Abstract | March 29, 2023

Role of Suction Assisted Lipectomy for Treatment of Facial Silicone Granulomatosis

Jessica Leonhardt, MD

Paige Leonhardt, MD, 3rd Year; Rowan Brooks, MD, 3rd Year; Paulina Le, Plastic Surgery, PGY-3; Akio Kozato, MD, PGY-1; Nikki M Burish, MD; Marcia Barnett, MD/MBA, John Henry Pang, MD; Jess Ting, MD

Learning Objectives

  1. Describe the development of facial silicone granulomatosis within high risk transgender patient population
  2. Propose SAL technique for mitigation of silicone granulomas
  3. Discuss contribution/addition of SAL to facial feminization surgery and related improvement in gender dysphoria

Background:

The purpose of this study was to present suction assisted lipectomy (SAL) as a less invasive method of softening migrated facial silicone and granulomatosis without the need for medical treatment or aggressive surgical excision.

Methods:

If determined to be appropriate during the pre-operative assessment for facial feminization surgery, SAL is performed. Tumescent local anesthesia is infiltrated to the affected areas through a 2-mm stab incision, and liposuction is performed with a Coleman cannula of the granulomas and migrated silicone. Post-operative visits are performed at 1-week, 2-week, and 6- to 8-week intervals after surgery. If necessary, additional rounds of liposuction can be performed.

Results:

A total of 18 patients underwent SAL in combination with facial feminization procedures performed by a single surgeon from 2018-2020. Of these, 4 patients required a second round of liposuction 16-24 weeks post-surgery due to continued palpability and discomfort of silicone. No other sequelae were noted by the surgeon including bleeding, seroma formation, pain at the liposuction sites, or irregular contour deformity. Pre- and post-surgical surveys were administered to each patient to quantify the level of gender dysphoria the patient experienced specific to the face. Among the seven patients who responded, the average level of gender dysphoria experienced pre-surgery was 9 out of 10, and post-surgery was 2 out of 10.

Conclusions: The SAL technique is a minimally invasive and effective method of removing silicone granulomatosis, and results in excellent aesthetic outcomes and improved gender dysphoria for the transgender patient.

 

References

Vundelinckx B, Herman B, Getgood A, Litchfield R. Surgical Indications and Technique for Anterior Cruciate Ligament Reconstruction Combined with Lateral Extra-articular Tenodesis or Anterolateral Ligament Reconstruction. Clin Sports Med. 2017 Jan; 36(1):p. 135-153.

Sonnery-Cottet B, Vieira TD, Ouanezar H. Anterolateral Ligament of the Knee: Diagnosis, Indications, Technique, Outcomes. Arthroscopy. 2019 Feb; 35(2): p. 302-303.

Song GY, Hong L, Zhang H, Zhang J, Li Y, Feng H. Clinical Outcomes of Combined Lateral Extra-articular Tenodesis and Intra-articular Anterior Cruciate Ligament Reconstruction in Addressing High-Grade Pivot-Shift Phenomenon. Arthroscopy. 2016 May; 32(5): p. 898-905.




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