Some of Them Presented Decades Later

The published case series is small — twelve patients — and it is one of the more sobering things in the aesthetic literature, because of what the twelve had in common and how long the fuse was.

Journal of Clinical and Aesthetic Dermatology, 2019. Twelve patients, ten women and two trans women, median age 45, all Hispanic, nine of the twelve on Medicaid. Procedures had been performed in the Dominican Republic, Guatemala, Venezuela, Mexico and Puerto Rico, and by unlicensed providers within the United States. Injection sites: breasts, buttocks, face, thighs, lips.

The complications, as the series lists them: infection. Implant rupture. Silicone migration away from the injection site. Granuloma formation. Silicone embolization to the lungs and other organs. Hypercalcemic granulomatous disease. Implant rupture is a solid-implant event rather than an injectable one, and the series does not say which patients had implants; I am reproducing the list as published rather than tidying it.

And the detail that changes how you read the whole thing — some complications appeared decades after the original injection. Multiple hospitalizations and reconstructive surgeries, with mixed outcomes.

Decades. Meaning a person can have this done at twenty-five, be entirely fine at forty, and present at fifty-five with a granulomatous disease that nobody connects to a procedure she had half a lifetime ago in another country.

What the material is

Industrial or non-medical grade silicone, and a category of substances referred to in Latin America as biopolymers — a loose term covering silicone, mineral oils, and various synthetic materials injected for body contouring.

None of it is a filler in the sense the word is used in a licensed clinic. Approved fillers are designed to be either resorbable or removable, in measured volumes, in defined planes. Free silicone injected in volume is permanent, mobile, and has no removal procedure — you cannot aspirate it back out. Excision means removing the tissue it has infiltrated.

There is a separate published case series on ASIA syndrome — autoimmune/inflammatory syndrome induced by adjuvants — triggered by illegally injected gluteal biopolymers, published in Toxicology Reports in 2021. ASIA is a contested diagnostic entity rather than a settled one, which is worth knowing when it is invoked. The FDA has issued a safety communication specifically warning against injectable silicone for body contouring, citing migration, embolism, granuloma and death.

Who ends up here, and why it is not a judgment

The demographics in that series are not incidental. All Hispanic. Three-quarters on Medicaid. Two trans women in a cohort of twelve.

Licensed cosmetic procedures in the US cost what they cost, and for body contouring the figures run into five digits. For a trans woman seeking feminizing contour, the licensed pathway may be expensive, gatekept, waitlisted, or simply unavailable from a provider willing to treat her respectfully. For a woman on Medicaid, it is not a pathway Medicaid pays for at all, which means the whole cost falls on her.

What exists instead is a network of providers who will do it now, for a fraction of the money, without a consultation or a referral or a judgment — frequently within the community, frequently by someone known and trusted, which is precisely why the warning does not land.

I am not going to write about this as a series of poor decisions. It is a market responding to an access gap, and it has the complication profile that unregulated markets have.

Two things worth saying out loud

The second is the more important.

If you are considering it: the distinguishing question is not price or country. It is what material, in what quantity, by whom. A licensed surgeon in the Dominican Republic performing a fat transfer with a named technique is a different proposition from a silicone injection in an apartment, and both get described as getting work done abroad. Ask what is going in, whether it is resorbable, what the removal plan is if something goes wrong, and who manages a complication once you are home — because the answer to that last one is frequently nobody, and the emergency department you end up in will have never seen it before.

If you already had it, possibly years ago: tell your doctor. Say the word silicone, say roughly when, say where in the body. Not because anything needs to be done today, but because the presentations in that series — nodules, unexplained hypercalcemia, respiratory symptoms, granulomatous disease — are diagnosable when somebody knows the history and close to impossible when they do not. A patient who does not mention a procedure from 1998 will be worked up for sarcoidosis instead, possibly for years.

There is a specific kind of silence around this, and it is a shame-based silence, and it costs people diagnoses. It is not a confession. It is a line in a medical history, and it is the single most useful thing you can supply.

This article is educational and is not a substitute for care from someone who can look at your skin. Anything new, changing, painful or spreading should be assessed rather than researched.