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Cheekbones from Hell (1992)

Cheekbones from Hell (1992)

©1992, 2013 by Dallas Denny

Source: Dallas Denny. (1992). Cheekbones from hell, or injected silicone: Bad news. TV-TS Tapestry, 61, 46-48. Re-released in 2003 by Gender Education & Advocacy, Inc.

I”ve been warning about the dangers of injected silicone since 1989. This is, I think, my best take on the subject.



Tapestry Pages (PDF)



In 1990 Margaux Schaffer made me aware of the widespread use of injections of illegal silicone in the transgender community. She produced a full-page ad titled “Dangerous Curves Ahead,” which was widely distributed by the American Educational Gender Information Service. The ad appeared in assorted transgender-related newsletters and magazines, including AEGIS’ Chrysalis Quarterly. I spoke about the dangers of silicone at Atlanta’s transsexual support groups and distributed flyers in September at the first Southern Comfort. During the conference, I was confronted in a hotel hallway by an angry woman known for keeping a pistol in her purse. She defended the local silicone pumper, another transsexual woman. I didn’t back down. She didn’t produce her Glock.

Dangerous Curves Ahead Public Service Ad (PDF)


I wrote “Cheekbones From Hell” in 1992. Shortly thereafter, the U.S. Food and Drug Administration called a moratorium on silicone breast implants, which are prone to rupture and leak liquid silicone into the body. While there is some controversy about whether leaking silicone implants can cause various systemic illnesses, the hazards of injecting silicone are well-documented. It is dangerous, illegal, disfiguring, and sometimes fatal. 


Cheekbones From Hell, or Injectable Silicone: Bad News

By Dallas Denny


Back in 1991, in the second issue of Chrysalis Quarterly, the magazine of AEGIS, GEA’s predecessor organization, we ran an ad called “Dangerous Curves Ahead,” warning of the dangers of injecting silicone into the human body. We chose injectable silicone for our first public service ad because many people in the transgender community seemed unaware that injecting silicone is both dangerous and illegal (Rivera, 1992). Unlike silicone breast implants (now also banned by the FDA), in which the silicone is placed in a specially designed plastic bag which is then surgically implanted, when injecting a large-bore needle is used to insert the silicone directly in cheekbones, lips, chins, foreheads, thighs, breasts, hips, hands, and other parts of the body. Unfortunately, this is usually not done under sterile conditions in a doctor’s office by a cosmetic surgeon, but by a lay “practitioner” in a motel room or in the back of a van. Often non-sterile, industrial-grade silicone is used, rather than medical-grade, and it may be adulterated with substances like oil or paraffin, which can cause serious medical complications. The individual injecting the silicone typically has no training in either medical techniques or aesthetics, and has little regard for the well-being of the “patient,” who has not been warned of the dangers of the procedure, and is not likely to be looked after properly in the event of a catastrophic reaction. Occasionally an unfortunate injectee drops dead on the spot (Greer, 1993, Florida Fugitive Arrested in Greenville, 13 April, 2001.)

The U.S. Food and Drug Administration (FDA) has maintained since 1965 that only those physicians who it has authorized to experiment with silicone are allowed to procure or use the substance— and there are currently no physicians authorized to do so and no authorized supplier of medical grade injectable silicone (Auto-Shop Silicone Used for Injection, 18 February, 1993). According to an article in the New York Times in 1992, a survey of 2000 cosmetic and plastic surgeons by the American Academy of Cosmetic Surgery found silicone injection the ninth most popular procedure in cosmetic surgery; there were nearly 60,000 injections reported in the U.S.A. in 1990. Most were done to nontransgendered women. David Kessler, former FDA Commissioner, repeatedly warned physicians they must stop silicone injections. It was under Kessler’s watch that a moratorium was called on silicone breast implants in the US, and that moratorium continues.

Most plastic surgeons and dermatologists do not do silicone injections. Those who do limit their injections to small drops to fill in facial wrinkles or “pump up” parts of the face. Although those who used only small amounts of silicone reported few complications, many stopped upon Kessler’s warning, according to the New York Times. Other physicians, however, claim that the FDA has no jurisdiction over them, and continue the practice. A few inject massive amounts of the substance— as much as 2 liters— into breasts, thighs, and hips.

