摘要
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.
