Filler Nodules: Inflammatory or Infectious? A Review of Biofilms and Their Implications on Clinical Practice

Ibrahim, Omer; Overman, J R; Arndt, Kenneth A.; Dover, Jeffrey S.

doi:10.1097/dss.0000000000001202

Cited by 39 publications

(39 citation statements)

References 56 publications

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“…The role of biofilms in granuloma formation has been evoked by some experts, 122 and is debated among physicians. Anyway, infection has to be ruled out, or else antibiotherapy should be initiated.…”

Section: Treatment Guidelines For Pcl Filler Complicationsmentioning

confidence: 99%

Polycaprolactone: How a Well-Known and Futuristic Polymer Has Become an Innovative Collagen-Stimulator in Esthetics

Christen¹,

Vercesi²

2020

CCID

111

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Compared to other domains, tissue engineering and esthetics have dramatically expanded in recent years, leading to both major biomedical advances and futuristic perspectives. The two share a common approach based on biomaterials, especially polymers. This paper illustrates this with the example of polycaprolactone (PCL), a polymer synthesized in the early 1930s, and one of its most recent applications, a PCL-based collagen stimulator, a filler used in esthetics. PCL is biocompatible and biodegradable. Its specific physicochemical and mechanical properties, viscoelasticity and ease of shaping led to the production of PCL-based products with various shapes and durations dependent on its biodegradation kinetics. PCL has been safely used in the biomedical field for more than 70 years, from sutures to tissue and organ replacement by 3D printing. The PCL-based collagen stimulator is composed of PCL microspheres suspended in a carboxymethyl-cellulose gel carrier providing immediate and sustained volumizing effects when injected; the morphology, the biocompatibility of the PCL microspheres embedded with the collagen fibers produced all contribute to the creation of a unique 3D scaffold for a sustained effect. Its safety has been investigated in clinical studies and vigilance surveys. Recently published experts' recommendations on injection modalities and techniques should help further optimize treatment outcome and safety. This paper also integrates reviews and recommendations on the prevention and management of adverse events related to dermal and subdermal fillers including the PCL-based collagen stimulator. In addition, in terms of efficacy and safety, this product benefits from its daily clinical use in esthetics worldwide and continuous extensive fundamental and clinical research, both on it and the PCL polymer. Forthcoming data from further investigations will reinforce knowledge of the product and procedures in the field.

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Section: Treatment Guidelines For Pcl Filler Complicationsmentioning

confidence: 99%

Polycaprolactone: How a Well-Known and Futuristic Polymer Has Become an Innovative Collagen-Stimulator in Esthetics

Christen¹,

Vercesi²

2020

CCID

111

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“…Polymerase chain reaction (PCR), fluorescent insitu hybridization, and electron microscopy of tissue specimens may be contributory in establishing the infectious agent. 19 A biopsy and tissue culture should be obtained if there is no resolution following treatment. 8,16,17,19 Ultrasound imaging is considered as diagnostic "gold standard" in several publications, 10 based on its abilities to specify the exact location of delayed-onset nodules in relation to other structures, as well as to demonstrate the density of the filler composition.…”

Section: Discussionmentioning

confidence: 99%

“…According to the literature, the first-line treatment of choice is antibiotics, 7,13,[16][17][18][19][20][21][22] and the use of dual or triple antibiotic therapy is favored. 7,13,[18][19][20][21] Several authors recommend combining therapy with broadspectrum antibiotics (ie, fluoroquinolones) and a macrolide, such as clarithromycin, 7,[17][18][19][20][21] to be taken over a period of several weeks. Macrolides are considered especially effective due to their ability to restrain quorum sensing along with their ability to accumulate in adipose tissue, bearing in mind that fillers are mostly located in fat.…”

