Leg ulcers following subcutaneous injection of a liquid silicone preparation

We present an unusual case of leg ulcers occurring 23 years after the patient had received large-volume subcutaneous injections of a liquid silicone preparation into her legs for cosmetic reasons. Light microscopy of a biopsy specimen from the edge of the ulcer showed optically clear vacuoles in the dermis, together with a mixed cellular infiltrate. Scanning electron microscopic studies revealed amorphous spherules within the vacuoles, and energy-dispersive spectroscopy established the presence of silicon in these spherules. Nearby tissue not containing spherules did not show a silicon peak. This case adds to the growing documentation of morbidity associated with injections of silicone of uncertain purity.