Journal of Clinical and Aesthetic Dermatology

APR 2017

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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50 JCAD journal of clinical and aesthetic dermatology April 2017 • Volume 10 • Number 4 A A 34-year-old woman was referred to the authors' dermatology clinic for e valuation of right labial swelling and dyspareunia. Her symptoms began after receiving a liquid silicone injection into the buttocks at a cosmetic plastic surgery clinic that was operating illegally by an unlicensed provider. A single prior debulking surgery had produced only temporary relief of symptoms, and the swelling returned. Work-up including magnetic resonance imaging and skin biopsy revealed migration of the injected silicone from her buttock to the subcutaneous tissue of the right labia majora, with an associated granulomatous immune response to the silicone. To the authors' knowledge, the extent of contiguous soft tissue involvement shown in this case has not yet been reported in the medical literature, nor has the finding of migration from the buttocks to the vulvar tissues to produce such dramatic asymmetry. Treatment with intralesional steroids and minocycline was initiated with improvement noted at one- month follow-up. Large volume and adulterated silicone injections are associated with a host of complications, including silicone migration and granuloma formation. No consensus for treatment exists, [Abstract continued on next page] A b S T r A C T C A S E r E p o r T Vulvar Asymmetry Due to Silicone Migration and Granulomatous Immune Response Following Injection for Buttock Augmentation a DAVID B. HARKER, MD; b JAKE E. TURRENTINE, MD; a SEEMAL R. DESAI, MD a The University of Texas Southwestern Medical Center, Dallas, Texas; b Medical College of Georgia at Augusta University, Augusta, Georgia A 34-year-old woman with no significant medical history presented to the authors' dermatology clinic as a referral from her obstetrician/gynecologist (OB/GYN) for right labial swelling. The swelling began 3 to 4 years prior, following liquid silicone injections into the bilateral buttocks at an illegally operating cosmetic plastic surgery clinic. A few months following the procedure, she began experiencing right vulvar pain and gradually developed swelling of the right labia majora. The swelling was associated with mild chronic pain and dyspareunia, but review of systems was otherwise negative. Six months after the swelling developed, the patient sought surgical correction at an outside facility, where some of the swollen tissue was excised under local anesthesia. This intervention provided temporary relief from the Disclosure: The authors report no relevant conAicts of interest. Author correspondence: Jake E. Turrentine, MD; E-mail: jakturrentine@augusta.edu

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