Staphylococcal and streptococcal infections can lead to abscesses and cellulitis, which require a broad spectrum oral antibiotic therapy (Figure 6). Mycobacterium chelonae and Mycobacterium abscesses infection have also been shown after using contaminated fillers and usually documented as delayed onset infections.21,22 Biofilm formation over the dermal fillers has also been demonstrated and can lead to a variety of side effects including cellulitis, nodules, abscesses, or granulomatous inflammation, which can present even years after dermal filler injections. Infections may also result from recent medical or dental procedures in the vicinity of dermal filler injection area. For instance, dental root infections or professional tooth cleaning can cause filler complications, such as infections that can mimic a dental infection.23
Empiric antibiotic therapy with two or three classes of antibiotics is recommended in cases of suspected biofilms while waiting for the PCR.24 Another treatment option for the management of biofilm is low doses of triamcinolone with 5-fluorouracil injected into the lesion, which has been hypothesized to act by interacting with AriR, a regulatory gene that inhibits the formation of biofilm.6 The risk of infection with filler injection can be minimized by using an aseptic injection, using the smallest gauge needle possible technique, reducing the number of piercings while injecting, and avoiding injecting into infected or inflamed skin, and avoiding injecting through previously injected filler.25 Systemic Reactions PMMA-induced hypercalcemia is a potentially deadly adverse event that has been reported with high volume injections even years after filler placement. Clinical symptoms resemble those of rheumatic disorders and includemyalgia, arthralgia, and fatigue. 26
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