Five Complications of Silicone BBL · Los Angeles
Five Complications of Silicone Disease After Illegal Buttock Injections
Silicone disease can produce a wide range of symptoms. These five complications are among the most common and most disabling experienced by patients who seek evaluation at Kare Plastic Surgery in Los Angeles.
1 · Chronic Inflammation
The body treats injected liquid silicone as a permanent foreign substance and mounts an ongoing immune response that does not resolve on its own. This chronic inflammatory state can cause the surrounding tissue to become red, warm, swollen, and progressively hardened. Over time, chronic inflammation leads to fibrosis of the skin and fat, which is the scarring and thickening of tissue that reduces blood flow, restricts movement, and permanently alters the texture and appearance of the buttocks and surrounding areas. The inflammatory process can also extend beyond the original injection site as the silicone migrates through tissue planes, causing inflammation in the thighs, lower back, groin, and lymph nodes.
2 · Skin Changes and Discoloration
Liquid silicone in the buttocks causes progressive changes in the overlying skin that become more pronounced over time. Patients commonly notice areas of skin that are darker, mottled, or discolored compared to the surrounding tissue. The skin may feel thick, indurated, or woody to the touch, and the surface may take on an irregular, uneven texture. In severe cases, chronic inflammation and poor tissue perfusion caused by silicone can lead to ulceration, in which the skin breaks down over the affected area. These skin changes are visible signs of the deeper inflammatory and fibrotic process occurring in the subcutaneous tissue and are an indication that prompt evaluation and treatment are needed.
3 · Chronic Pain and Discomfort
Chronic pain is one of the most debilitating symptoms reported by patients with silicone disease. The pain may be localized to the buttocks and hips or may radiate down the legs to the knees, ankles, and feet. Some patients describe a constant aching pressure, while others experience sharp or burning pain that worsens with sitting, standing, or walking. The pain is caused by a combination of the inflammatory response in the surrounding tissue, compression of nearby nerves by fibrotic scar tissue and granulomas, and the mechanical effects of silicone that has migrated into the deep fat and muscle planes. Moving or traveling can become severely limited in patients with advanced silicone disease.
4 · Itching
Persistent itching in and around the buttocks, thighs, and areas where silicone has migrated is a very common complaint in silicone disease. The itching results from the ongoing inflammatory response in the skin and superficial tissue layers, driven by the presence of foreign silicone particles and the immune cells that accumulate around them. The itching is often severe enough to disrupt sleep and daily activity, and it does not respond to standard treatments for dry skin or rash because it is caused by internal tissue inflammation rather than a surface skin condition. Topical treatments provide minimal or no relief, and the itching typically persists and worsens until the underlying silicone and inflammatory tissue are addressed surgically.
5 · Granuloma Nodules (Siliconoma)
Granulomas, also called siliconomas when caused by silicone, are firm, lumpy nodules of inflammatory tissue that form when the immune system surrounds and attempts to wall off individual deposits of injected silicone. They can be felt as hard bumps beneath the skin and may be visible on the surface of the buttocks as irregular raised areas. Granulomas are often painful or tender to the touch, and they can continue to grow over time as additional immune cells are recruited to the area. They also represent a risk for overlying skin ulceration when they are large or superficially placed. Surgical removal of granulomas along with the underlying silicone deposit is the most effective way to address this complication. Steroid injections can temporarily reduce granuloma size but do not eliminate the underlying foreign material.
Silicone Migration
Liquid silicone does not remain where it is injected. Over months and years it migrates through tissue planes to surrounding areas including the thighs, lower back, groin, labia, and in some cases the regional lymph nodes. In the most severe cases, silicone particles enter the bloodstream and travel to the lungs, causing silicone embolism syndrome, a potentially fatal condition characterized by respiratory failure. Silicone migration is a critical reason why early evaluation and surgical removal planning is important. The longer silicone remains in the body and the further it travels, the more complex and potentially incomplete any removal procedure will be. An MRI is typically used before surgery to map the extent and location of silicone throughout the affected area.
The Karamanoukian Grading Scale for Soft Tissue Inflammation
Dr. Karamanoukian developed the Karamanoukian Grading Scale to classify the severity of silicone disease and biopolymer-related tissue inflammation in patients who have received illegal injections. The scale guides surgical planning, determines whether immediate surgery or pre-surgical preparation is most appropriate, and provides a consistent framework for assessing treatment response. It is the proprietary classification system used at Kare Plastic Surgery as the foundation of every silicone disease evaluation in Los Angeles.
Karamanoukian Grading Scale · Soft Tissue Inflammation · Kare Plastic Surgery
1
Grade 1: Minimal inflammation. Soft tissue is pliable with little or no skin change. The patient has few or no symptoms. May be suitable for conservative monitoring with early intervention planning.
2
Grade 2: Mild to moderate inflammation. Early skin changes including mild discoloration and surface texture change. Palpable firmness in the subcutaneous tissue. Localized itching or mild pain may be present.
3
Grade 3: Moderate to severe inflammation. Significant skin discoloration, thickening, and induration. Palpable granuloma nodules. Moderate to severe pain and itching. Evidence of migration to adjacent areas.
4
Grade 4: Severe inflammation with fibrosis. Woody, thickened skin with poor perfusion. Ulceration may be present. Severe pain, restricted movement, and potential systemic involvement. Staged surgical approach required.
Kare Plastic Surgery · Santa Monica, Los Angeles · Leading Center for Silicone Disease
Schedule Your Silicone BBL Reversal Consultation with Dr. Karamanoukian
Dr. Karamanoukian's Silicone BBL Reversal Technique
Silicone removal from the buttocks is among the most technically demanding procedures in plastic surgery. The surgical approach is individualized to each patient's grading, the extent of migration, the degree of tissue involvement, and the patient's overall health status. Dr. Karamanoukian uses a protocol-based approach developed over years of treating silicone disease patients from across the United States.
