**3. Dietary intake and silicon**

*Cosmetic Surgery*

**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

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

*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].*

emulsification, and mild inflammatory reaction [5–7].

**2**

**Figure 1.**

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, and vegetables are the greatest producers [12].

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., silicone intake may affect bone density [13].

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.