If the FDA contends—and it does— that silicone encapsulated in plastic bags is dangerous, you can imagine its opinion of the use of industrial-quality silicone by non-physicians— a practice which is common among some groups in the U.S. including exotic entertainers, street prostitutes, Asian women, female impersonators, and transgendered and transsexual women. Some ten years ago, when we wrote Dr. Kessler about the black market in silicone, we received a reply from Sterling D. Gary of the FDA’s Division of Compliance Operations, assuring us that the FDA shared our concerns about “the practice of injecting non-sterile, non-medical grade liquid silicone into the body,” and indicating the FDA was willing to “take appropriate action” against those who did so.

The problem, of course, is how to effectively protect consumers. It’s one thing for the FDA to clamp down on a physician who has a license and works out of a fixed location, but quite another to locate and prosecute an unscrupulous practitioner who flies around the country with a bag of needles and a tube of silicone caulk purchased in an auto parts or hardware store. We doubt the FDA has the resources to mount an effort to stop the dangerous and illegal practice of injecting silicone. The effort must come instead from within the transgender and gay communities, and the first step is to make the problem known through articles like this one, and through advertisements like our “Dangerous Curves Ahead.”

We frequently hear transgendered people say, “I have silicone in my face and I’ve never had any problems.” To them, we say, “You’re lucky.” The problems with injected silicone are legion, and directly proportional to the amount injected. Thus, a small amount in the face is less likely to cause complications than large amounts in the torso, but any injection is potentially lethal.

What are the problems with injected silicone? The most immediate danger is respiratory distress which may lead to death. The authors of a paper called “Acute and Latent Pneumonitis after Subcutaneous Injections of Silicone in Transsexual Men” (Chastre, et al., 1986) treated 13 male-to-female transsexual people who were hospitalized for respiratory symptoms resulting from “… illicit subcutaneous injections of silicone.” Seven of the patients had begun having problems breathing immediately following injections, and five at varying periods after injections. The thirteenth become ill following a brawl in which the silicone became dislodged. The authors concluded that silicone injections carried “… a serious respiratory risk since it can induce acute respiratory failure”; that this can be induced “… by local trauma to tissues containing silicone, even if injections were performed several years before the traumatic episode”; and that “… latent silicone pneumonitis may be observed in patients who develop local inflammatory phenomena at the sites of previous injections.” Other papers (Couland, et al., 1973; Ellenborgen & Rubin, 1975; McCurdy & Solomons, 1977; Solomons & Jones, 1975) have reported the deaths of individuals due to respiratory distress following silicone injections.

Another problem with injected silicone is that it moves around in the body, especially when present in quantity (Chaplin, 1969; Parsons & Titering, 1977). In a postmortem, Ellenborgen & Rubin (1975) found silicone in all organs and in massive quantities in the lungs. Dr. Stanley Biber showed a slide at the 1992 IFGE Coming Together convention in Denver in which the face of a young woman looked as if it had melted and run. She had lumps and bumps all over her face, and appeared to be at least 20 years older than her actual age. She had come to him after having had facial silicone injections. He was unable to help her.

Silicone is especially dangerous when introduced into the breast. The paper by Parsons & Titering (1977) begins, “All plastic surgeons are aware by now that the injection of liquid silicone for breast augmentation leads to difficult, even disastrous complications.” Theirs and other articles provide graphic evidence of what silicone can do to the chest. Despite patients’ claims of being pleased with initial results, the breasts typically become hard and lumpy, may develop infections, form cysts or open sores, become hyperpigmented, and may even develop gangrene (Kopf, et al., 1976). When injected in large amounts, silicone is very difficult to remove (Parsons & Titering, 1977), and is almost certain to disfigure the breasts. In fact, it is often necessary to do a radical mastectomy (Chaplin, 1969), and even if an attempt is made to save the breast, the cosmetic result is not likely to be satisfactory either to the patient or to the surgeon (Parsons & Titering, 1977). Parsons & Titering point out that the breast is an organ with a high susceptibility to cancer, and that injected silicone may lead to increased risk of cancer. They cite several authors who found cancer in patients with silicone-injected breasts.