Section: Discussionmentioning

confidence: 99%

“…16 Antibiotic treatment should be based on results of cultures, and a macrolide may be considered for 2-4 weeks in the event that no laboratory diagnosis has been reached. Other first-line options include IL hyaluronidase, 12,18,19 IL steroids, 5,22 or the combination of both. 5,18,22,23 Hyaluronidase enables the bond between C4 of the glucuronic acid and C1 of the glucosamine to disintegrate, whereupon the HA undergoes hydrolysis.…”

Section: Discussionmentioning

confidence: 99%

“…12 The most popular choice for second-line therapy is IL steroids. 12, 13,[16][17][18][19][20][21]23 To further reduce the number of complications secondary to IL steroids as well as temporary skin atrophy, many authors have suggested reconstitution of steroids with other agents, such as 5-FU, lidocaine, or saline. Alternative options for second-line treatments are antibiotic therapy, 12,23 IL hyaluronidase, 7,16,17 IL 5-FU, 22,23 radiofrequency therapy, 18,21 laser therapy, 21,23 human platelet-rich plasma, 12 or extraction of the material with a 16-gauge needle and a syringe while applying negative pressure.…”

Section: Discussionmentioning

confidence: 99%

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Delayed Inflammatory Reactions to Hyaluronic Acid Fillers: A Literature Review and Proposed Treatment Algorithm

Artzi¹,

Cohen²,

Dover³

et al. 2020

CCID

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Background and Objectives: There is a wide diversity of opinions regarding the management of delayed inflammatory reactions (DIRs) secondary to hyaluronic acid (HA)-based fillers. The plethora of approaches has led the authors to conduct a review regarding management and treatment of DIRs as well as establish therapeutic guidelines for this purpose. Materials and Methods: A review of the literature was performed through databases such as PubMed using keywords including HA-fillers and complications, delayed HA filler sequelae and therapy, soft tissue and dermal filler reactions and management. Additionally, a survey comprised of questions regarding the management and treatment of DIRs was sent to 18 physicians highly experienced with soft-tissue filler injections in 10 countries. Their answers and recommendations were analyzed and debated amongst these panelists. Results: Sixteen panelists favored antibiotic therapy as first-line treatment for DIRs, specifically dual antibiotic therapy consisting of a fluoroquinolone along with a tetracycline or macrolide for a period of 3-6 weeks. The majority refrained from the use of intralesional (IL) or systemic steroids except in the case of disfiguring or recalcitrant reactions. IL hyaluronidase was recommended by 13 panelists; however, some preferred a watchful waiting approach for a period of 48 hours to 2 weeks prior to IL hyaluronidase, and in cases where antibiotics did not lead to improvement. Conclusion: A consensus was reached and summarized to propose a clear, easy-to-follow, stepwise algorithm for the treatment of DIRs.

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Delayed sclerosing granulomatous reaction to dermal filler injection of poly‐hydroxyethyl‐methacrylate suspended in hyaluronic acid: Histochemical and confocal laser scanning microscopical analysis

Capodiferro

Sportelli

Limongelli

et al. 2019

Clinical Case Reports

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Filler Nodules: Inflammatory or Infectious? A Review of Biofilms and Their Implications on Clinical Practice

Abstract: Awareness of biofilm infections is key in the assessment of filler reactions in order to ensure timely and accurate diagnosis and treatment.

Cited by 39 publications

References 56 publications

<p>Polycaprolactone: How a Well-Known and Futuristic Polymer Has Become an Innovative Collagen-Stimulator in Esthetics</p>

<p>Polycaprolactone: How a Well-Known and Futuristic Polymer Has Become an Innovative Collagen-Stimulator in Esthetics</p>

<p>Delayed Inflammatory Reactions to Hyaluronic Acid Fillers: A Literature Review and Proposed Treatment Algorithm</p>

Delayed sclerosing granulomatous reaction to dermal filler injection of poly‐hydroxyethyl‐methacrylate suspended in hyaluronic acid: Histochemical and confocal laser scanning microscopical analysis

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