Management of Nasal Silicone Granuloma

*Ago Harlim*

## **Abstract**

The use of silicone as filler material has been banned by the FDA. Nevertheless, there are still some risks of using topical silicone, particularly cosmetic products that contain silicone. Bioavailability of silicone in skin tissues and long-term complications of silicone use in cosmetic products must be evaluated for safety reasons. Silicone can penetrate to the skin by injection. Because of economic issues and the rarity of medical grade silicone, various developing countries use industrial silicone, which results in even more complications. Patients with liquid silicone injected to their nose will usually visit a doctor after experiencing complication issues such as granuloma, edema, and redness with telangiectasia. Usually the patients want to remove the silicone and treat the complication. Unfortunately, silicone is difficult to be removed completely. Some complications are difficult to treat. To handle this complication issue, the doctor has to create a specific design of nose implant, perform curettage, or remove silicone and granuloma, and then a laser treatment and steroid injection will be performed.

**Keywords:** silicone, skin, topical, nasal implant, laser

### **1. Introduction**

Silicone injection has been used since 40 years ago, and at that time, many problems occurred such as migration, inflammation, and granuloma. In 1992, the FDA prohibited silicone injection for cosmetic use [1]. In addition to injection, silicone may be introduced into our body or skin through food intake and cosmetic. Silicone has been widely used in daily cosmetics. Nowadays, due to technology advances, topical drugs can pass through skin barrier and can be penetrated into the skin, which has become a great concern as it may induce granuloma formation. There are relatively very few studies that have been done on silicone concentration in the normal skin.

A study conducted by Harlim in 2018 found that a normal skin contained silicon. The study was performed by taking skin samples from normal subjects and those with face-lift procedure and subsequently compared those samples using the same criteria with the control group, which included skin samples of subjects that had received silicone injection, and the study found granuloma formation. The study found an average amount of silicon level of 44.07 ± 75.86 μg/g in patients with normal skin, while in patients with granuloma, they found 38 times greater silicon level (1709.21 ± 1851.72 μg/g) [2].

### **2. Silicone**

Injectable-grade silicone for medical use has been manufactured widely since the element has been known for its stable and inert characteristics [3, 4]. It includes the use of silicone oil, which has been utilized in the treatment of complicated retinal detachment and heavy silicone oil tamponade. The treatment seems to offer promising results, particularly on improving visual acuity as well as great results on some anatomical parameters; however, there are some concerns as it may cause several complications such as cataract, increased ocular pressure, heavy silicone oil emulsification, and mild inflammatory reaction [5–7].

Injectable-grade silicone has also been widely used in the form of silicone oil injection. Some studies have suggested that it may have an essential role in reducing the risk of developing diabetic foot ulcer due to its pressure-reducing properties; therefore, it can maintain plantar tissue thickness and alleviate symptoms of diabetic foot ulcer, which may be associated with foot biomechanics [8, 9].

Although it brings advantages, silicone injection may still develop some complications, either local or systemic complications. Local complications may include formation of palpable nodule surrounding injection site, arthralgia, fatigue, electrical neuropathy, and electrical sensation [10], while systemic complications may also occur in the form of lymphadenopathy, renal disease, and hepatic disease. It indicates that the injected silicone can migrate from injection site to other organs causing local and systemic complications. An animal experimental study in mouse model may explain the pathogenesis of such complications. The study has demonstrated that macrophage of skin tissue may engulf the injected silicone and the silicone may be distributed through lymphatic circulation, ultimately causing accumulation in lymph nodes, adrenal glands, and the kidney, liver, and spleen as well as granuloma formation in the skin [11]. Complications due to silicone injection, particularly the granuloma formation may be dose-dependent. A study by Harlim has demonstrated that granuloma formation could be developed when there is a large amount of silicone exposure as the study only found a low level of silicone without any granuloma formation in the normal skin (**Figure 1**) [2].

Cultural changes have been encouraging people to pursue their passion on beauty and youth; therefore, cosmeticology has been rapidly growing. With technological advances, more mixed drug ingredients have been added to cosmetic products in order to beautify their customers. Thus, it may indirectly increase the use of topical

#### **Figure 1.**

*The level of silicon (Si) in normal subjects who had never received silicone injection (never injected) and in subjects with granuloma who had received silicone injection. (cited from A Harlim, et all) [2].*

**3**

*Management of Nasal Silicone Granuloma DOI: http://dx.doi.org/10.5772/intechopen.87188*

**3. Dietary intake and silicon**

and vegetables are the greatest producers [12].

silicone intake may affect bone density [13].

**4. Silicone in cosmetics**

product of the skin [4, 5].

cosmetics that usually contain silicone; therefore, it will lead to increase silicone uptake to the skin. It has raised a concern that the prolonged and continuous use of cosmetics will cause granuloma formation and other chronic inflammatory effects.

Aside from medical use, silicon has also been used in food industry, cosmetics, and pharmaceutical industries. Our data shows that the silicon levels in gastrointestinal medications (e.g., antacids), mineral water, and soda drinks are 44.1, 25.6, and 2.91 μg/g, respectively. It can be said that there are many routes for administering silicon into our body. The average daily intake of silicon for European and North American populations is 20–50 mg/day. In China and India, the daily intake of silicon is larger that may reach as many as 140–200 mg/day, in which wheats, fruits,

A research institution of healthy aging and nutrition in the United Kingdom has recently reported a strong correlation between silicon in dietary intake and the health of bone and connective tissue. Therefore, it can be assumed that the correlation is associated with collagen synthesis and/or stabilization of mineral matrix, i.e.,

Another study, which is an animal experimental study, has demonstrated that there is no evidence of silicon accumulation in silicon consumption. Silicon can be eliminated through digestion process and can be found in feces (93–97%), urine (0.001–0.22%), and expired air (0.01–0.02%) [3]. It indicates that silicon is a stable element and at certain degree it can be resistant to digestive enzymes including gastric acid; therefore, it seems that silicon is not accumulated in the gastroinstestinal system.

Beauty products for face, hair, and cosmetics may have high silicone content, in which it will be accumulated in the skin tissue. When a topical beauty product containing silicone is applied to the skin, the elastomeric particles of silicone will absorb various liquids including emollient and oil; therefore, silicone is used in skin care product as vehicle (carrier) of active ingredient for the skin or as oil control

• Dimethicone—clear, inert, liquid solubility depends on the length of polymer

• Dimethicone copolyol—silicone that contains an —OH group; therefore, it is more water-soluble resulting in easier incorporation into water-based formu-

• Cyclomethicone—the shortest cyclic molecule, which has many similarities with dimethicone except it can evaporate, while dimethicone cannot.

• Cyclo-dimethicone—a combination of dimethicone and cyclomethicones.

The great use of silicones in cosmetic product may increase the risk of accumulation of the substance in our body, particularly in the facial skin. No clear evidence has been found on the bioavailability and concentration of accumulated silicone in topical uses.

Types of silicone that are commonly used in cosmetic products:

lations and also reduces the "slip effect" of the silicone.

backbone ranging in thickness from watery consistency to thick.

cosmetics that usually contain silicone; therefore, it will lead to increase silicone uptake to the skin. It has raised a concern that the prolonged and continuous use of cosmetics will cause granuloma formation and other chronic inflammatory effects.
