Ok, those of us with severe scars can now put this case into perspective. Would you rather stare at a mirror and be constantly reminded of your damaged skin day in and day out, or pursue a route in which there is at best a 1% chance many years later of developing a complication that by that time will be completely treatable given the rapid advancements in medical science?
It is a pointless debate with gross exaggeration. We all know what the risks are and that they are VERY VERY rare, but so what??!! Any other scar treatment out there carries just as much risk as silicone, so what's the difference and what's the point? Why single this out? I mean we could talk about pigmentation loss or keloid scar formation by dermabrasion or CO2 laser, or a rare allergic reaction to bovine collagen, causing lumps and permanent dyschromia. We may as well exaggerate those effects too with articles of those cases in medical journals!
My point is it is not worth getting into a heated debate over this, so nobody should take anything personally or try to credit themselves with negative attention. You either want to do something about your scars, or you don't. And if something comes along that produces these results, with no downtime and manageable cost let me know! I too have researched this to death and came to an informed decision to have this done. This was after having extensive resurfacing and surgical work to no avail with no improvement and ADDITIONAL scarring!
FYI...as a side note, Dr Orentreich has recommended triethanolamine injections to subdue nodules on the rare occassion it happens. Though I have read in his 35 years of performing the injections he has never had to resort to it.
The comparison with other treatments seems spurious, given that the controversy about LIS seems quite unique, Im not aware of similar controversy in regards to laser resurfacing or any other scar revision treatment are you? There must be good reason that is the case or are you a subscriber to the conspiracy theory from one of our earlier posters that doctors with lasers are trying to force LIS doctors out of business. Critics as well as advocates admit that some side effects from LIS can be permanent and untreatable whereas side effects from other modalitites can be treated thats the difference.
Dr Rapaport says Untreatable complications include chronic cellulitis, nodules, foreign-body reactions, lymphedema. Management of the complications with systemic and intralesional corticosteroids is of limited benefit, and extensive surgery to remove the offending silicone also has variable success. thats different than losing some pigment from laser which can be camouflaged or hypertrophic or keloid scars which can also be treated. Quite strong words for Rapaport to describe LIS as a time bomb Im not aware other scar revision methods being called time bombs.
The moral of this story is we need to mention the bad with the good when we post, there is no rule saying we have to but our own moral compass should make us mention the bad with the good I felt there were too many LIS posts in recent times which didnt mention the potential problems and I could feel a momentum building towards it just like there was to dermabrasion a few years ago and heaven knows what else before then. You bring up dermabrasion with Dr Y I remember the euphoria a few years ago about dermabrasion in general and Dr Y in particular with people flying thousands of miles from distant countries to see him and anyone who dared to express an opposing view was accused of being criminally insane.
Problem was none of those posts mentioned the potential down sides of this treatment so more and more people rushed off to have it but eventually some posts became less positive than at first and some posts eventually became downright negative so the euphoria was replaced by a more sobre view of dermabrasion. Unfortunately we dont seem to learn our lessons and keep posting about how great this or that is without mention of the down sides. Fraxel laser is a case in point god help you if you say something negative about fraxel your seen as a subversive and told to get out of the thread. While fraxel seems safe enough it may not be the sure bet some think it is but you cant say that because your not allowed to mention the bad stuff.
Melisconca- so far you haven't posted any scientific research on the long-term effects of the use of silicone administered using the micro-droplet technique. You won't be able to find any, only conceptual articules by practitioners who specialize in other procedures and who view silicone micro-droplet technique as a threat to their speciality. Those "studies" will of course be subjectively biased. Thanks for your concerns about my health. Mark
Unless your blind you should have noticed Rapaport mentioned the microdroplet method has been discussed and used since 1950.. Dr Duffy unlike Rapaport who is an advocate of silicone admitted the incidence of severe side effects is around 1% even when best practice is adhered to so whats your problem ? All you have to do is admit as Duffy does that serious complications can and will occur, albeit rarely, despite slavish adherence to optimal protocols. and that you chose to do it anyway which is a perfectly legitimate decision instead of living in denial blaming others for a conspiracy theory against silicone.
