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Vanity does have a price, and in this story the cost can be health problems. NPR's Patti Neighmond reports on a controversial cosmetic procedure: silicone injections.

PATTI NEIGHMOND: In the late '70s, when a woman named Julia started noticing wrinkles, she says she went to a well-known New York dermatologist who suggested injections of silicone. They would be permanent, and they would give her face a more youthful look.

JULIA: And I wasn't told that there could be any problems with it. And so I started a series of small injections into the line from the nose corner down to the fat of the mouth.

NEIGHMOND: Julia liked the results, but a few years ago, she noticed changes around her lips and chin.

JULIA: Particularly on one side, where it has been like lumpy, a little bumpy. If I touch that spot, which I'm doing right now, you know, I can feel a little lump.

NEIGHMOND: And there are other lumps on her chin, and she says one side looks puffy. Julia is embarrassed about how she looks now. She sees dermatologist Amy Newberger, who's reduced the swelling a bit by treating her with a steroid solution. But the lumps can't be totally removed. Dr. Newberger says she has other patients with more dramatic deformities, like a woman who had injections in her forehead when she was in her 40s.

Dr. AMY NEWBERGER (Dermatologist): As she proceeded into her 60s and her skin started to thin, well, the silicone didn't thin, of course. So she was left with ridges. So where she had had wrinkles, now she had these slightly discolored ridges that just stood up, sort of like a Klingon.

NEIGHMOND: Silicone can harden over time. It's never absorbed and broken down by the body. It can migrate to other places in the body. One of Dr. Newberger's patients has walnut-sized lumps on her cheeks.

Dr. NEWBERGER: You cannot anticipate what will happen down the line. And you cannot anticipate that the material will remain inert.

NEIGHMOND: New York City dermatologist David Orentreich feels much more positive about silicone injections. He says silicone is safe if it is pure and injected by an experienced physician.

Dr. DAVID ORENTREICH (Dermatologist): Each injection puts in a tiny droplet. It's like a period on a page. Around that, you grow collagen. Now when you spread it out like that, you get a very even building up of tissue.

NEIGHMOND: Wrinkle therapy involves small amounts of silicone, but there are patients who have greater amounts injected. Chasedy Morgan(ph) plans to get several ounces injected this month, and probably not by a physician. Morgan is a transgender woman - born male, transitioning to female.

Mr. CHASEDY MORGAN: I liked my insides to match my outside. And if I feel like a woman, I want to actually look like one. It kind of eats you up inside. So, why not, you know, slowly change my outside to match my inside?

NEIGHMOND: Morgan attends a support group at the transgender center at Los Angeles Children's Hospital's adolescent health clinic. Dr. Marvin Belzer directs the clinic. He cautions patients like Morgan against using silicone, but he says like Morgan, many are so anxious about their appearance, they're not willing to wait for medical hormone treatments to work.

Dr. MARVIN BELZER (Director, Los Angeles Children's Hospital): Someone says hey, you can have silicone and I can give you large breasts, I can give you a cuter face, and you can look like that in a few hours. All you got to do is come up with the money.

NEIGHMOND: Belzer says transgenders meet and inject each other, or worse, they get injected by someone selling the treatment who may even use industrial grade silicone and mix it with mineral oil, paraffin or even car transmission fluid.

Dr. BELZER: They could take anything that you buy from the hardware store and, you know, put it into a syringe if it's - as long as it's kind of, you know, partially thick and, you know, viscous and not real watery so it'll fill up the skin and make the skin into the shape that they want it to.

NEIGHMOND: The consequences can be serious. Such patients have been hospitalized because chemicals mixed with silicone caused severe burns. Injection areas can become infected. And the worst case: A piece of silicone can break away, get caught in the blood stream and cause a deadly embolism.

Patti Neighmond, NPR News.

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