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Semin Plast Surg 2016; 30(02): 083-086
DOI: 10.1055/s-0036-1580734
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Etiology, Prevention, and Management of Infectious Complications of Dermal Fillers

Ryan D. Wagner
1   Division of Plastic and Reconstructive Surgery, Baylor College of Medicine, Houston, Texas
,
Abdulla Fakhro
1   Division of Plastic and Reconstructive Surgery, Baylor College of Medicine, Houston, Texas
,
Joshua A. Cox
1   Division of Plastic and Reconstructive Surgery, Baylor College of Medicine, Houston, Texas
,
Shayan A. Izaddoost
1   Division of Plastic and Reconstructive Surgery, Baylor College of Medicine, Houston, Texas
› Author Affiliations
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Publication History

Publication Date:
04 May 2016 (online)

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Abstract

The demand for aesthetic augmentation with soft tissue fillers has greatly increased in recent years and has led to an expansion in the number of products available. Unfortunately, an increase in adverse events has followed. These can be categorized into early, late, and delayed. Early infectious complications generally present as a localized skin infection, cellulitis, or abscess. Fillers can also serve as a focus for chronic infection, which is associated with the development of foreign body granulomas, a late complication. Bacterial colonization and indolent infections of the filler site can lead to biofilms that are extremely difficult to treat. Therefore, it is important to focus on prevention through eliciting a thorough patient history including an injection history, practicing sterile technique, and minimizing tissue trauma. Looking forward, much can be done to curtail complication rates. Early teaching and training, a central recording registry for complications, and a standardized filler passport for patients are suggested.

Keywords

fillers - infectious complications - foreign body granuloma - biofilm
 

  • References

  • 1 Rohrich RJ, Ghavami A, Crosby MA. The role of hyaluronic acid fillers (Restylane) in facial cosmetic surgery: review and technical considerations. Plast Reconstr Surg 2007; 120 (6, Suppl) 41S-54S
    CrossrefPubMedGoogle Scholar
  • 2 Monheit GD, Rohrich RJ. The nature of long-term fillers and the risk of complications. Dermatol Surg 2009; 35 (Suppl. 02) 1598-1604
    CrossrefPubMedGoogle Scholar
  • 3 The American Society for Aesthetic Plastic Surgery. Cosmetic Surgery National Data Bank statistics. Aesthet Surg J 2014; 34 (1) (Suppl. 01) 1-20
    CrossrefPubMedGoogle Scholar
  • 4 Sherman RN. Avoiding dermal filler complications. Clin Dermatol 2009; 27 (3) S23-S32
    Google Scholar
  • 5 Beasley KL, Weiss MA, Weiss RA. Hyaluronic acid fillers: a comprehensive review. Facial Plast Surg 2009; 25 (2) 86-94
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Bray D, Hopkins C, Roberts DN. A review of dermal fillers in facial plastic surgery. Curr Opin Otolaryngol Head Neck Surg 2010; 18 (4) 295-302
    CrossrefPubMedGoogle Scholar
  • 7 Kablik J, Monheit GD, Yu L, Chang G, Gershkovich J. Comparative physical properties of hyaluronic acid dermal fillers. Dermatol Surg 2009; 35 (Suppl. 01) 302-312
    CrossrefPubMedGoogle Scholar
  • 8 Rohrich RJ, Monheit G, Nguyen AT, Brown SA, Fagien S. Soft-tissue filler complications: the important role of biofilms. Plast Reconstr Surg 2010; 125 (4) 1250-1256
    PubMedGoogle Scholar
  • 9 Alam M, Dover JS. Management of complications and sequelae with temporary injectable fillers. Plast Reconstr Surg 2007; 120 (6, Suppl) 98S-105S
    CrossrefPubMedGoogle Scholar
  • 10 Lemperle G, Rullan PP, Gauthier-Hazan N. Avoiding and treating dermal filler complications. Plast Reconstr Surg 2006; 118 (3, Suppl) 92S-107S
    CrossrefPubMedGoogle Scholar
  • 11 Funt D, Pavicic T. Dermal fillers in aesthetics: an overview of adverse events and treatment approaches. Plast Surg Nurs 2015; 35 (1) 13-32
    CrossrefPubMedGoogle Scholar
  • 12 Beer K, Avelar R. Relationship between delayed reactions to dermal fillers and biofilms: facts and considerations. Dermatol Surg 2014; 40 (11) 1175-1179
    CrossrefPubMedGoogle Scholar
  • 13 Bjarnsholt T, Tolker-Nielsen T, Givskov M, Janssen M, Christensen LH. Detection of bacteria by fluorescence in situ hybridization in culture-negative soft tissue filler lesions. Dermatol Surg 2009; 35 (Suppl. 02) 1620-1624
    CrossrefPubMedGoogle Scholar
  • 14 Christensen L, Breiting V, Janssen M, Vuust J, Hogdall E. Adverse reactions to injectable soft tissue permanent fillers. Aesthetic Plast Surg 2005; 29 (1) 34-48
    CrossrefPubMedGoogle Scholar
  • 15 Arron ST, Neuhaus IM. Persistent delayed-type hypersensitivity reaction to injectable non-animal-stabilized hyaluronic acid. J Cosmet Dermatol 2007; 6 (3) 167-171
    Google Scholar
  • 16 Rzany B, DeLorenzi C. Understanding, avoiding, and managing severe filler complications. Plast Reconstr Surg 2015; 136 (5, Suppl) 196S-203S
    CrossrefPubMedGoogle Scholar
  • 17 Mertz PM. Cutaneous biofilms: friend or foe?. Wounds 2003; 15 (5) 129-132
    PubMedGoogle Scholar
  • 18 Bailey SH, Cohen JL, Kenkel JM. Etiology, prevention, and treatment of dermal filler complications. Aesthet Surg J 2011; 31 (1) 110-121
    CrossrefPubMedGoogle Scholar
  • 19 Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR ; Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Guideline for Prevention of Surgical Site Infection, 1999. Am J Infect Control 1999; 27 (2) 97-132 , quiz 133–134, discussion 96
    CrossrefPubMedGoogle Scholar
  • 20 Cassuto D, Sundaram H. A problem-oriented approach to nodular complications from hyaluronic acid and calcium hydroxylapatite fillers: classification and recommendations for treatment. Plast Reconstr Surg 2013; 132 (4) (Suppl. 02) 48S-58S
    CrossrefPubMedGoogle Scholar
  • 21 Gelfer A, Carruthers A, Carruthers J, Jang F, Bernstein SC. The natural history of polymethylmethacrylate microspheres granulomas. Dermatol Surg 2007; 33 (5) 61-620
    PubMedGoogle Scholar