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Page 2 of 8 Ulusal. Plast Aesthet Res 2018;5:7 I http://dx.doi.org/10.20517/2347-9264.2017.81

INTRODUCTION
Age-specific changes in facial soft tissues and their effects on facial morphology has been clearly decribed
[1-3]
elsewhere . Restoration of soft tissue through augmentation, modify facial contours, correct tissue loss
associated with normal aging. For over five decades, liquid injectable silicone has been used for soft-tissue
[4-6]
augmentation . It is believed that the historical complications and delayed type hypersentitivity reactions
were due to the impurities of silicone products . Modern highly purified silicone products are available in
[7]
the current practice which allow safer applications. Highly purified liquid silicone is chemically pure, free
of particulate matter, clear, colorless, odorless, tasteless, nonvolatile, viscosity-constant within the range of
human body temperatures . Silicone fluids range in viscosity from 0.65 cSt (thinner than water) to more
[8]
than 20,000,000 cSt (thicker than chewing gum) . The longer the polymer, the higher the viscosity. Viscosity
[9]
does affect flow behavior and solubility. The higher the viscosity, the more slowly the polymer will flow
and less soluble in some solvents . Currently various silicone brands with different viscosities are available
[9]
such as Biopolimero-350, Silikon-1000, AdatoSi 1-500, and Bioplastique. Usually liquid silicone with a
1000-centistokes (cp) viscosity has been used as a tissue filler [10-15] . Microdroplet serial puncture technique
is currently considered to be a safe and efficacious tissue-biocompatible material for permanent intra- and
subdermal implantation within the human body .
[10]
There can be impressive results and significant complications associated with injectable silicone. Clark et al. in 1989
[7]
reviewed the safety of silicone injections and concluded that these complications are related primarily to the
use of impure product, excess volumes, or inappropriate location.

METHODS
Forty-three patients were treated with liquid silicone (Biopolimero-350 cp, ZNK, Spain) between the years
2011 and 2016. An informed consent was obtained from each patient. Prior to treatment, the patients were
fully informed of the precautions, method of administration, likely treatment responses, and potential
adverse reactions. The procedures followed were in accordance with the ethical standards of the responsible
committee on human experimentation.

All patients were female and mean age was 46 ± 8 years. No anesthetic or epinephrine was used. Before
commencing injection, the skin was inspected for the presence of any dermatologic diseases, inflammation
or infection (active acne, herpes simplex, etc.). All makeup were removed and the area was cleansed with an
antiseptic. The areas to be augmented are marked with a pen with patients in a seated position under optimal
lighting. No test for hypersensitivity was performed.

All injections were done subcutaneously through a 22-G needle. Nasolabial, chin, cheek and melolabial
areas were treated [Table 1]. The needle is inserted into the subcutanous plane with a 30-degree angle. The
plunger of the syringe was pulled back and wait for a few seconds to see if the needle is in a blood vessels.
The area to be treated is filled with liquid silicone by retrograde linear threading technique. While injecting
the material, manual moderate pressure is applied with the the non-dominant hand index finger to control
the depth of injection, to provide evenness and equal distribution of the liquid silicone. The injections
were slowly performed and the needle is always moved to prevent embolic complications that could
lead to tissue loss or blindness. The contour defects were deliberately undercorrected at the first session.
Gradual augmentation was performed and at least 2 sessions were required for complete correction which
are spaced 1 month apart. Optimal correction usually required 2 to 3 treatments. Usually the required
volume for correction is reduced at the following sessions. No overcorrection was done. Cool compresses
were recommended for 15 min immediately after the treatment to reduce redness, bruise and swelling.
Topical ibuprofen (DolgitTM cream %5, ADEKA) was commenced twice daily and continued for 1 week.
Cosmetics were avoided for 24 h.