Do I have a biofilm infection from Juvederm voluma? (photos)
Doctor Answers 7
Causes of biofilm infections, how to treat them, and avoiding them altogether
To first give you a bit about my background — I’m a Board-certified cosmetic surgeon and a Fellowship-trained oculofacial plastic and reconstructive surgeon, practicing in Manhattan and Long Island for over 20 years. I use injectable fillers like Juvederm and Juvederm Voluma quite frequently in my practice, so I can certainly help you with your concern.
Biofilm is basically the presence of some kind of a bacteria that can lay on top of an implant, so it generally occurs in implant placement procedures such as breast augmentation and the like. In terms of injectable fillers, fillers can actually have bacteria travel with it or even bacteria conceived within that filler, and later cause some type of infection. One of the things that makes it difficult for biofilm to be treated, for example with breast implants, is that there is often a capsule or space where there is direct blood supply and that’s where bacteria can stay and remain dormant for extremely long periods of time, until it is triggered.
A concern I have is how people perceive injectables. People will think of surgical procedures as being invasive, but consider injectables to be non-invasive. Personally, I treat the injectable fillers the same way I treat surgery, because this is something going through and under your skin. I do everything with a very high level of sterility and we also have a specific process and protocol in place for such procedures. I would say that certain fillers also have an advantage over other fillers in terms of the risk of potential biofilm.
Ideally, more details and information regarding your medical history are needed to make a more accurate diagnosis, but I think that the issue of whether this is biofilm or just delayed hypersensitivity reaction to the material is almost unimportant. If someone like yourself came to my practice with the same type of symptoms of swelling and tenderness, I would do something to treat inflammation, treat infection, and then do something dissolve the Juvederm.
Patients who’ve had biofilm problems from implants have often needed extensive antibiotic treatment and required additional surgery to remove some of this implanted material. This is where a hyaluronic acid filler like Juvederm is advantageous, as it can be easily dissolved. In our practice, we also treat patients with biofilm problems with the help of platelet-rich plasma, which stimulates improved blood supply.
I recommend that you go back to the doctor who performed this procedure and go over your medical history with them — there could be an instance of sinusitis, sinusitis infection, or dental procedure within the time frame of you having this experience that is contributing to these symptoms. This is something that you don’t want to wait on and should have treated right away.
I hope that was helpful and I wish you the best of luck!
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Voluma Reaction Under Eye
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It may need some antibiotics, cortisone injections, or hyaluronidase injections.
Belotero Balance, Teosyal Redensity II, Restylane Silk Are More Appropriate Injectable Fillers For Use Under The Eyes
Going forward, it would be wise to discuss the use of Beletero Balance (My choice in my Upper East Side Manhattan practice) or Restylane Silk or Teosyal Redensity II (My favorite in my Israel satellite facility, where a far greater number of regulatory agency approved fillers and volumizers are available.) Beletero has little to no tendency to give rise to the unwanted, bluish Tyndall Effect when injected superficially within the delicate under eye skin.
The history and the appearance in the photo do suggest the possibility of a Biofilm reaction, although allergy or simply swelling from the tissue fluid-attraction properties of hyaluronic acid are other potential causes.
If a biofilm, I have found the use of oral antibiotics combined with intralesional anti-inflamatory injections and/or hyaluronidase to be extremely helpful. If simply allergy or tissue fluid retention, simple antiinflammatory injections and hyaluronidase are ordinarily enough to bring about resolution.
Once resolution is achieved, prior-to-retreatment intradermal testing to various agents might be in order to find a suitable injectable for your continuing needs.
Be sure that you are being treated by a board certified aesthetic physician with experience and expertise in the more advanced uses of fillers and volumizers for nonsurgical facial and periorbital rejuvenation.
Reaction from Voluma under the eyes
Voluma is not meant to be injected under the eyes. It could be that you have a biofilm infection or that you have an allergic reaction to the Voluma. Please have the product dissolved and contact a professional who is experienced with these cosmetic fillers as well as the reactions. Best, Dr. Green
Is this biofilm infection?
It is possible that there is biofilm contributing to the Voluma and the clinical history fits, namely the timing of the swelling a month after and the intermittent exacerbation.
Antibiotics should be initiated by the injecting physician and careful reassessment made to see if Vitrase injections can help break down the extracellular matrix to allow 1) breakdown of product and 2) help efficacy of the antibiotics.
Biofilm infections are stubborn to treatt and once diagnosed, require aggressive treatment.