There are other complications of silicone (for instance, there was one report of blindness), but we have elected to cite only enough evidence to convince skeptics that injected silicone is, indeed, dangerous and can be disfiguring and sometimes lethal, even when done by cosmetic surgeons. Now we want to move things closer to home, talking about the problem as it exists in reality in the transgender community. Why would anyone agree to let themselves be pumped with silicone in some back room by an unskilled and unlicensed person?

Why indeed! The answer is: instant curves. Silicone is seen as a quick fix by many transgendered men and women. It’s less expensive than plastic surgery (on the front end, that is), requires no letters of authorization from psychologists or psychiatrists, and gives instant gratification.

The short-term effect of injected silicone is enhanced body contours. Cheekbones can be made more prominent, lips more pouty, clefts in chins removed, breasts enlarged. Hips and thighs can be sculpted to resemble those of born females. Male curves can be simulated, too: instant pectoral, gluteal, or calf muscles.

And so, transgendered people pay $200, $300, even $500 for injections of impure silicone, administered, usually, by someone with no medical training, no knowledge of human anatomy, no knowledge of sterile techniques, no idea of what to do if a medical emergency develops, and who may well be reusing needles without sterilizing them— and this individual will more than likely have a very poor aesthetic sense. Their clients go back time and again, until they have pints or even quarts of silicone in their bodies (Kulick, 1998). The result is Dangerous Curves— what we sometimes refer to as Cheekbones from Hell— body contours, especially lips and cheekbones, which just do not occur in nature. With repeated visits (and much money spent), the individual becomes a caricature, a cartoon, a person of exaggerated proportions. To the naive eye, such people may seem more attractive because of those curves, but they lose the “realness” that is so important in order to live a viable life in the preferred gender. And the long-term consequence is disfigurement, often severe and life-threatening.

Injecting silicone is big business. As far as we’ve been able to tell, there are a half-dozen or so individuals who travel around the country; word spreads that they are on the way, and when they arrive, a steady stream of “customers” file in and out of the hotel room — or, in one case in Atlanta, through the back room of an upscale hairstyling parlor — dropping several hundred dollars each. We’re talking big bucks here, for as many as 30 or 40 “customers” can be treated in one afternoon, and most customers require multiple injections.

We’ve found out the hard way that it can be dangerous to interfere with such “enterprise,” even to the extent of declaring our position with the “Dangerous Curves” ad. At one gender meeting in 1991, two AEGIS staffers found themselves confronted by a pistol-packing member of a local support group who had heard about the Dangerous Curves ad (she didn’t actually point the weapon at them, but she let them know it was in her purse and that she would be willing to use it. She was afraid we would somehow interfere with her position as procurer for someone we will call “Rochelle,” who was reportedly in town to capitalize on the conference. “Rochelle is licensed in six states to do this!” she shouted, waving her finger (and fortunately not her pistol) in our faces. Apparently, our ad had been sufficient to alarm the silicone set. “Rochelle” stayed away from the conference, but it was a long time before we slept easily.

If the FDA has maintained for more than 25 years that injected silicone is dangerous even when given by physicians, it stands to reason that it is unthinkable to seek it from a nonphysician. Those who are desirous of enhanced body contours should seek a plastic or cosmetic surgeon. It may cost a little more for the initial procedure, but the results will be much less likely to compromise your health, and the aesthetic results will be much better and last much longer. In the long run, it will be much, much less expensive than “Dangerous Curves.”

Remember: there is no agency or school that grants a license to inject silicone. If you don’t believe us, do your own research, but for goodness sake, don’t take the words of the “Rochelles” of this world.

You Can Be Beautiful, Too! Vignettes Based on Experiences of Actual People With Injected Silicone


Rona made the mistake of accompanying her friend Chris when Chris went for injections to her breasts. Stephanie, the women with the silicone, told Rona, “You really should let me do something for that cleft in your chin, dear.”

