INTRODUCTION: Silicone injections and prostheses have been used in the past to reconstruct facial contour deformities. However, Silicone is associated with complications like malposition, sinus tract formation, granulomatous reaction and severe soft- tissue scarring and contractures, which result in facial disfigurement. Patients who have had skin and soft tissue complications from silicone implantation pose a challenging surgical dilemma. Over a 12 - year period, we have successfully treated 23 such patients with severe facial deformities from silicone-associated complications using microsurgical free tissue transfer.

METHODS: A retrospective review of 23 patients who underwent correction of silicone-associated complications on the face with microsurgical free tissue transfer was carried out. The etiology of facial deformity included facial atrophy, post-parotidectomy/radical neck dissection defects, vascular malformations and post-radiation sequelae. When the soft-tissue involvement was mild to moderate, a one-stage operation included excision of silicone, contracture-release and re-contouring with microsurgical free tissue transfer. In cases of severe soft tissue involvement, correction was performed in two stages. The first stage included wide subcutaneous undermining beyond the extent of the deformity with excision of silicone and contacture-release. In the second stage, 3-5 days later, a microsurgical free flap was used to re-contour the facial deformity.

RESULTS: 23 patients (19 women, 4 men) with complications of silicone implantation for facial deformity were corrected with microsurgical free tissue transfer. A total of 24 free flaps (22 inframammary extended circumflex scapular and 2 superficial inferior epigastric) were performed. One patient had bilateral reconstruction. 17 free flaps were performed immediately after the excision of silicone and 7 flaps were transferred during the second stage. Flap survival was 100%. Hematoma and partial skin necrosis was encountered in 8% (2/24). 22/24 flaps required revisions.

CONCLUSION: In patients with facial contour deformities, we strongly discourage the use of any form of silicone for soft tissue augmentation due to its potentially harmful effects on the skin and soft tissue. Microsurgical free tissue transfer is a successful method of salvaging skin and soft tissue damaged by previous silicone implantation.