Laser resurfacing of silicone-injected skin: The "silicone flash" revisited

Objective: To determine whether prior silicone injection increases the risks associated with carbon dioxide laser resurfacing. Design: Laboratory determination of the effect of laser energy on liquid silicone; histologic evaluation of silicone-injected skin after lasing; and histologic demonstration of silicone deposits in all layers of dermis years after injection of silicone as filler fluid. Setting: Tertiary care medical center. Patient-Related Data: Histologic examination of freshly excised skin injected with microdroplets of liquid silicone and subjected to application of carbon dioxide laser energy; histologic examination of skin excised years after silicone injection. Interventions: High-speed clinical photographic imaging of the effect of laser energy on silicone fluid; histologic examination of hematoxylin-eosin-stained sections of skin injected with liquid silicone and subsequently lased. Main Outcome Measures: Response of liquid silicone to application of laser energy; effect of this response on surrounding normal skin. Results: Exposure of microdroplets of liquid silicone to carbon dioxide laser energy produced flaring with frank flame. Flaring of dermal silicone caused collateral skin damage. Conclusions: Prior injection with liquid silicone is a relative contraindication to cutaneous resurfacing with the carbon dioxide laser. Surgical excision of silicone-injected skin may be preferable for many patients. A strenuous needs assessment should be done, alternatives for skin rejuvenation considered, and comprehensive informed consent obtained from the patient before embarking on laser resurfacing of silicone-injected skin.