Dermatologic Surgery
Volume 28 Issue 7 Page 590 - July 2002
doi:10.1046/j.1524-4725.2002.22081_1.x
Volume 28 Issue 7
The Silicone Conundrum: A Battle of Anecdotes
David M. Duffy , MD
serious complications are rare (a fraction of 1%) when small volumes of sterile pure liquid silicone are used
Serious complications to liquid silicone may take the form of inflammatory granulomas and/or migration.
Serious complications can occur months to years after treatment.
Advocates do concede that another category of complications "idiosyncratic reactions" to liquid silicone do occur at an incidence of 1:5000 to 1:10,000 treatment sessions. These reactions, which are described as swelling with or without erythema, can occur months to years after injections and are "frequently preceded by an infection at a distant site."
Silicones used for tissue augmentation in the past were considerably less viscous than the newer silicone oils; do you expect different patterns of response and complications?
Probably. Every implant material in every location may elicit different host responses. Moreover, more viscous silicones require larger needles and may make this process somewhat more technique sensitive.
Since your office is a clearinghouse for complications of silicone on a referral basis, have you seen granulomas following the use of FDA-approved, more viscous silicones?
Yes. I don't know if this is related to increased technique sensitivity or the possibility that the more viscous silicone oils provide a more favorable substrate for inflammatory granulomata.
Can granulomatous reactions be predicted or avoided?
As yet there's no foolproof method of doing this.
Over what time frame were granulomata noted to occur following the use of "pure" liquid silicone in small volumes?
One month to 15 years.
What evidence is there linking biofilm infections and inflammatory silicone granulomata?
They share a large number of clinical characteristics. (a) Biofilms, which colonize inert surfaces, grow very slowly in multiple locations and are often slow to produce clinical symptoms (time lag for silicone granulomata). (b) Even in immunocompetent individuals, biofilm infections are rarely resolved by host defenses. ? Antibiotic therapy, which can reverse symptoms caused by planktonic bacteria, often fails to eradicate the biofilm itself. Typically biofilm infections recur after cycles of antibiotic therapy, often failing to fully respond unless the implant is surgically removed (which parallels exactly the history of relapsing and difficult silicone granulomata). (d)
How many patients do you estimate have been treated, and what percentage have developed serious complications that did not respond to treatment?
A fair estimate would be at least 200,000 people have been treated worldwide using all forms of pure and adulterated silicone in protocols which are often less than optimal. If one peruses the literature looking for individuals who have had serious and untreatable reactions to a large variety of these injectable agents, one can find no more than several hundred. Accordingly I believe the instance of serious and untreatable complications following the use of liquid silicone in approved protocols is some fraction of 1%, just as it was in the one FDA-approved study.
My experience and investigation into this modality suggests that liquid silicone used properly is extraordinarily useful, permanent, and capable of providing excellent results for the overwhelming majority of those who are treated. However, despite the protestations, I believe that serious complications can and will occur, albeit rarely, despite slavish adherence to optimal protocols. All foreign substances can elicit some degree of response in biologic systems. None are absolutely inert. Complications following permanently implanted substances of all sorts may take years to become apparent. There is no doubt that the evolution of knowledge regarding the interaction between indigenous bacteria and implanted materials will provide us with new therapies when such events occur. I'm convinced that the benefits of liquid silicone clearly outweigh its risks in properly selected patients, and that this valuable modality should not be abandoned until a suitable substitute is found.
Interesting thread. Whilst I respect krugstoneco's post above about needing proper scientific studies, I do not agree with the post. You see my experiene of life is that the world is not such an organised place that if a scientific study does not exist than that means there is no danger. Unfortunately I feel that i have to get as much info as I can and go on my feelings. In other words hedging my bets, the best I can. We take risks all day long you know, based on the information we have at hand.
My hunch is that the horrible side effects from silicone experienced by some is down to silicone rather than arguments over technique or type of silicone or quantity. Some will be fine for a lifetime, others may have worse luck.
