Just diagnosed with biofilm infection. What will I look like following tear trough implant removal (silicone)? (photos)

I had under eye fat removal with tear trough implant (silicone) at the end of August. After complications started 1 month post op, ( residual swelling, occasional redness and red bumps that dissipate) I sought a second opinion ( my ps was baffled), and was diagnosed with biofilm infection. Implant removal was recommended. I'm terrified that I will look hollow and worse than I did before surgery. What can I expect to look like? When can I begin revisions? What type of procedures are available ?

Doctor Answers 7

Tear trough impant infection

I would agree that removal would be necessary since infections around implants usually do not resolve with antibiotics.  Most likely your postop appearance will be what she'll look like before the implants were placed.  Of course, you would want to wait at least  one month after the infection is completely resolved before considering any injectables (fillers).  This means that the induration , redness and/or tenderness has been completely resolved for at least 1 month ( preferably longer )  before ANY  fillers are injected. 


Santa Barbara Facial Plastic Surgeon
5.0 out of 5 stars 1 review

Infected tear trough implants

Taking a different approach, I think that permanent facial implants are problematic implants and should rarely be done, especially if fillers, even though temporary, could be done.

Infected implants need to be removed and will leave deformity, which could then be treated.

Richard O. Gregory, MD
Orlando Plastic Surgeon
5.0 out of 5 stars 11 reviews

Chronic infection of silicone implants should resolve after removal.

Your second photo appears to show redness by your left tear trough implant. I believe it would be unusual to have an infectious process like biofilm affecting both implants, however, inflammation and diffuse redness from biofilm is associated with HA injectable fillers where multiple treated areas appear red and inflamed. 

Without examining you, we cannot give specific advice for your situation. If there is chronic or recurrent inflammation of silicone implants, removal may be curative. 

Try not to worry about the after effects. Once swelling resolves after implant removal, there may be several options for addressing hollowing should it occur.

Keep us posted, and don't hesitate getting a third opinion from a specialist familiar with the placement and removal of silicone tear trough implants. Wishing you well moving forward. Dr Joseph


Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 397 reviews

Surgeons vary in their opinions regarding the timing of replacing an implant.

All implants have the possibility of becoming infected.  It is very hard to clear these infections with antibiotics.  The biofilm on the implant protects the bacteria from the antibiotics.  The only practical treatment is removal of the implant.  Generally I advise that the implant be removed in these circumstances.  Regarding the timing of replacing the implant, ideally the implant is replaced long after the tissues have healed.  I recommend 6 months but surgeons will have different ideas about this.  Obviously the area will look much less full than it does now.  When the implant is replaced, it is a good idea to use a different approach for its replacement rather than putting in through the mouth.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
4.9 out of 5 stars 23 reviews

Fillers Work Well For Tear Troughs & Under Eye Hollows

First, let me say how sorry I am that you are having this problem. From your description, it does seem prudent to remove the foreign body implants. Additional treatment with appropriate antibiotics and antiinflammatory agents may be needed. Once you are symptom free for several months, post-fat removal surgical hollows and residual tear troughs under the eyes may be addressed via the use of fillers, which has become one of the most common procedures in recent years as as a first choice in lieu of invasive surgical blepharoplasty and implant procedures. In experienced hands, filler injections usually take less than five minutes per under eye to perform, and the results typically engender an immediate "Wow!" reaction and little to no downtime. So, you can relax on this score. When the time comes, be sure you consult with a board certified aesthetic physician with experience and expertise in nonsurgical eye rejuvenation. And be certain to ask to see his/her before and after photos before agreeing to proceed. Wishing you the best.

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.8 out of 5 stars 23 reviews

Implants

Sorry about your problem. You certainly will look flatter, but if you wait a while perhaps fillers can be used to make up for the difference.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Tear trough implants

Tough to say that this is an actual biofilm without a biopsy and culture.  However if you have chronic inflammation over any implant that does not respond to antibiotics, they need to be removed.  You will be a little flat initially.  Once everything is non-inflammed you should be able to put some HA filler in there.  BUt need to wait until all evidence of injection and inflammation resolved. 

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 25 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.