Are Liquid Silicone Injections Safe?

Professional cosmetologist injecting silicone in lips
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Liquid silicone injections are the subject of much controversy, thanks to sensational news stories about celebrity cosmetic procedures gone wrong. Yet there are some doctors who swear by the benefits of liquid silicone as a dermal filler and/or lip plumper. Is liquid silicone safe to inject for cosmetic purposes? 

For more than fifty years, liquid injectable silicone has been used for soft-tissue augmentation, drawing polarized reactions from both the public and from physicians. While many doctors consider silicone too risky for facial cosmetic injections (and it is not FDA-approved for this use), there are doctors who use it legally (and successfully, they say) for off-label use.

The Arguments Against Cosmetic Silicone Injections

Opponents to cosmetic use of liquid silicone injections cite the many reports of complications, including granulomas and pneumonitis. Though these events are rare yet significant.

Although it has not been established that silicone causes any systemic disease, numerous studies have shown that silicone may be potentially problematic. For instance, delayed granulomatous reactions to liquid silicone fillers can occur months to years post-procedure and are often refractory to treatment and associated with significant cosmetic morbidity. Migration (movement away from the intended site) is a possibility, and localized inflammation can present issues of its own, including exerting pressure on nearby nerves, which can affect sensation and movement of the facial muscles.

Furthermore, the quality sometimes touted as silicone’s main advantage — its permanence — is also possibly its biggest liability. If things go wrong, liquid silicone is impossible to remove without causing significant (often disfiguring) damage to the surrounding tissue.

The Arguments in Favor of Cosmetic Silicone Injections

On the other hand, proponents of silicone use point to its inert chemical structure, ease of use, long-lasting results, and low cost as advantages over other available injectable fillers. They say that liquid silicone injections have been successfully used for decades in applications like the filling of acne scars, improvement of facial areas affected by AIDS-induced lipoatrophy, and even non-surgical rhinoplasty.

Another popular argument put forth in favor of the use of liquid silicone injections for soft tissue augmentation is that while not FDA-approved for facial injections, liquid silicone is approved for injection into the eyeball to treat a detached retina, and as a lubricant for hypodermic needles. Technically, liquid silicone is being introduced in tiny amounts every time anyone receives an injection of any kind.

Silicone advocates emphasize that most notable complications are usually the result of a large-volume injection and/or industrial grade, counterfeit, or adulterated material. They are quick to point out that many reports in the media (and even in some respected medical journals) fail to distinguish between the injection of medical-grade silicone injected by well-trained physicians using the microdroplet technique and the injection of large volumes of industrial grade products by unlicensed or unskilled practitioners.

Where Everyone Agrees

It is important to note here that both opponents and proponents agree that there are certain practices which are categorically unsafe and should never be attempted with liquid silicone. The first is the injection of large volumes of liquid silicone to augment body parts such as the breasts, calves, and buttocks. This dangerous and disfiguring trend has been unfortunately associated with the transsexual community and an activity called “pumping” or “plumping” parties.

This brings us to the second major silicone “no-no” — self-injection of industrial (not medical) grade silicone or injection by the unlicensed and inexperienced practitioners who offer these parties. These types of practices invariably lead to unsatisfactory (and often disastrous) results.

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