INTRODUCTION
The use of emulsified medical-grade silicone (Silikon®;
Alcon Pharmaceuticals, Fort Worth, TX) with crosslinked
hyaluronic acid (HA) is described. Previous studies
have demonstrated the benefits of silicone fillers.1-5 More
than 20,000 cases have been documented.6,7 Unfortunately,
overinjection by untrained physicians or unlicensed laymen
have tainted the benefits of silicone.8,9 Used correctly, it is a
safe permanent filler. By way of overview, most syringes and
needle tips are siliconized, and microinjections of this silicone
during daily injections by diabetics over a lifetime have never
resulted in problems.10 Previous investigators have coined
the term microdroplet silicone injections, which translated to
small droplets injected with small-bore needles over multiple
sessions.11 Facial plastic surgeons often touch up a defect in
a face-lift or rhinoplasty during a follow-up office visit with
microdroplet silicone injections (R. C. Webster MD, oral communication,
January 15, 1985).
To avoid the possibility of injecting "lakes" of silicone, the authors
have developed a simple method to emulsify silicone with
cross-linked HA through a Luer-Lok attachment between two 3-cc
syringes. This solves the problem of overdelivery of silicone, as
only microdroplets are available. The U.S. Food and Drug Administration
(FDA) has approved silicone (Silikon®) for use as an
intraocular injection for a detached or torn retina.12-14 The use of
this product for tissue augmentation is considered off-label by the
FDA.15 For additional safety, the vials of medical-grade silicone
from Alcon are equipped with a silicone stopper, which has solved
the problems faced by previous investigators of adulteration of
the liquid silicone by contaminates leached from rubber stoppers.
The purpose of this report is to inform the cosmetic surgeon
about methodology and pitfall avoidance. The results in 95
patients with emulsified silicone microdroplet injections are
reviewed (Table 1).
METHODS
Patient Selection
Any facial defect can be examined for filling. Broad-based facial
scars that pass the "pinch test" are good candidates for filling
(Figure 1). Nasal defects, smoker's lines, glabellar frown lines,
nasolabial folds, depressed scars, or poorly defined cheekbones
or chins can be improved. Patients on isotretinoin, who
are pregnant or nursing, or who have skin infections or systemic
diseases such as uncontrolled diabetes are not candidates.
Informed Consent
The risks and benefits of this procedure and the risks and benefits
of alternative treatments, including no treatment at all,
are discussed with the patient. Patients are told to stop blood
thinners that may cause bruising 2 weeks before procedures.
All questions are answered. The facial defects are document-
