Patients who present with a history of silicone injection or biopolymer injections to the buttocks or gluteal region may present with debilitating complications, such as chronic pain, chronic infections such as cellulitis and abscesses; skin necrosis and silicone granulomas that may cause deformity of the buttocks.  Unfortunately, silicone toxicosis of the gluteal region (buttock) can be difficult to manage.

 

Management of Silicone Toxicosis of the Buttock

• An MRI of the gluteal region will need to be obtained to evaluate the location and extent of the silicone granulomas

• Treatment may range from surgical excision versus suction-assisted lipectomy with VASER liposuction with concomitant fat transfer to the buttock to correct the resulting deformity from liposuction

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Before & After Biopolymer Injection Removal from the Buttock with VASER Liposuction followed by fat transfer to the buttock for reconstruction.  Procedure performed by Emmanuel De La Cruz MD, PLLC

 

MRI of the Buttock and Areas of Silicone or Biopolymer Injections

• An MRI of the area where one had the silicone or biopolymer injection  is essential to determine where your surgeon will remove the silicone granuloma/foreign body/biopolymer.  This would serve as a map prior to surgery.  This will also determine if there is migration of the material.

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Figure 3:  MRI of the Pelvis/Buttock showing diffuse silicone granulomas. (A) Axial view  STIR with water sat; (B) Axial view T1 image; (C) Coronal view T2 image; (D) Coronal View T1 showing clusters of soft tissue nodules with surrounding fat stranding in the gluteal subcutaneous fat (buttock).  The nodules are hyperintense and bright on T2 images (A and C), and isointense (same intensity) on T1 images (B and D.)  Fat will show bright on T1 images as found on B & D, and inflammation (water) will be bright on T2 images (T2 = H20).

 

Clinical Study using VASER Liposuction for Removal of Silicone Granulomas of the Buttocks

• "Average patient age was 36 years (range, 25-43 years). All patients initially presented with intense pain as assessed by a visual analog scale; by the 12th week postoperatively, the entire cohort experienced remission in pain. At 1 year postoperatively, no patients had infections (vs 75% preoperatively; P = .028), visited the ER (vs 50% preoperatively; P = .058), or were hospitalized (vs an average of 1.5 hospitalizations per patient preoperatively; P = .066)."

• "Liposuction with immediate intramuscular fat transfer for buttock augmentation appears to be a safe surgical option that preserves aesthetic appearance for patients with gluteal silicone toxicosis."

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Patient Safety During Surgery

 

Dr. De La Cruz values patient safety during your surgery.  For large volume high-definition liposuction, there are certain criterias that should be met before your plastic surgery.

1. For patients who have co-morbidities, such as Diabetes, obstructive sleep apnea, a medical and cardiac clearance are required prior to surgery. For patients whose age >45, a cardiac clearance from a cardiologist is required by Dr. De La Cruz prior to your surgery.  Safety is priority in our practice.

2. Prevention of Infection:  During your surgery, peri-operative intravenous antibiotics are given to prevent a wound infection.  The fat harvested is also washed with antibiotic irrigation to further reduce the risk of infection during the fat transfer procedure.

3. DVT Prophylaxis:  Dr. De La Cruz calculates your Caprini Score to evaluate your risk for Deep Venous Thrombosis. All patients would have an intermittent sequential compression device during your surgery to prevent a DVT.  Moreover, an anti-coagulant, such as Heparin or Lovenox, is given to further reduce your risk for a Deep Venous Thrombosis. 

4. For large volume high-definition liposuction patients, all patients are admitted in the hospital overnight to monitor your recovery.  A hospitalist and Dr. De La Cruz would typically oversee your care while you are in the hospital.

5. The use of the VASER liposuction system is associated with less bleeding when it comes to large volume liposuction.  A randomized clinical trial had shown that the VASER liposuction is associated with less bleeding during surgery when compared with traditional tumescent liposuction.  This is key when it comes to large volume liposuction.  It is essential to minimize your risk of bleeding when it comes to undergoing this procedure.

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Potential Complications of the Biopolymer Removal

• Wound infection/Cellulitis (<2%)

• Seromas/hematomas

• Asymmetry

• Fat necrosis

• Fat embolism (rare)

• Partial reabsorption of grafted fat

• Transient sciatic paresthesias (numbness)

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Emmanuel De La Cruz MD, PLLC

» Contact Dr. De La Cruz today for more information by calling 832.520.1844