Iraj Zandi

Failure to remove soft tissue injected with liquid silicone with use of suction and honesty in scientific medical reports.

Honesty is a fine jewel, but much out of fashion. —Gnomologia, Thomas Fuller, 1732 In August of 1985, I reported in Plastic and Reconstructive Surgery the first successful case of removal by using suction of soft tissue injected with liquid silicone.1 One year later, I reported in the same journal2 that the identical procedure was unsuccessful when used in multiple locations. Since then, I have performed approximately 20 procedures by using the same technique, attempting to remove injected silicone and, in all honesty, I cannot document any other cases as wholly successful as the first one. Because of lack of success, I abandoned this procedure several years ago. In the same journal in 1988,3 I reported an error in skin graft gauging and how it was corrected. Although it is unconventional to report one’s failures and errors, I do so to illustrate a point and, thereby, emphasize the benefits of such candor to the profession at large. In the past 30 years of reading Plastic and Reconstructive Surgery, I have seen a profusion of highly selected and beautiful pictorial results of different procedures performed by surgeons in private practice as well as those in academia, bent on promoting their causes or specific operations. Rarely do I read about the poor results of any procedures or the errors that have been made. Personally, I have learned more from my errors and failures than from my successes. I believe that this is true about the specialty in general. Presenting more of our errors and failures and publishing them teaches us how to avoid them, thus reducing repeated failures. I would also like to express my critical opinion about articles written by other authors on the subject of removal by using suction of soft tissue injected with liquid silicone. These authors attempt to confirm the success of the procedure, but in my respectful opinion, they have failed to do so. In the first one, published by Hugh Bailey et al.,4 the authors correctly claim the localization of injected silicone with magnetic resonance imaging, which I concur to be the proper method. However, on review of the article and the preoperative and postoperative photographs, I found no proof that the soft tissue injected with silicone or the silicone itself had been eliminated from the patient’s face. It seems that the preoperative photographs show a great deal of general inflammation in the entire soft tissue of the face, which is shown to be improved in the postoperative photograph. This improvement, in my opinion, is most probably due to a general subsiding of the inflammatory process, which can occur spontaneously or with the use of antiinflammatory agents used in this case. The cosmetic improvement also could be due to contouring effect of liposuction of uninflamed fatty tissue. Additionally, there is no postoperative magnetic resonance imaging scan present, which is most important in proving silicone removal. Dilia Acosta Almeida, M.D., from Brazil, published the second report under the title “Employment of Suction for the Removal of Siliconomas.”5 On critical review of this article, I could not find any evidence that siliconoma had been removed from soft tissue. Showing