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Page 4 of 8 Ulusal. Plast Aesthet Res 2018;5:7 I http://dx.doi.org/10.20517/2347-9264.2017.81

Figure 1. Effective correction of the facial creases and smile lines was achieved

soft, smooth and plump during the entire follow-up period [Figure 2]. None of the patients experienced late
facial deformity, lump or other complications due to silicone migration. At the marionette and nasolabial
creases, despite the ongoing process of aging, the results remained satisfactory for at least 1 year [Figure 3].
In patients with longer-term follow up (> 30 months), the deformity relapsed to an extent but no additional
injections were demanded.

Since no overcorrection is done, the texture of soft tissue augmented with liquid silicone is usually natural
with no irregularities, rubbery feeling or lumpiness.

DISCUSSION
Aging is not limited to the skin but also to its supporting structures. Atrophy of the subcutaneous adipose
tissue, sagging skin due to loss of skin collagen lead to a loss of volume and change in facial contours. Facial
creases (nasolabial, melolabial) progressively deepen, smile lines and periorbital lines become visible in the
lower face . In a young face superficial and deep fat is distributed evenly with smooth primary arcs and
[1-3]
convexities. With age, the distribution of fat becomes altered by fat atrophy and hypertrophy producing hills
[16]
and valleys with demarcations between the cosmetic units .
Dermal and subcutaneous fillers, used either alone or as an adjunct to surgical and nonsurgical facial
rejuvenation techniques, are a logical and effective treatment choice for “lifting and filling” the facial soft
tissues . The aesthetic goal is to create a smooth transition between the units and to restore the ample,
[17]
balanced distribution of facial fullness that exemplifies the youthful face . The hills and valleys should be
[18]
smoothed over and the former primary arcs and convexities of youth, rebuilt .
[19]
Currently fat transfer, silicone and artefill are the choices for permanent facial augmentation, enhancement
and rejuvenation. In my practice, I have been performing fat injection for the last 12 years. The outcomes
depend on the number of the survived fat cells and this is partly technique and partly patient dependent;
therefore usually the results are unpredictable. The operation takes time, requires at least 2 sessions, expensive
and should be performed under strict sterile conditions. In the last 5 years, upon patients’ demand, I have
started using liquid silicone since I feel quite comfortable and skilled for filler applications. This alternative
offers a rapid, practical and an effective way for patients who demand “permanent” facial volumizing and
contour restoration.

Injectable liquid silicone has many qualities that could make it a suitable material for long-term soft-
tissue augmentation. At the same time, there are still many unanswered questions pertaining to potential
complications that need to be addressed before it can be considered for this purpose.