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Laser resurfacing of silicone-injected skin: the "silicone flash" revisited
1Department of Otolaryngology-Head and Neck Surgery, Jefferson Medical College, 925 Chestnut St, Philadelphia, PA 19107, USA.
Objective:
To determine whether prior silicone injection increases the risks associated with carbon dioxide laser resurfacing.
Design:
Laboratory determination of the effect of laser energy on liquid silicone; histologic evaluation of silicone-injected skin after lasing; and histologic demonstration of silicone deposits in all layers of dermis years after injection of silicone as filler fluid.
Setting:
Tertiary care medical center. PATIENT-RELATED DATA: Histologic examination of freshly excised skin injected with microdroplets of liquid silicone and subjected to application of carbon dioxide laser energy; histologic examination of skin excised years after silicone injection.
Interventions:
High-speed clinical photographic imaging of the effect of laser energy on silicone fluid; histologic examination of hematoxylin-eosin-stained sections of skin injected with liquid silicone and subsequently lased.
Main Outcome Measures:
Response of liquid silicone to application of laser energy; effect of this response on surrounding normal skin.
Results:
Exposure of microdroplets of liquid silicone to carbon dioxide laser energy produced flaring with frank flame. Flaring of dermal silicone caused collateral skin damage.
Conclusions:
Prior injection with liquid silicone is a relative contraindication to cutaneous resurfacing with the carbon dioxide laser. Surgical excision of silicone-injected skin may be preferable for many patients. A strenuous needs assessment should be done, alternatives for skin rejuvenation considered, and comprehensive informed consent obtained from the patient before embarking on laser resurfacing of silicone-injected skin.
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