I have some complications post Voluma injections, is biofilm formation probable? (Photo)

Thank you for sharing your question and photograph and I am sorry to hear of your Voluma issues.  If your left cheek fullness is along the area of Voluma placement I would recommend continuing treatment with a hyaluronidase to dissolve remaining filler and oral antibiotics to clear the infection/biofilm.  Because of the manufacturing that allows for its duration of effects, Voluma often requires larger and more frequent hyaluronidase treatments to clear.  Hope this helps.

First, let me say that is is rare and since you're in the business you should know that it's not the filler that is the problem, but the sterile technique. Some fillers today are designed to last a long time and sterile injection is a must! I don't believe a little wipe with 70% alcohol pad is enough for long lasting fillers. We have a 3 step approach including the initial alcohol wipe, then hibiclens, and then chloraprep. No one can drop the risks of infection to zero, but we feel this is the best approach for the lowest risk. Then the injector has to be sure their hands maintain sterility throughout the procedure. If your filler was Juvederm, the Vycross technology is suspected to lead to episodes of intermittent swelling and perhaps inflammation. That's why I never inject in the tear trough. Perhaps some product persist and it's time to try recombinant hyaluronidase (Hylenex) which might work better. Imaging with an MRI may also show if product remains in the tissue, but if no product is seen then you will have piece of mind. Speak with the physician who is supervising your work and see if you want to pursue this diagnosis more.Best wishes, Dr. ALDO

I would consult a board certified dermatologist for evaluation.  It is possible that more Vitrase needs to be injected to dissolve the product.  There may be an allergy or an underlying infection.  I would not have any other fillers injected until this is resolved.  Best, Dr. Green

This can happen with Voluma and Vobella. It needs to be dissolved. I use Hylenex for this. It doesn't look like infection but would add Bactrim. It is related Vycross manufacturing process it has been speculated. Firmness and swelling develop months to years later. Although not suspected, there are cases of atypical mycobacterium infections as well with similar presentations.

Only had one case in the several thousand that I have performed, but treated quite a few before from referrals. The EXACT cause is unknown, like Dr Weiner said, there are cases related to atypical mycobacterium infection, some related due to cross reaction of antigens, allergies, biofilm etc... I normally perform a full cross antigen screen (almost always negative), I add Prednisone, tapering over a month, an antihistamine, and also Bactrim or Doxycycline antibiotics. If this is does not resolve, you will need more Hylase under Pred cover. As for future fillers, this is contentious. Sure a test patch on the back can see if you react to Juvederm, however reactions are often delayed. IMO once every thing settles, I would use a different HA based product, even if there is a negative allergy test. Dr Davin Lim. Brisbane. Australia.