Abscess Formation as a Complication of Injectable Fillers
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.
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.
Cite this paper
Conrad, K. , Alipasha, R. , Thiru, S. and Kandasamy, T. (2015) Abscess Formation as a Complication of Injectable Fillers. Modern Plastic Surgery, 5, 14-18. doi: 10.4236/mps.2015.52003.
Conrad, K. , Alipasha, R. , Thiru, S. and Kandasamy, T. (2015) Abscess Formation as a Complication of Injectable Fillers. Modern Plastic Surgery, 5, 14-18. doi: 10.4236/mps.2015.52003.
References
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[1] Mah, T.F. and O’Toole, G.A. (2001) Mechanisms of Biofilm Resistance to Antimicrobial Agents. Trends in Microbiology, 9, 34-39. http://dx.doi.org/10.1016/S0966-842X(00)01913-2 [2] Almeida, C., Azevedo, N.F., Santos, S., Keevil, C.W. and Vieira, M.J. (2011) Discriminating Multi-Species Populations in Biofilms with Peptide Nucleic Acid Fluorescence in Situ Hybridization (PNA FISH). PLoS ONE, 6, e14786. http://dx.doi.org/10.1371/journal.pone.0014786 [3] Caristo, E., Parola, A., Rapa, A., et al. (2008) Clarithromycin Resistance of Helicobacter pylori Strains Isolated from Children’ Gastric Antrum and Fundus as Assessed by Fluorescent in-Situ Hybridization and Culture on Four-Sector Agar Plates. Helicobacter, 13, 557-563. http://dx.doi.org/10.1111/j.1523-5378.2008.00642.x [4] Juhna, T., Birzniece, D., Larsson, S., et al. (2007) Detection of Escherichia coli in Biofilms from Pipe Samples and Coupons in Drinking Water Distribution Networks. Applied and Environmental Microbiology, 73, 7456-7464. http://dx.doi.org/10.1128/AEM.00845-07 [5] Forrest, G.N., Roghmann, M.-C., Toombs, L.S., et al. (2008) Peptide Nucleic Acid Fluorescent in Situ Hybridization for Hospital-Acquired Enterococcal Bacteremia: Delivering Earlier Effective Antimicrobial Therapy. Antimicrobial Agents and Chemotherapy, 52, 3558-3563. http://dx.doi.org/10.1128/AAC.00283-08 [6] Foreman, A., Jervis-Bardy, J., Boase, S.J., Tan, L. and Wormald, P.-J. (2013) Noninvasive Staphylococcus aureus Biofilm Determination in Chronic Rhinosinusitis by Detecting the Exopolysaccharide Matrix Component Poly-N-Acetyl-glucosamine. International Forum of Allergy & Rhinology, 3, 83-88. http://dx.doi.org/10.1002/alr.21115 [7] (2012) Materials: SLIPS Blitz Biofilms. Nature, 488, 133. http://dx.doi.org/10.1038/488133d [8] Wong, T.-S., Kang, S.H., Tang, S.K.Y., et al. (2011) Bioinspired Self-Repairing Slippery Surfaces with Pressure-Stable Omniphobicity. Nature, 477, 443-447. http://dx.doi.org/10.1038/nature10447 [9] Epstein, A.K., Wong, T.-S., Belisle, R.A., Boggs, E.M. and Aizenberg, J. (2012) Liquid-Infused Structured Surfaces with Exceptional Anti-Biofouling Performance. Proceedings of the National Academy of Sciences of the USA, 109, 13182-13187. http://dx.doi.org/10.1073/pnas.1201973109 [10] Lewis, K. (2007) Persister Cells, Dormancy and Infectious Disease. Nature Reviews Microbiology, 5, 48-56. http://dx.doi.org/10.1038/nrmicro1557 [11] Dayan, S.H., Arkins, J.P. and Brindise, R. (2011) Soft Tissue Fillers and Biofilms. Facial Plastic Surgery, 27, 23-28. http://dx.doi.org/10.1055/s-0030-1270415 [12] Eppley, B.L., Sadove, A.M., Holmstrom, H. and Kahnberg, K.E. (1995) HTR Polymer Facial Implants: A Five-Year Clinical Experience. Aesthetic Plastic Surgery, 19, 445-450. http://dx.doi.org/10.1007/BF00453878 [13] Eppley, B.L., Summerlin, D.J., Prevel, C.D. and Sadove, A.M. (1994) Effects of a Positively Charged Biomaterial for Dermal and Subcutaneous Augmentation. Aesthetic Plastic Surgery, 18, 413-416. http://dx.doi.org/10.1007/BF00451350