And anything which you inject into your face which isn't from your body poses a risk of problems. I have read an awful lot on boards over the last 3 years. And I remember stories of people who had the temporary fillers, collagen and restylane and have experienced nodules lasting for a signigicant time ie. 6 months plus. Whether these resolved or not I cannot remember. Unbeknown to newbies, scar revision poses risk. That is real risk, not pie in the sky risk. And you must take into consideration how you are going to deal if you draw the short straw. This should be a key part of the decision process of trying any of these scar procedures.
People are saying how effective silicone is for levelling scars but I'm not seeing much photographic evidence here. Having had subcision, I don't see how tethered down rolling scars can be levelled with microinject silicone. The ropes holding them down are too strong. So I am dubious as to these claims.
As for the incidence of side effects, its hard to get the true numbers on anything. The FDA says that for every side effect reported there will be 100 similars who don't report. I also remember reading an article on silicone with one derm saying how he didn't think silicone side effects were being well documented.
Ylem, was your mum's last procedure aquamid? Does this mean she can't get anything done again? aquamid being permanent and all that. Or at least semi-permanent.
There comes a time when you have tried everything and your not satisfied with your scars, i think ylem has made that decision and so far its working out for him im happy for him and i hope it continues to work out. it all depends on the indivdual and the ammount of risk your willing to take to fix your skin.
doing chemical peels = low risk, but also = very little improvement in scars
doing dermabrasion = farily high risk, but also if done correctly = good results.
so its all about the risks your ready to take, i myself will exhaust, needling,subcision,fraxel,peels,etc if these do not work then i look into a perm filler. hopefully by then we have better answers
Ylem, when and what did Dr Y do for you? Does he still pratice?
All you guys are smart and do your research so we all benefit from your insight and experiences. Perhaps there could be less rancor, but each of you back up your arguments. I am trying Fraxel and do not feel compelled to report positively. I report it as I see it, just as I want others to do.
Rupert - Yes, it was Aquamid that she had performed, and I don't remember where and by who. I think it was overall a big disappointment for her because she spent a lot of money and went through so many treatments. I am worried this could happen to me with the silicone. Oddly enough, there are a handful of people I have come across so far who have not had success with silicone after many treatments, some over 10!! 
Melisconca - Do you know on average how long it takes someone to expereince negative side effects when treated by an inexperienced doctor with the proper "pure" silicone oil? Reason I ask is that I know my doctor doesnt have vast experience in it, but I have not experienced any "overfilling" or overcorrecting" after 3 treatments.
Best thing I can say about silicone so far is that it DEFINITELY helps if all goes right. I don't know how far I can take it, or what the end result is going to look like. I definitely have expereinced a dramatic shallowing to my largest crater, though you can still see it (if that makes any sense). It's like the base of the scar has risen, but the actual craters are still visible in light. I think I will be one of those fortunate ones who gets permanent improvement (and hopefully no complications). I still stand by my case of it being the best thing out there for me. This is after trying many many other invasive procedures.
Rupert - Yes, it was Aquamid that she had performed, and I don't remember where and by who. I think it was overall a big disappointment for her because she spent a lot of money and went through so many treatments. I am worried this could happen to me with the silicone. Oddly enough, there are a handful of people I have come across so far who have not had success with silicone after many treatments, some over 10!!
Melisconca - Do you know on average how long it takes someone to expereince negative side effects when treated by an inexperienced doctor with the proper "pure" silicone oil? Reason I ask is that I know my doctor doesnt have vast experience in it, but I have not experienced any "overfilling" or overcorrecting" after 3 treatments.
Best thing I can say about silicone so far is that it DEFINITELY helps if all goes right. I don't know how far I can take it, or what the end result is going to look like. I definitely have expereinced a dramatic shallowing to my largest crater, though you can still see it (if that makes any sense). It's like the base of the scar has risen, but the actual craters are still visible in light. I think I will be one of those fortunate ones who gets permanent improvement (and hopefully no complications). I still stand by my case of it being the best thing out there for me. This is after trying many many other invasive procedures.
