Guide to Filling Wrinkles

Learn about all the different kinds of wrinkle fillers.

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Plasmagel
This substance, not particularly popular, is made from the patient’s own blood and vitamin C. It lasts about three months. I do not know any plastic surgeons who use it.

Silicone
Silicone was used extensively in the 1970s. I remember ‘‘Imus in the Morning’’ stating that the greatest achievement of a Playboy model was enduring the pain of silicone injections into her breasts. In fact, silicone liquid has been injected into breasts and faces for more than thirty years. It sounds like a good idea, in that it does not break down over time. However, most authentic plastic surgeons have seen disasters from these injections. The FDA says silicone can cause swelling, reddening of the skin, lumpiness, and soft-tissue tumors. The scar around the silicone can be very thick, creating nodules, or it can be thin, allowing the material to drift through the tissues, ending up via gravity in the most southern location.

Once injected, the game is over. If the area becomes infected, the infected tissue needs to be cut out. Countless women have undergone mastectomies or removal of whole sections of the face because of infected silicone. The American Society of Plastic Surgeons says injectable silicone can harden, migrate, cause inflammation, and kill skin. As a result, the FDA banned it in 1991. The next year, it enforced its ban by having three noted New York dermatologists sign an agreement to stop injecting liquid silicone. At the time, FDA commissioner David Kessler, M.D., said, ‘‘People who undergo these injections are exposing themselves to unknown, potentially dangerous risks.’’ Again in 1993, the FDA took action against a Miami plastic surgeon who had injected liquid silicone.

The next year, silicone oil was approved by the FDA for treating retinal detachment in AIDS patients. This created an avenue for physicians to once again inject silicone into wrinkles, arguing that its use would be off-label and not illegal. In 2004, highly purified silicone oil was injected into the atrophied faces of AIDS patients, restoring contour without side effects. Long-term problems were not assessed, however. In 2006, an unlicensed nurse injected silicone into a patient’s buttocks. Some of the silicone traveled through the bloodstream into the lungs, causing respiratory failure.

I know that there are still physicians who inject silicone. I wonder why. As a patient, I would select a physician who practices ‘‘safe surgery’’ and not ‘‘what I can get away with’’ surgery.