Preoperative Evaluation and MRI
Every patient presenting for silicone BBL reversal undergoes a thorough clinical evaluation using the Karamanoukian Grading Scale, combined with MRI imaging of the buttocks, hips, and thighs to map the extent and location of silicone deposits and any migration to adjacent areas. This imaging guides surgical planning, helps anticipate areas of complex anatomy, and identifies any material that may have reached the lymph nodes, groin, or labia. Patients are also evaluated for systemic involvement including lung assessment when indicated by symptoms or history.
Open Surgical Excision
The primary surgical technique for silicone removal from the buttocks is open excision, in which incisions are made in carefully planned locations to access the injected silicone and surrounding granulomatous tissue. The incisions are placed in areas that allow the most complete removal while minimizing visible scarring, often within the buttock crease or fold. The silicone, granuloma nodules, and surrounding fibrotic tissue are removed together. It is important to understand that complete removal of all liquid silicone is not always possible, because dispersed particles integrate with surrounding fat over time, but the most thorough removal achievable significantly reduces the disease burden and symptoms.
Staged Procedures for Severe Disease
Patients with Grade 3 or Grade 4 silicone disease may require a staged surgical approach in which the removal is performed in more than one procedure. Staging allows each wound to heal safely before additional tissue is addressed and reduces the risk of complications including wound breakdown and infection. The interval between stages is typically several months, during which Dr. Karamanoukian monitors healing and manages any residual inflammation. Reconstruction with fat grafting to restore volume and contour can be considered after the tissue has fully recovered and no active inflammation remains, typically at a separate procedure several months after the final removal stage.
Reconstruction After Silicone Removal
After silicone removal, many patients are left with volume deficiency and contour irregularities in the buttocks from both the original silicone disease and the tissue removed during surgery. Fat grafting, also known as a reconstructive BBL using the patient's own fat, can be performed after the tissue has fully healed and the inflammatory process has resolved. Reconstruction is never performed at the same time as silicone removal, as this significantly increases the risk of infection and fat necrosis. Dr. Karamanoukian plans reconstruction as a separate stage after confirming that the tissue is healthy and ready to receive fat transfer.
Kare Plastic Surgery serves patients from across the United States: Dr. Karamanoukian evaluates and treats silicone disease patients from Los Angeles, Beverly Hills, Santa Monica, Miami, New York, and across the country. Patients who traveled outside the United States for buttock injections and are now experiencing complications are also evaluated and treated at Kare. Bring any available treatment records, imaging, or information about what was injected to your consultation. Call (310) 998-5533 for a same-week appointment in Los Angeles.
"My approach to silicone disease begins with a thorough evaluation using the Karamanoukian Grading Scale. Knowing the severity of the inflammation and the extent of tissue involvement before any incision is made is what allows me to give the patient a realistic understanding of what surgery can achieve and to plan the safest path to the most complete removal possible."
— Dr. Raffy Karamanoukian, MD FACS · Silicone Disease Specialist · Kare Plastic Surgery, Los Angeles
Frequently Asked Questions
What is silicone disease after a BBL?
Silicone disease refers to the constellation of symptoms and tissue changes that develop when liquid silicone or other biopolymers have been injected into the buttocks or other areas outside of an approved medical setting. Complications include chronic inflammation, granuloma formation (siliconoma), skin discoloration and hardening, chronic pain, itching, and in severe cases systemic symptoms affecting the lungs and other organs. Dr. Raffy Karamanoukian at Kare Plastic Surgery uses the Karamanoukian Grading Scale to evaluate and classify each patient's severity before designing a removal protocol. Call (310) 998-5533.
Can all silicone be removed from the buttocks?
Complete removal of all injected liquid silicone is not always possible because it disperses into soft tissue and integrates with surrounding fat over time. However, the majority of accessible material and surrounding granulomatous tissue can be removed through open surgical excision, significantly reducing symptoms and disease burden. Dr. Karamanoukian at Kare Plastic Surgery performs comprehensive silicone removal using a staged approach when necessary. Call (310) 998-5533.
What is the Karamanoukian Grading Scale?
The Karamanoukian Grading Scale for Soft Tissue Inflammation is a proprietary classification system developed by Dr. Raffy Karamanoukian to evaluate the severity of inflammation and disease burden in patients who have received illegal silicone or biopolymer injections. It guides surgical planning and determines whether immediate excision, staged procedures, or pre-surgical preparation is most appropriate. It is used at Kare Plastic Surgery as the foundation of every silicone disease consultation. Call (310) 998-5533.
How long does recovery take after silicone BBL removal?
Recovery varies depending on the extent of removal and whether staging was required. Most patients resume light activity within two to three weeks. Heavy lifting and strenuous exercise are restricted for six or more weeks. Patients requiring staged procedures for extensive disease have a longer overall recovery. Dr. Karamanoukian provides individualized recovery guidance and close follow-up at Kare Plastic Surgery. Call (310) 998-5533.
Can a BBL be performed after silicone removal?
Yes, but not at the same time as silicone removal. Reconstruction with fat grafting to restore volume after silicone removal must be performed as a separate procedure after the tissue has fully healed and all active inflammation has resolved, typically several months after the final removal stage. Combining fat grafting with silicone removal in the same operation significantly increases the risk of infection and failure of the transplanted fat. Dr. Karamanoukian plans each stage carefully and discusses reconstruction timing at your consultation. Call (310) 998-5533.
Schedule Your Silicone BBL Reversal Consultation