The Optimal Filler: Immediate and Long-Term Results With Emulsified Silicone(1,000 centistokes) With Cross-Linked Hyaluronic Acid
November 2012 | Volume 11 | Issue 11 | Original Article | 1336 | Copyright © November 2012
Silicone is one of the oldest and longest lasting of the dermal fillers. Microdroplet silicone injections have proven
to be safe and effective. This paper describes how to obtain microdroplet silicone (1,000 centistokes) in a consistent manner,
including a discussion of its efficacy and safety.
Methods and Materials:
A simple, permanent method of tissue augmentation is described. U.S. Food and Drug Administration- approved liquid silicone (Silikon®
) is emulsified with cross-linked hyaluronic acid through a Luer-Lok to Luer-Lok connector
between two 3-cc syringes. This stable emulsion is injected through a 27G needle or through a 25G or 27G microcannula into the
middermis, subcutaneous tissue, or periosteum.
The results of 95 cases are described. The emulsion is most beneficial for distensible acne valleys, nasolabial folds,
glabellar frown lines, augmentation of the vermilion border of the lips, and projection of the nose, cheekbones, and chin. Exterior
nasal deviations and soft tissue defects are also improved. Complications are minimal and include temporary bruising, erythema,
and mild edema. Any temporary small nodules are easily leveled with massage. Occasionally, it takes a repeat session at 1 month
to completely elevate depressions. The resulting elevations remain stable during the 2-year follow-up period. No silicone granulomas
This methodology has replaced many indications for temporary, semipermanent, or permanent fillers.
J Drugs Dermatol.
The use of emulsified medical-grade silicone (Silikon®;
Alcon Pharmaceuticals, Fort Worth, TX) with crosslinked
hyaluronic acid (HA) is described. Previous studies
have demonstrated the benefits of silicone fillers.1-5 More
than 20,000 cases have been documented.6,7 Unfortunately,
overinjection by untrained physicians or unlicensed laymen
have tainted the benefits of silicone.8,9 Used correctly, it is a
safe permanent filler. By way of overview, most syringes and
needle tips are siliconized, and microinjections of this silicone
during daily injections by diabetics over a lifetime have never
resulted in problems.10 Previous investigators have coined
the term microdroplet silicone injections, which translated to
small droplets injected with small-bore needles over multiple
sessions.11 Facial plastic surgeons often touch up a defect in
a face-lift or rhinoplasty during a follow-up office visit with
microdroplet silicone injections (R. C. Webster MD, oral communication,
January 15, 1985).
To avoid the possibility of injecting "lakes" of silicone, the authors
have developed a simple method to emulsify silicone with
cross-linked HA through a Luer-Lok attachment between two 3-cc
syringes. This solves the problem of overdelivery of silicone, as
only microdroplets are available. The U.S. Food and Drug Administration
(FDA) has approved silicone (Silikon®) for use as an
intraocular injection for a detached or torn retina.12-14 The use of
this product for tissue augmentation is considered off-label by the
FDA.15 For additional safety, the vials of medical-grade silicone
from Alcon are equipped with a silicone stopper, which has solved
the problems faced by previous investigators of adulteration of
the liquid silicone by contaminates leached from rubber stoppers.
The purpose of this report is to inform the cosmetic surgeon
about methodology and pitfall avoidance. The results in 95
patients with emulsified silicone microdroplet injections are
reviewed (Table 1).
Any facial defect can be examined for filling. Broad-based facial
scars that pass the "pinch test" are good candidates for filling
(Figure 1). Nasal defects, smoker's lines, glabellar frown lines,
nasolabial folds, depressed scars, or poorly defined cheekbones
or chins can be improved. Patients on isotretinoin, who
are pregnant or nursing, or who have skin infections or systemic
diseases such as uncontrolled diabetes are not candidates.
The risks and benefits of this procedure and the risks and benefits
of alternative treatments, including no treatment at all,
are discussed with the patient. Patients are told to stop blood
thinners that may cause bruising 2 weeks before procedures.
All questions are answered. The facial defects are document-