Nonsurgical means of rejuvenation are plentiful. Some of them I use in my plastic surgery practice: Restylane, Perlane, Botox, Juvederm, Sculptra, and some of them I do not: Artefill, Radiesse, free liquid silicone. As we become more informed as science progresses, we are looking at injectable fillers a little differently. When a patient has a complication from the filler: a granuloma or nodule, we have chalked this up to inflammation. But what if it is a low grade infection? what if it is biofilm?
For those patients who do the HA fillers (hyaluronic acid fillers like Restylane, Perlane, and Juvederm) and for those who do Botox, you are low risk.
But this idea of biofilm may explain why people have delayed issues with long acting fillers. Free silicone was used by some doctors in the early 80s to treat acne pit scars and other issues. It stopped because of issues. What you saw years later was the silicone encapsulated and became a hard little ball. These balls would spit out as well. Why? Some of this hardening and forming little balls may have been due to inflammation and scar.
But a new theory is this may be due to biofilm. The idea is the biofilm leads to more inflammation and perhaps a low grade infection.
At the TIPS meeting in San Francisco, June 2011, I heard a talk about biofilm and fillers. It is rare to see someone symptomatic with this. The speakers said higher risk products were:
- volumizing
- long lasting (last more than a year)
- mass volume
- foreign bodies, which cause a capsule response (like artefill and free silicone)
- immunosuppressed patients
- acne / sebaceous patients
So the higher risk products would be Radiesse, Artefill, Sculptra, and any “permenant” foreign filler (not fat). For my patients, the largest risk would be in Sculptra patients. What can you do?
- Avoid make up before and after the injection for 8 hours
- Avoid injecting in the lips (which we do not do with Sculptra)
- Do not do injection if you have an active acne infection
- Good skin prep
- Consider an antibiotic prophylaxis before doing any major dental work or cleaning
If anyone has swelling, redness, or any odd reaction after injection, please see your doctor immediately. Of note, this reaction is rare and will be delayed. In this talk at the TIPS meeting they described it as happening a year out. This is new information, but one to be heeded. I had a patient who had an odd swelling episode months after her last Sculptra injection. She had Sculptra for over two years with three prior injections with no issue. When she got this odd swelling, she had no fevers, no elevated white count. But she had facial swelling that came on quickly and left quickly after a few days. It puzzled all the doctors around her.
Education and Prevention: It is part of why I went to this talk, and I will incorporate what I have learned. Though this is rare, as long acting (more than one year) filler use grows, safety is key.