After injecting fillers for over 20 years, I had my first biofilm complication this past year. It seemingly occurs as surface skin bacteria gets injected along with the product. Voluma is dense cross-linked product that acts as a safe-harbor for the bacteria to hide and evade macrophages and other local immune responses. I was able to successfully treat it with intralesional hyaluronidase, intralesional Kenalog and oral antibiotics. To minimize the chance of this complication from arising, antiseptic cleansing should be done as diligently as possible.