After that, Rona thought often about how nice it would to be rid of her cleft chin. The next time Stephanie was in town, Rona not only had her chin done, but her lips, too, to get that “pouty” look. Unfortunately, although the chin was improved, the silicone in the lip shifted almost immediately, making it look as if a bee had stung her on the left side of her face. Rona caught Stephanie before she left town, asking her to do something. Stephanie studied Rona’s face for a moment, and then said, “We can just give you a little here,” and proceeded to pump silicone into the right side of Rona’s mouth to provide symmetry.

Stephanie is out of town, long gone. Rona is now drinking through a straw, for she has lost much of the feeling in her lower lip, and, and there is so much silicone around her mouth that she cannot close it normally. She dribbles when she drinks from a glass, and she cannot chew without dropping food. Moreover, her career as a sex worker has been dealt a severe blow, for she finds it impossible to perform oral sex in an effective manner.

The first plastic surgeon Rona consulted just shook his head and sent her elsewhere; the second said he thought he could remove most of the silicone, but was giving no guarantees, and he told her there would be scarring. A third said he could remove the silicone through the inside of her mouth, so that scars would not be visible, and referred her to a neurologist. There the news was not good; he told Rona that it was likely the loss of sensation in her lower lip would be permanent.


Natalie fancied herself a Cher look-alike, and to make herself as much like her muse as possible, sought the services of Rochelle, who pumped her cheeks full of silicone. “Isn’t this too much?” Natalie asked.

“No, dear,” said Rochelle. “The oil in the silicone will bleed away, and your cheeks will look just fine.” But the oil didn’t “bleed away.” Natalie was left with cheekbones that made her look ridiculous, and to make matters worse, her boyfriend popped her one and the silicone in her left cheek moved forward about an inch. She sought out Rochelle the next time she was in town and had even more silicone injected to make her face symmetrical.

Today, Natalie does a good impression of a chipmunk without even trying. She has talked to a plastic surgeon who gave her an estimate of $4000 for removing the silicone from her cheeks; he said he would implant prosthetic inserts for an additional $4000, if her face was not too damaged to tolerate them.

Natalie doesn’t have that kind of money, but she does have $500, and the next time Rochelle is in town, she plans to have her breasts injected.


Carmilla had both her breasts “done” five years ago. Except for the fact that silicone constantly seeped from her nipples, everything was fine for two years. Then the skin on her right breast began to bulge, and an open abscess soon developed. Within months, she developed an abscess on her left breast. Finally, when the pain became so great that she was unable to move normally and her breasts had developed a foul odor, she saw a physician who told her her breasts had become gangrenous. He put her in the hospital immediately for radical double mastectomy. Carmilla now has no breasts, and has been on two talk shows, complaining bitterly about Rochelle, who injected her.

Now Carmilla’s doctor tells her that the lethargy, joint pain, and mental confusion she is feeling is probably due to the delayed effects of silicone. He tells her it’s good the silicone is out of her body; at least now it probably won’t get worse. Carmilla doesn’t tell him about the silicone in her face and thighs.



Auto-shop silicone used for injection. (1993, 18 February). Oakland (CA) Tribune, A8.

Chaplin, C.H. (1969). Loss of both breasts from injections of silicone (with additive). Plastic and Reconstructive Surgery, 44(5), 447-450.

Chastre, J., Brun, P., Soler, P., Basset, F., Trouillet, J.L., Fagon, J.Y., Gilbert, C., & Hance, A.J. (1987). Acute and latent pneumonitis after subcutaneous injections of silicone in transsexual men. American Review of Respiratory Disease, 135(1), 236-240.

[In this title the phrase “transsexual men” refers to transsexual people who began life in male bodies; within the transsexual community “transsexual men” now is applied to men who are transsexual, or who began life in female bodies, but who now live as men.]

Coulaud, J.M., Labrousse, J., Carli, P., Galliot, M., Vilde, F., & Lissac, J. (1983). Adult respiratory distress syndrome and silicone injection. Toxicological European Research. Recherce Europeenne en Toxicologie, 5(4), 171-174.

