Toxicology ->Pulmonology ->Emergency Medicine -> Cosmetic Complications

History of Present Illness

22-year-old female presents to the Emergency Department after receiving non-medical grade silicone putty sourced from a home improvement store, inspired by TikTok, injected directly into her buttocks in her living room for cosmetic augmentation. She notes significant aesthetic deformity, localized discomfort, and sudden-onset anxiety, palpitations, and rapid breathing, which she initially attributed to a panic attack.

Patient Presentation — Chanel Sutton presenting to the ED in distress.Patient presents with tachycardia and tachypnea, expressing extreme anxiety after an illicit cosmetic procedure.

Emergency Department Course

Bedside Evaluation

00:09:17S01E06Room 16

Tachycardic, tachypneicDr. Samira Mohan

Patient experiencing severe acute anxiety and concern over severe cosmetic deformity following illicit gluteal injections.

+1Details

Medical Decision Making

Evaluating the injection sites for active cellulitis, abscess formation, or tissue necrosis, while evaluating patient's hyperventilation and tachycardia in the context of recent high-risk foreign material injection.

DDx

Panic Attack / Acute Anxiety ReactionForeign Body Reaction / GranulomaSilicone Intravasation / Silicone Embolism Syndrome

Diagnostics & Findings

Physical examination of gluteal injection sites

Findings:

Severe tissue irregularity and poor aesthetic appearance
Absence of frank overt acute infection at the injection site
Subjective feeling of impending doom and panic attack

Interventions

Patient counseling and reassurance
Preparation for diagnostic escalation

⮑ Outcome & Reassessment

Patient acknowledged the gravity of the decision to use non-medical silicone, stating she felt stupid and was actively experiencing palpitations and shortness of breath.

Clinical Media

MDM Discussion

00:09:38S01E06Room 16

Tachycardia, TachypneaDr. Robinavitch, Dr. Samira Mohan

Mohan presents the case to Robby discussing patient's high-risk mechanism and systemic vital sign abnormalities.

Details

Medical Decision Making

Although the patient attributes her tachycardia and tachypnea to a panic attack, high-pressure injection of industrial silicone putty into the vascular gluteal venous plexus carries an extremely high risk of venous intravasation leading to silicone pulmonary embolism syndrome (diffuse alveolar hemorrhage/pneumonitis) or pulmonary thromboembolism. CT pulmonary angiogram / chest CT is mandatory to rule out life-threatening pulmonary vascular embolization.

DDx

Silicone Pulmonary Embolism SyndromePulmonary Embolism (Thromboembolic)Panic Disorder / Hyperventilation SyndromeChemical Pneumonitis / Systemic Inflammatory Response

Diagnostics & Findings

Ordered emergent Chest CT (CT Angiography / High-Resolution Chest CT)

Findings:

History of industrial silicone putty direct injection
Persistent tachycardia and tachypnea

Interventions

Initiated workup for emergent chest imaging and systemic monitoring

⮑ Outcome & Reassessment

Plan established to transport patient directly to the CT scanner to evaluate for pulmonary silicone embolization.

Diagnoses & Disposition

Evolving Diagnoses

[S01E06]Illicit Non-Medical Gluteal Silicone Injection with Cosmetic Complications
[S01E06]Tachycardia and Tachypnea, Rule Out Silicone Pulmonary Embolism Syndrome vs. Acute Panic Attack

Current Disposition

Transferred to CT Radiology for emergent chest scanning / Pending definitive inpatient admission for pulmonary and plastic surgery consultation.

Casebook Analysis

Episode Context

Serves as a timely, cautionary medical subplot highlighting the alarming rise of social media-driven unlicensed cosmetic procedures (e.g., DIY buttock augmentation using industrial hardware store silicone) and emphasizes the clinical vigilance required by emergency physicians to distinguish severe embolic emergencies from benign panic attacks.

Attending's Review

Medical Accuracy

Highly accurate emergency clinical decision-making. Non-medical grade liquid or gel silicone injected into the rich gluteal venous plexus can easily enter the inferior vena cava and pulmonary circulation, leading to Silicone Embolism Syndrome (SES). Symptoms often mimic an acute panic attack (tachypnea, tachycardia, dyspnea, agitation) before rapidly progressing to diffuse alveolar hemorrhage, ARDS, or death. Ordering immediate cross-sectional chest imaging rather than anchoring on a psychiatric/anxiety diagnosis is the exact standard of care.

Clinical Pearls

Never anchor on a psychiatric diagnosis (such as a panic attack) when an acute cardiopulmonary vital sign abnormality occurs following an invasive or illicit procedure.

Silicone Pulmonary Embolism Syndrome (SES) presents with triad/features of dyspnea, hypoxemia, tachycardia, and altered mental status, classically showing bilateral ground-glass opacities or diffuse alveolar hemorrhage on chest CT.

Treatment for silicone embolization is primarily supportive, often requiring intensive care monitoring, supplemental oxygen/mechanical ventilation, and high-dose systemic corticosteroids.

Once life-threatening Silicone Embolism Syndrome (SES) and necrotizing soft-tissue infection are ruled out, definitive local management of gluteal silicone is multidisciplinary and complex: free liquid/putty silicone permeates tissue planes, making simple incision, drainage, or liposuction ineffective and contraindicated. Inflammatory siliconomas and granulomas are managed medically with intralesional or systemic corticosteroids, oral minocycline/doxycycline (for immunomodulatory effects), or broad-spectrum antibiotics if superinfected, whereas refractory granulomas, chronic draining sinuses, or tissue necrosis necessitate staged radical surgical debridement and reconstructive plastic surgery.