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Silicone Injections and ASIA Syndrome: Pain and Symptoms Years Later

Why You're Experiencing Pain and Skin Changes Years Later

If you’re experiencing pain, swelling, or skin changes years after receiving silicone injections, you’re not alone. Many people who underwent illegal or unregulated silicone injections for cosmetic enhancement develop late-onset symptoms that affect their quality of life. One possible cause of these symptoms is ASIA syndrome (Autoimmune/Inflammatory Syndrome Induced by Adjuvants) which was first described by an Israeli physician, Dr. Shoenfeld, in 2011.1 Our blog explains how silicone injections can lead to delayed symptoms, what ASIA syndrome is, and why your symptoms may only now be appearing—even if everything seemed fine for years.

What Are the Skin and Pain Symptoms of Liquid Silicone Injections?

The immediate cosmetic results of liquid silicone injections may appear desirable, but the long-term consequences can be serious, with some complications being permanent.

Common symptoms include:

  • Chronic pain — Ongoing tenderness, burning, or aching at or near the injection sites.
  • Inflammation and swelling — The immune system may treat silicone as a foreign body, causing persistent puffiness or localized swelling.
  • Nodules or granulomas — Firm lumps under the skin caused by chronic immune responses; these may be painful, itchy, or visibly disfiguring.
  • Skin discoloration or hardening — The skin may darken, become tough, or appear uneven over affected areas.
  • “Crepey” or thinning skin — Over time, skin over silicone deposits may appear fragile or crinkled.
  • Migration of silicone — Silicone injections can migrate from the original site to other areas of the body, leading to pain, asymmetry, or the development of new lumps. This migration can occur years—even decades—after the initial injection and may involve critical organs such as the lungs or kidneys, regardless of where the silicone was originally injected (e.g., breasts, face, buttocks, or penis).

For example, silicone injected into the buttocks or penis may migrate:

  • Down the legs, sometimes reaching as far as the ankles;
  • Around the spinal column, potentially compressing nerves and causing pain or difficulty walking;
  • Into the rectum, perineum, or vagina, leading to significant local tissue damage.
  • Infection — Silicone disrupts tissue integrity and can harbor bacteria, leading to infections even years later. Silicone can be colonized with bacteria. See our blog on silicone injections and infection.

Why Is This Happening Now? I Was Fine for Years.

If you’ve suddenly developed symptoms long after your silicone injections, you might feel confused or even in disbelief. It’s common to think, “Why now? I was fine for so long.” Here’s the key insight: the immune system doesn’t always react immediately. Studies show that the average time from silicone injection to the onset of symptoms is about 9 years, but symptoms can begin as soon as a few days or as late as 20+ years.2 That means you could feel completely fine for years before experiencing symptoms such as pain, fatigue, or skin changes.

What is ASIA Syndrome?

ASIA syndrome stands for Autoimmune/Inflammatory Syndrome Induced by Adjuvants. In this condition, the immune system becomes chronically activated in response to a foreign substance—like liquid silicone—which leads to widespread inflammation and autoimmune-like symptoms.

Symptoms of ASIA Syndrome

ASIA syndrome can cause:

  • Muscle and joint pain
  • Fatigue
  • Brain fog or cognitive difficulties
  • Skin rashes or changes in skin texture
  • Swelling or tenderness near injection sites
  • Dry eyes or mouth
  • Low-grade fevers

Symptoms can emerge months or even years after the initial silicone injection, often making diagnosis challenging—especially if the provider isn’t familiar with ASIA syndrome. In many cases, symptoms fluctuate over time, coming and going in unpredictable waves.

Do ASIA Syndrome Symptoms Come and Go?

Yes—ASIA symptoms can come in cycles. People frequently report:

  • Flares of fatigue, swelling, or joint pain that worsen for days or weeks
  • Periods of improvement or even symptom remission
  • Worsening after triggers like illness, stress, or surgery

This relapsing-remitting pattern is typical of many autoimmune conditions. Your body may temporarily adapt or reduce its response, only for symptoms to return when your immune system is triggered again. Understanding these symptom cycles is important. They validate what many patients experience and explain why ASIA can be so hard to recognize early.

What Is an Adjuvant?

In medicine, an ‘adjuvant’ is any substance that boosts the body’s immune response. For example, in vaccines there are adjuvants such as aluminum salts that are added in tiny amounts to enhance the immune system’s response to the vaccine. Aluminum salts are cleared naturally by the body.

In ASIA syndrome, the adjuvant is something that doesn’t go away on its own. In the case of liquid silicone, it stays in the body and is not naturally cleared like vaccine adjuvants. The immune system continues to recognize it as a threat and mounts a persistent attack.

