TITLE:
Abscess Formation as a Complication of Injectable Fillers
AUTHORS:
K. Conrad, Rassouli Alipasha, Siva Thiru, Thileeban Kandasamy
KEYWORDS:
Injectable Filler, Abscess, Biofilm, FISH Test, Hyaluronidase
JOURNAL NAME:
Modern Plastic Surgery,
Vol.5 No.2,
April
2,
2015
ABSTRACT: Importance: Dermal
filler use in aesthetic clinics, are now widespread and although complications
are rare, the formation of granulomas or abscesses and subsequent defects can
be devastating to the patient. Design: Retrospective chart review of 4 cases over
the period of 10 years, from 2002-2012 were examined from The Nasal and Facial
Plastic Cosmetic Surgery Institute. Results: Four female patients experienced
delayed onset reactions (>2 weeks) with sterile abscess formation and
eventual resolution with serial drainage and macrolide antibiotics were
observed over a prolonged period until resolution occurred. Only 1 case
identified an organism (streptococci) on culture after 8 months, however, the
initial culture still showed only sterile abscess. All 4 had a history of
previous injectable fillers, 2 patients had evidence of pre existing autoimmune
disorders. Conclusions and Relevance: Since the treatment of all of these
patients, there is new evidence that infections may present as delayed onset
sterile abscesses due to biofilm formation. Fluorescent in situ hybridization (FISH) test has shown to be as specific in
identifying responsible organisms in biofilm infections as simple culture but
is more sensitive; thus preventing misdiagnosis of sterile abscess. Counter
intuitively steroid injection may promote abscesses, while hyaluronidase may be
useful.