Ellenbogen, R., & Rubin L. (1975). Injectable fluid silicone therapy: Human morbidity and mortality. Journal of the American Medical Association, 234, 309-309.

 Florida fugitive arrested in Greenville. (2001, 13 April). Yahoo Daily News <>. (As of 2011 this URL no longer works).

Greer, R. (1993, 17 February). Silicone injection killed man, police say. Atlanta Journal-Constitution, B6.

Kulick, D. (1998). Travesti: Sex, gender and culture among Brazilian transgendered prostitutes. Chicago: The University of Illinois Press.

Kopf, E.H., Vinnik, C.A., Bongiovi, J.J., & Dombrowski, D.J. (1976). Complications of silicone injections. Rocky Mountain Medical Journal, 75, 77-80.

McCurdy, H.X.H., & Solomons, E.T. (1977). Forensic examination of toxicological specimens for dimethopolysiloxane (silicone oil). Journal of the Annals of Toxicology, 1, 221-223.

Parsons, R.W., & Titering, H.R. (1977). Management of the silicone injected breast. Plastic and Reconstructive Surgery, 60, 534.

Rivera, C. (1992, 29 February). U.S. files suit to halt silicone use by doctor. Los Angeles Times, 111, A25.

Solomons, E.T., & Jones, J.K. (1975). The determination of polydimethylsiloxane (silicone oil) in biological materials: A case report. Journal of Forensic Science, 20, 191-199.

News 02/28/1992


Food and Drug Administration


Sharon Snider (301) 443-3285

The Food and Drug Administration announced today that three New York physicians have signed consent decrees agreeing to stop injecting liquid silicone into patients to correct wrinkles and acne scars. The physicians will no longer be allowed to use injectable silicone for cosmetic treatment unless the product is approved by FDA either for marketing or for investigational studies.

Also today, the Department of Justice filed an injunction on behalf of FDA against a California physician to stop him from using injectable liquid silicone.

“Consumers should know that liquid silicone injections have never been scientifically evaluated for safety and effectiveness,” said FDA Commissioner David A. Kessler, M.D. “People who undergo these injections are exposing themselves to unknown, potentially dangerous risks.”

Adverse reactions to the injections may include swelling, reddening of the skin, lumpiness of the face and development of soft tissue tumors.

The consent decrees, signed by Drs. Norman and David S. Orentreich and Michael A. Kalman of the Orentreich Medical Group and filed in the U.S. District Court in Manhattan, prohibit the physicians and anyone working in their clinic from using or promoting injectable silicone.

The injunction was filed in the U.S. District Court in Los Angeles against Dr. James E. Fulton and two clinics owned by Fulton, Vivant (also known as Fulton Pharma-Cal Inc.) and Acne Research Institute, Inc.

FDA considers liquid silicone injections to be adulterated because the product does not have an approved application for marketing or an approved investigational exemption to permit scientific study of the device. The product has been regulated as a device by FDA since l976. It was previously regulated as a drug.

Actions to prevent the physicians and their clinics from using liquid injectable silicone were begun after they failed to heed warnings by FDA and the Justice Department that their use of injectable silicone is illegal and that the product is adulterated.

The doctors had been purchasing silicone, then injecting it into patients to treat such conditions as wrinkles and acne scars and to enlarge lips. Orentreich bought industrial grade silicone which he processed before using.

FDA inspection of Orentreich’s clinic in July and September 1991 revealed that Orentreich’s medical group was continuing to openly use and promote liquid silicone for the treatment of facial defects. On Nov. 12, 1991, FDA notified Orentreich that unless he took prompt action to correct the violation, FDA could take regulatory action against him.

In June 1991, FDA investigators attended a seminar where Fulton described and promoted his use of liquid silicone injections. An inspection of his clinics in August 1991 confirmed that he was openly promoting and using the product. On Sept. 23, 1991, the U.S. Attorney’s office in Los Angeles notified Fulton that the use and promotion of liquid silicone is illegal.

FDA is one of the eight Public Health Service agencies in HHS.