Are Bacterial Growth and/or Chemotaxis Increased by Filler Injections? Implications for the Pathogenesis and Treatment of Filler-Related Granulomas

Abstract

Background: As microbial agents have been associated with late adverse effects related to fillers antibiotic treatment has been envisaged. Objective: To determine whether biomaterials favor bacterial growth and/or attract bacteria. Methods: Hyaluronic acid, semi-permanent fillers, such as calcium hydroxylapatite, and permanent fillers, such as polyalkylimide/polyacrylamide, were used. Experiments were performed with Escherichia coli, strain HVH-U47. Bacteria were transferred to Sven-Gard agar to test mobility. Striae of this bacterial strain with a MacFarland 1 turbulence pattern were seeded from a spot of inoculated biomaterial using Müller-Hinton medium. The chemoattractive properties of the biomaterials were analyzed 10 days after inoculation. Bacterial growth over the biomaterial and in-depth growth were assessed as well. Results: Semi-permanent fillers did not stimulate bacterial growth but they allowed bacterial colonization over the filler. Permanent acrylic compounds neither presented chemoattractant properties nor showed bacterial growth over the biomaterial. Similar results were obtained when performing in-depth cultures. Conclusions: Permanent and semi-permanent fillers did not facilitate bacterial growth when flagellated E. coli HVH-U47 was used. Our results do not argue in favor of antibiotics as the mainstay of therapy in late granulomas related to permanent fillers. In the case of resorbable/semi-permanent fillers, more studies are needed before recommending antibiotic therapy.

Oral granuloma formation after injection of cosmetic filler

“…corticosteroids can be also used due to their ability to control granulomatous reactions (Sanchis-Bielsa et al, 2009). Based on the association of late reactions to cosmetic fillers with infections, suggesting that bacteria and viruses might be involved in this process, some authors had suggested the use of antibiotic therapy (Christensen et al, 2005), but this does not represent a consensus and should not be a mandatory treatment (Alijotas-Reig and Garcia-Gimenez, 2008;Alijotas-Reig et al, 2010;Alijotas-Reig and Garcia-Gimenez, 2011). Surgical excision should be the last option, since foreign body granulomas extend in finger-shaped growth within the surrounding tissues ).…”

“…In spite of their wide use all over the world, the medical literature is full of reports and discussions of complications after the use of cosmetic fillers (Lemperle et al, 2004;Christensen et al, 2005;Lemperle et al, 2006;Anastassov et al, 2008;Alijotas-Reig and Garcia-Gimenez, 2008;Alijotas-Reig et al, 2010;Lemperle et al, 2010). More recently, dental journals have carried such reports in order to help surgeons, general dentists and oral pathologists to come to a correct diagnosis (Lombardi et al, 2004;Da Costa Miguel et al, 2009;Jham et al, 2009;SanchisBielsa et al, 2009;Mandel et al, 2010).…”

Probable biofilm formation in the cheek as a complication of soft tissue filler resulting from improper endodontic treatment of tooth 16

“…7 Especially with regard to the latter, hyaluronic acid has been used for drug delivery and therefore it has become of key importance to understand its relationship to pathogens and to study its effect on inflammatory mediators, the immune system, and markers of oxidative stress. For instance, hyaluronic acid has been used to transport chemotherapeutic drugs.…”

Hyaluronic Acid Dermal Fillers: Safety and Efficacy for the Treatment of Wrinkles, Aging Skin, Body Sculpturing and Medical Conditions

“…On the other hand, HA filler did not show chemoattractive properties or stimulate bacterial growth in experimental settings. 74 Further studies are needed to better understand the mechanism leading to granuloma formation.…”