitment. Unlike most other fillers that break down over time, silicone is here to stay. Best-case scenario: it provides a permanent solution without the need for repeat treatments. Worst case: it's a lifelong issue, requiring costly and potentially risky repair work. Be sure to discuss all the pros and cons with several trusted medical professionals before proceeding with silicone injections.
