Can Restylane Injections Cause Infections?

What type of streptococcus bacteria is Restylane fermented from?

Doctor Answers 5

There are no bacteria in Restylane

Restylane is derived, in the lab, from the fermentation of equine streptococcus, which is a form of beta-hemolytic strep. The important point is that the bacteria are used to create the chemical that is then processed into Restylane. There are no streptococci in Restylane, just like there is not Botulinum bacteria in Botox and no bread mold in penicillin.

Any filler can result in an infection. However that would most likely be the result of bacteria on your skin or in your system, not the bacteria used to create the product. Fortunately, infections following hyalauronic acid fillers are very rare.

Hope this is helpful.

Philadelphia Oculoplastic Surgeon
4.8 out of 5 stars 24 reviews

Streptococcus Equi

Restylane is prepared from a fermentation process using a bacteria Streptococcus equi. This particular strain was chosen because it produces copious amounts of hyaluronic acid. It is then cross linked using a small amount of BDDE (butanediol diglycidyl ester). Since Restylane uses esterification in its process, it tends to be a bit "stiffer" than its Juvederm cousin. Also, the rare allergic reaction stems from a tiny remnant of BDDE which might be left over.

There is no danger of a bacterial infection since Q Med, the Swedish company that produces Restylane, uses the hyaluronic acid produced by the bacteria and not the bacteria itself.

Certainly you can get an infection. The skin should be properly cleansed and sterile technique employed rigorously. You certainly could get an infection from the dental block if this is performed. ( I received one when I was undergoing dental work last year myself.).

Also, as Dr. Janjua mentioned, you can develop an outbreak of herpes labialis since we are working around the mouth. This hopefully would be recognized early and treated appropriately.

Arnold R. Oppenheim, MD
Virginia Beach Dermatologist
4.7 out of 5 stars 14 reviews

Restylane causing Strep Infection

I am not sure whic Streptococcus is used to ferment Restylane but I doubt you could get an infection from Restylane because of that process. It is possible to get a herpetic breakout (cold sore) which can then get infected by streptococcus or more likely staphlococcus. However, that is not related to the product.

Improper handling i.e, not cleaning the skin with alcohol, not washing hands, not wearing gloves can transfer bacteria (staph or strep) to the injection sites and cause infection.

I have seen herpetic breakouts in areas other than lips as well and can look like mild blisters. Be on the look out for them as they can be hard to diagnose.


Tanveer Janjua, MD
Bedminster Facial Plastic Surgeon
5.0 out of 5 stars 107 reviews

Restylane, BOTOX, Facial contouring, cosmetic surgery

Dear Awalk,

Restylane itself can not/will not cause an infection. You can develop an infection at the site of the injection by bacteria from the skin being introduced to the site...... however this is very unusual. i have seen 2 infections over the past many years and very few other minor complications. Restylane is a very safe soft tissue filler and can be used in the nasal folds as approved by the FDA and off label in many other areas of the face and body.

With Warm Regards,

Trevor M Born MD

Trevor M. Born, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 115 reviews

Restylane and skin infections

If an infection is caused by an injection, it is the bacteria on the skin that creates the infection. The gram positive streptococcus bacteria is used in the laboratory for synthesis of the product, but the living bacteria do not get incorporated into the product so they would not be the cause of the infection.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 37 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.