I agree ylem,
I count myself fortunate because I have seen decent results from every procedure I have undergone to correct my scarring:
-dermabrasion -doing it myself and from dr. Y (although it did cause some rolling scars)
-fraxel -overall smoother appearance (7-8% improv)
-silicone injections - have had very good success with this! the shadows caused by my rolling scars are dramatically more shallow, even after 2 treatments.
Most have probably already seen this, but there may be a few that might be interested.
I have experience with silicone from 20 years ago. Dr Fulton (well known) injected me with it and I was left with a few red bumps. I don't know how much was injected, luckily I didn't need much at the time because I still had collegen in my scars. I only went one time. It seems the technique and maybe the silicone they use might be different from 20 years ago. But I don't really know. I've tried a dermabrasion to get rid of the bumps, but it didn't help. I've had cortisone injected and it helps somewhat, making them smaller, but over time they come back fully. Now I'm attempting 5-FU shots with Dr. Fitzpatrick (well known laser dr.)He said he's had very good results using 5-FU on silicone/ or other permanent fillerss. He's had 3 patients and they all improved. The read about the 5-FU on the attached article. This article has really good info on fillers. I would think that the permanent filler that was the easiest to remove if needed would be what I would pick if I were doing it today. I've read, I think it was this site about people actually removing one of the other permanant fillers themselves.
www.miinews.com/stage/pdf/Dermal_Fillers_CME.pdf
I have experience with silicone from 20 years ago. Dr Fulton (well known) injected me with it and I was left with a few red bumps. I don't know how much was injected, luckily I didn't need much at the time because I still had collegen in my scars. I only went one time. It seems the technique and maybe the silicone they use might be different from 20 years ago. But I don't really know. I've tried a dermabrasion to get rid of the bumps, but it didn't help. I've had cortisone injected and it helps somewhat, making them smaller, but over time they come back fully. Now I'm attempting 5-FU shots with Dr. Fitzpatrick (well known laser dr.)He said he's had very good results using 5-FU on silicone/ or other permanent fillerss. He's had 3 patients and they all improved. The read about the 5-FU on the attached article. This article has really good info on fillers. I would think that the permanent filler that was the easiest to remove if needed would be what I would pick if I were doing it today. I've read, I think it was this site about people actually removing one of the other permanant fillers themselves.
www.miinews.com/stage/pdf/Dermal_Fillers_CME.pdf
To be fair to the silicone users the people who use other permanent filles like Aquamid and Bio Alcamid can be just as fanatical and in denial about the potential side effects and have large amounts pumped into their faces as if its childs play. The spectacular skin board is full of women having the stuff pumped into their faces and their attitudes are just irresponsible there is one particular fanatical lady called Hallie on the spectacular skin board whos had Aquamid all over her face and recommends it to every Tom, Dick or Jane her attitude is all wrong. Just beware of the fanatics they are dangerous people. Whenever I talk about permanent fillers I try and do so in measured tones ie use it in small quantities as adjunctive therapy in combination with other treatments and beware a filler is only as good as the injector, if wrongly placed it will disappear down the toilet along with your money or leave you with difficult to remove lumps and for heavens sake dont try and self inject a permanent filler take it from me Ive tried and its doomed to failure despite what the fanatics tell you. I think thats a better attitude than fanatics shrieking at the top of their voices about how marvelous how fantastic how absolutely divine this or that filler is and how easy it is to self inject they are just deluded braggards.
It's been about five years since I had my first two injections and no bad results from that. I had another round last year and had some inflammation where the needle was inserted. It was different doctor and I think her technique might have been lacking. I won't go back to her. I am giving up on fillers for my scars as they don't seem to help much.
It's been about five years since I had my first two injections and no bad results from that. I had another round last year and had some inflammation where the needle was inserted. It was different doctor and I think her technique might have been lacking. I won't go back to her. I am giving up on fillers for my scars as they don't seem to help much.
what kind of scarring do you have tricia? i wonder if it wouild work on boxscars/ice pick scarring. if ylem got good results from this then that means something becaus he has tried basically eveyrthing out there. too bad he doesnt have no pics to show. if soft tissue scars wont work for atrophic scarring or tissue loss why are websites claiming they can work to this date! scam artists i tell you...