Importance: Dermal filler use in aesthetic clinics, are now widespread and although complications\nare rare, the formation of granulomas or abscesses and subsequent defects can be devastating to\nthe patient. Design: Retrospective chart review of 4 cases over the period of 10 years, from 2002-\n2012 were examined from The Nasal and Facial Plastic Cosmetic Surgery Institute. Results: Four\nfemale patients experienced delayed onset reactions (>2 weeks) with sterile abscess formation\nand eventual resolution with serial drainage and macrolide antibiotics were observed over a prolonged\nperiod until resolution occurred. Only 1 case identified an organism (streptococci) on culture\nafter 8 months, however, the initial culture still showed only sterile abscess. All 4 had a history\nof previous injectable fillers, 2 patients had evidence of pre existing autoimmune disorders.\nConclusions and Relevance: Since the treatment of all of these patients, there is new evidence that\ninfections may present as delayed onset sterile abscesses due to biofilm formation. Fluorescent in\nsitu hybridization (FISH) test has shown to be as specific in identifying responsible organisms in\nbiofilm infections as simple culture but is more sensitive; thus preventing misdiagnosis of sterile\nabscess. Counter intuitively steroid injection may promote abscesses, while hyaluronidase may be\nuseful.
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