Silicone can stimulate the release of signaling molecules called cytokines, which influence T cells—key immune cells that multiply and assume specialized functions. Once injected, silicone may interact with surrounding connective tissue and trigger an ongoing immune response, particularly through inflammation or recognition of the silicone as a foreign substance. This persistent immune activation is thought to drive the symptoms of ASIA syndrome, where the immune system remains in a heightened state of alert and may begin attacking the body’s own tissues.3
How is ASIA syndrome diagnosed?
ASIA syndrome is initially diagnosed by a comprehensive history and physical by a physician who has experience with patients that have ASIA syndrome. The history will include evaluation of the adjuvant (e.g. silicone), the time frame that it was injected, the location, as well as the comprehensive review of symptoms. This constellation can include (but does not need to have all of them present):4
  • Exposure to an external stimulus (e.g. silicone, adjuvant) before clinical manifestations
  • Presence of ‘typical’ clinical manifestations
  • Improvement after removal of causing agent
  • Skin changes or rashes
  • Myalgia (muscle pain), myositis, or muscle weakness
  • Arthralgia (joint pain)
  • Chronic fatigue, sleep disturbances
  • Neurological manifestations
  • Cognitive impairment, memory loss
  • Dry mouth
  • Fever

In addition to the symptoms above, blood tests often show elevated inflammatory markers. Biopsies may reveal silicone particles in tissues on pathological analysis. Radiographic studies such as MRI will often demonstrate the presence of illegal silicone with granulomas, scar tissue, fibrosis, and can assist the surgeon in the pre-operative planning process.

At our surgical practice in Miami, we proceed with radiographic evaluation: specialized MRI with IV contrast using the Miami Silicone MRI Protocol (MSRP), which is a protocol developed by an expert radiologist that Dr. Arthur has worked extensively with over the past several years. If you wish to fly to Miami for a consultation with Dr. Arthur, our staff can also coordinate your specialized MRI using the MSRP protocol as part of your preoperative planning.

What is the treatment for ASIA syndrome ?

Treatment for ASIA syndrome typically begins with removal of the inciting adjuvant. In cases involving illegal silicone injections, definitive management requires surgical debulking—removing as much of the silicone as possible. Following silicone debulking, most patients experience significant improvement in ASIA symptoms.

For patients who are not surgical candidates, choose not to undergo surgery, or that have residual symptoms following surgery, treatment focuses on symptom management rather than cure. Non-surgical options include anti-inflammatory medications and corticosteroids to reduce inflammation and pain, immunosuppressants for more severe cases, pain relievers, and physical therapy to support mobility and function. Interestingly, there is literature to suggest hydroxychloroquine (Plaquenil) as an immunomodulator to suppress the systemic response to the adjuvant and can (in some cases) allow a patient to have less symptoms until surgical excision can be performed.5 [Note that some patients may not be candidates for Plaquenil because it can cause QT-prolongation seen on EKG and thus result in (potentially fatal) cardiac arrythmias. Thus, it is critical that patients are under the supervision of a primary care doctor or cardiologist if they are going to be on chronic Plaquenil use.]
Separately, in a cohort study, vitamin D levels in silicone-implanted breast patients were shown to be inversely related to antibody levels (Relative risk 3.14, 95%CI: 1.24–7.59).6 Although there is no direct evidence that vitamin D supplementation works in ASIA syndrome / illegal silicone injections, this cohort study result suggests the possible beneficial role of the immunomodulatory action of vitamin D in preventing the subsequent antibody formation in silicone-implanted patients.

In cases involving illegal silicone injections, the definitive treatment for ASIA syndrome is surgical excision of the silicone, with surgery regarded as the gold standard. Following removal of the foreign material, patients typically experience a marked improvement in ASIA-related symptoms.

[1] Shoenfeld, Yehuda; Agmon-Levin, Nancy (February 2011). “‘ASIA’ – autoimmune/inflammatory syndrome induced by adjuvants”. Journal of Autoimmunity. 36 (1): 4–8. doi:10.1016/j.jaut.2010.07.003. ISSN 1095-9157. PMID 20708902.

[2] Hilton JD, Steinke K. Extensive migration of injected free liquid silicone for breast augmentation with related major complications. BJR Case Rep. 2015 May 15;1(2):20150098, https://pmc.ncbi.nlm.nih.gov/articles/PMC6159137/

[3] Sun H H, Sachanandani N S, Jordan B, Myckatyn T M. Sarcoidosis of the Breasts following Silicone Implant Placement. Plast Reconstr Surg 2013;131:939e–40e.

[4] Watad A, Sharif K, Shoenfeld Y. The ASIA syndrome: basic concepts. Mediterr J Rheumatol. 2017 Jun 27;28(2):64-69. doi: 10.31138/mjr.28.2.64. PMID: 32185259; PMCID: PMC7046028.

[5] Nunes E Silva D, Gründler C, Spengler MDGMT, Horimoto AMC, Machado MA, Frazão IC, Takita LC. Autoimmune Syndrome Induced by Adjuvants (ASIA) after Silicone Breast Augmentation Surgery. Plast Reconstr Surg Glob Open. 2017 Sep 25;5(9):e1487. doi: 10.1097/GOX.0000000000001487. PMID: 29062654; PMCID: PMC5640359.

[6] Colaris M J, van der Hulst R R, Tervaert J W. Vitamin D deficiency as a risk factor for the development of autoantibodies in patients with ASIA and silicone breast implants: a cohort study and review of the literature. Clin Rheumatol 2017:1–3.

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