Resolution of Autoimmune/Inflammatory Symptoms After Debridement of Gluteal Silicone Injections: Correlation or Causation
John Samas, MD1, Sami U. Khan, MD1, Mahira Tanovic, MD2.
1Stonybrook University Hospital, Stonybrook, NY, USA, 2Advanced Plastic Surgery of North Shore, New Hyde Park, NY, USA.
BACKGROUND: In an attempt to “enhance” gluteal appearance, individuals have sought out silicone injections, which in recent years has become a frequent illegal practice. After undergoing injection, some of these individuals develop a wide range of both local and systemic symptoms. The Autoimmune/inflammatory Syndrome Induced by Adjuvants (ASIA) was defined in 2011 by Shoenfeld et al. as a condition in which the exposure to an adjuvant leads to an aberrant autoimmune response. The purpose here, is to present our series of 10 patients who presented with ASIA Syndrome after a history of undergoing illegal gluteal injection of silicone, with prompt resolution after surgical excision of the foreign material.
METHODS: A retrospective chart review identified ten (10) patients diagnosed with ASIA Syndrome after having undergone gluteal injection with an adjuvant. Demographic, pre-operative, and post-operative clinical data was collected, as well as pre-operative Magnetic Resonance Imaging (MRI). Patients were considered to have ASIA syndrome according to Shoenfeld’s diagnostic criteria: (when 2 major criteria were present, or when 1 major criterion & 2 minor criteria were present). Each patient underwent operative debridement of the injected material and had a minimum of six months follow-up after surgical intervention, to assess for symptom resolution and/or recurrence.
RESULTS: The mean age at symptom onset was 37 years (range 25-45 years), the mean latency period between gluteal injection and symptom onset was 31.4 months (range 4-49 months). All patients had silicone gluteal injection performed in the United States by an aesthetician, except for one case, which was performed in Colombia, by a physician. General weakness, myalgia, pruritis, chronic pain, lower extremity numbness, chronic fatigue, sleep disturbance, and skin discoloration were the most frequently reported symptoms. In all cases, the debrided material was reported to be silicone, by the pathologist. Following surgical debridement of the injected silicone, every patient reported complete symptom resolution within 3 weeks of their last debridement procedure. Mean follow-up time after debridement was 10.2 months (range 6-21 months).
CONCLUSIONS: This case series demonstrates that despite FDA warning, patients are still being augmented with injectable silicone. All patients in this series had complete resolution of all symptoms shortly after surgical debridement, without any recurrence during the follow-up period. Given the limitations of this study one would be hard-pressed to draw a causal relationship between patients receiving silicone injection and the development of their reported symptoms, or that surgical debridement was responsible for their symptom resolution.
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