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Page 6 of 8 Ulusal. Plast Aesthet Res 2018;5:7 I http://dx.doi.org/10.20517/2347-9264.2017.81

Figure 3. The improvement of the facial creases at 1 year

Currently, Food and Drug Administration-approved clinical trials are reported to be in progress for a liquid
silicone product specifically for treatment of human immunodeficiency virus-associated facial lipoatrophy
and for use in cosmetic indications .
[20]
Little is known about the study except that it involves the use of a microdroplet serial puncture technique,
[14]
[15]
as described by Orentreich and Orentreich . This injection technique was reported in the late 1970s. It
consists of depositing minute droplets of liquid silicone 0.01 mL or smaller into the subdermal tissues at
2 to 10 mm intervals. Injection of these microdroplets has been shown to produce a mild inflammatory
reaction, resulting in a fibroblastic response. It is believed that this neocollagen synthesis is complete after
approximately 3 months. The resulting fibrosis is responsible for the apparent soft-tissue augmentation. By
contrast, injections of larger doses (greater than 0.05 mL) has been shown to produce granulomas and
foreign body reaction [7,14] .

[21]
In 1971, Ashley et al. presented hundreds of animal studies and followed 90 patients for 3 months, with
excellent results. They did mention that it was important to use small volumes at each session. Their average
volume per injection was 4 mL, which was considered a small volume in the early 1970s. They also were the
first to use higher viscosity silicones up to 1000 cS, noting that large volumes of low-viscosity silicones tended
to migrate where the higher viscosity silicones did not migrate. As oppose to Ashley’s report, we have not
encountered migration even in a single case. The filler remained stable during the entire follow-up period. It
may be the injection technique (linear line versus microdroplet) that prevented migration. New histological
studies are required to reveal and compare the fibroblastic responses between the two techniques.

In linear threading technique, there are fewer needle punctures, and potentially a smoother result since it is
easier to produce contiguous layering. A smooth and even deposition of the filler could be attained in our
series. None of the patients complained of granuloma formation of filler beads.

In conclusion, lower viscosity of liquid silicone (350 cp) is effective and safe for correction of deep facial lines
and contouring. It provides soft and smooth facial contours and effectively volumize the face. Retrograde
linear threading technique seems a safe technique and migration is not a concern using silicone with 350 cp
viscosity.