Complications after liquid body contouring with site-enhancing oil injections


      Liquid body contouring by intramuscular injection of site-enhancing oils (SEOs) for muscle volume enlargement has increasingly become a popular practice in bodybuilding. Its immediate and long-term health consequences remain ambiguous, and postinjection complications are sparsely documented in medical literature. We report a series of patients presenting with postinjection complications upon self-attempted liquid body contouring through injection of SEOs. Ten patients visited our departments for plastic and reconstructive surgery for variable local and systemic complications. All patients gave a history of single or multiple SEO use and presented on average nine years postinjection with variable complications. Most patients experienced painful nodular indurations and swellings in the injected target muscles. Two patients showed signs of infection including erythema, fever, and local inflammatory findings. One patient presented additionally with a severe form of nonparathyroid hypercalcemia. Four patients ultimately underwent surgical treatment. The use of SEOs for liquid body contouring is a dangerous practice and is associated with potentially systemic and life-threatening complications. Surgical treatment may be the only therapeutic option in advanced cases and should be performed timely. Guidelines on diagnostic and therapeutic measures are warranted. Educational measures should be undertaken to raise awareness among athletes and medical professionals.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinics in Dermatology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Glicenstein J.
        Les premiers “fillers”, vaseline et paraffine. Du miracle à la catastrophe [The first “fillers”, vaseline and paraffin. From miracle to disaster].
        Ann Chir Plast Esthét. 2007; 52 ([in French]): 157-161
        • Pupka A
        • Sikora J
        • Mauricz J
        • Cios D
        • Płonek T.
        The usage of synthol in the body building.
        Polim Med. 2009; 39: 63-65
        • Banke I
        • Prodinger P
        • Waldt S
        • et al.
        Irreversible muscle damage in bodybuilding due to long-term intramuscular oil injection.
        Int J Sports Med. 2012; 33: 829-834
        • Munch IC
        • Hvolris JJ.
        Bodybuilding ved hjaelp af intramuskulaer injektion af valnøddeolie [Body building aided by intramuscular injections of walnut oil].
        Ugeskr Laeger. 2001; 163 ([in Danish]): 6758
        • Ghandourah S
        • Hofer MJ
        • Kießling A
        • El-Zayat B
        • Schofer MD.
        Painful muscle fibrosis following synthol injections in a bodybuilder: a case report.
        J Med Case Rep. 2012; 6: 248
        • Sisti A
        • Huayllani MT
        • Restrepo DJ
        • et al.
        Oil injection for cosmetic enhancement of the upper extremities: a case report and review of literature.
        Acta Biomed. 2020; 91e2020082
        • Prosperi-Porta G
        • Oleynick C
        • Vaughan S.
        Myositis from intramuscular oil injections in a bodybuilder.
        CMAJ. 2020; 192: E480
        • Figueiredo VC
        • da Silva PRP.
        Cosmetic doping—when anabolic–androgenic steroids are not enough.
        Subst Use Misuse. 2014; 49: 1163-1167
        • Gitz-Johansen G
        • Als AB
        • Pallesen KAU.
        A case of severe side effect due to muscle oil injections in combination with chemotherapy in a former bodybuilder.
        Clin Case Rep. 2021; 9: e04444
        • Petersen E
        • Lee K
        • Yao C
        • Jahan-Tigh R
        • Thomas V.
        No pain no gain: tender nodules in a competitive bodybuilder.
        Dermatol Online J. 2018; 24 (13030/qt5w91h58x)
        • Fink J
        • Schoenfeld BJ
        • Hackney AC
        • et al.
        Anabolic-androgenic steroids: procurement and administration practices of doping athletes.
        Phys Sportsmed. 2019; 47: 10-14
        • Hall M
        • Grogan S
        • Gough B.
        Bodybuilders’ accounts of synthol use: the construction of lay expertise online.
        J Health Psychol. 2016; 21: 1939-1948
      1. Brennan R, Overbye M, Van Hout MC, McVeigh J. “A slippery slope”: a scoping review of the self-injection of unlicensed oils and fillers as body enhancement. Perform Enhance Health.2021;8:100185.

        • Hameed M
        • Sahu A
        • Johnson MB.
        Muscle mania: the quest for the perfect body.
        BMJ Case Rep. 2016; 2016bcr2016217208
        • Khanna P
        • Khatami A
        • Swiha M
        • Rachinsky I
        • Kassam Z
        • Berberich AJ.
        Severe hypercalcemia secondary to paraffin oil injections in a bodybuilder with significant findings on scintigraphy.
        AACE Clin Case Rep. 2020; 6: e234-e238
        • Pehlivanov G
        • Kavaklieva S
        • Kazandjieva J
        • Kapnilov D
        • Tsankov N.
        Foreign-body granuloma of the penis in sexually active individuals (penile paraffinoma).
        J Eur Acad Dermatol Venerol. 2008; 22: 845-851
        • Ahmed U
        • Freeman A
        • Kirkham A
        • Ralph D
        • Minhas S
        • Muneer A.
        Self injection of foreign materials into the penis.
        Ann R Coll Surg Engl. 2017; 99: e78-e82
        • Sølling ASK
        • Tougaard BG
        • Harsløf T
        • et al.
        Non-parathyroid hypercalcemia associated with paraffin oil injection in 12 younger male bodybuilders: a case series.
        Eur J Endocrinol. 2018; 178: K29-K37
        • Gyldenløve M
        • Rørvig S
        • Skov L
        • Hansen D.
        Severe hypercalcaemia, nephrocalcinosis, and multiple paraffinomas caused by paraffin oil injections in a young bodybuilder.
        Lancet. 2014; 383: 2098
        • Visnyei K
        • Samuel M
        • Heacock L
        • Cortes JA.
        Hypercalcemia in a male-to-female transgender patient after body contouring injections: a case report.
        J Med Case Reports. 2014; 8: 71
        • Di Benedetto G
        • Pierangeli M
        • Scalise A
        • Bertani A.
        Paraffin oil injection in the body: an obsolete and destructive procedure.
        Ann Plast Surg. 2002; 49: 391-396
        • Ikander P
        • Nielsen AM
        • Sørensen JA.
        Injektion af synthololie hos bodybuilder gav kroniske sår og deformerende ar [Injection of synthol in a bodybuilder can cause chronic wounds and ulceration].
        Ugeskr Laeger. 2015; 177 ([in Danish])V12140642
        • Iversen L
        • Lemcke A
        • Bitsch M
        • Karlsmark T.
        Compression bandage as treatment for ulcers induced by intramuscular self-injection of paraffin oil.
        Acta Derm Venereol. 2009; 89: 196-197