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*Treatment results may vary
here is another article i found from a doctor in NY that also talk about the laser removal method
Dr. Narins
New York — Experts believe many side effects of fillers are caused by biofilms, but these infections are difficult to document because biofilms are hard to culture, says Rhoda Narins, M.D., of the Dermatology Surgery & Laser Center, New York, and clinical professor of dermatology, New York University Medical Center, New York.
Once a biofilm is suspected, however, choosing the right course of action is critical in effectively managing the condition.
Community of bacteria
Biofilms are complex collections of bacteria that behave differently than single bacteria, excreting a protective and adhesive matrix, Dr. Narins says.
"As biofilms progress, they become more antibiotic and culture resistant," she says. The matrix allows the community of bacteria cellular protection. "They can communicate through different biochemical signals and the bacteria ... cooperate."
Biofilms live in a quiescent state, but an active infection can be triggered by dental manipulation, trauma or other factors.
"It's a low-grade smoldering infection with a low response from the host," Dr. Narins says. "The bacterial activity is very low."
But biofilm can cause a local infection, a systemic infection or a granulomatous or inflammatory response.
"There are lots of things that can happen once you activate a biofilm," she says.
Treating the infection
While the physician plans a course of action, antibiotic treatment is the first step in treating a patient with suspected biofilm, even if the culture is negative. Dr. Narins says intralesional steroids should not be used before antibiotics; doing so can prolong the problem.
If a patient with a hyaluronic acid filler calls about a bump that is pain-free and not inflamed, Dr. Narins says the clinician can check the patient in a couple of weeks. If the bump is painful, red, or both, the doctor should see the patient for treatment.
After beginning treatment with an antibiotic in a patient with a hyaluronic acid filler, Dr. Narins suggests using hyaluronidase, making a nick in the skin and trying to press the substance out, or using a 16-gauge needle attached to a syringe with negative pressure on the plunger to extract the substance.
"With any biofilm, whether it's a permanent or a shorter-acting filler, once you get rid of the substance, you get rid of the biofilm," she says.
For polymethylmethacrylate fillers, she says, Daniel Cassuto, M.D., of Milan, has a laser that can melt the plastic of the substance so that it pours out of the area; however, the laser is not available in the United States.
Clinicians also can excise the material to get rid of the filler, which eliminates the biofilm.
Warning signs
In the long term, biofilms can cause a persistent nodule or granuloma or recurrent infection or abscess.
"Sometimes you have no choice. If you have a patient on one or two antibiotics and you can't excise or use hyaluronidase on the area, you might have to chronically treat it with antibiotics or treat it with intralesional steroids just to get it down," Dr. Narins says, "but you would not do that until after the patient is on an antibiotic and you've tried to get rid of it another way."
In some cases, filler problems may not be caused by a biofilm but by the body's response to the product.
"For instance, something like Sculptra (poly-L-lactic acid, Medicis) is a substance that causes the body to make collagen and occasionally it makes too much collagen in an area," she says. "The nodule, which is not red but just a firm nodule, may be due not to a biofilm, but just to overproduction for some reason of collagen."
Some filler materials, such as Artefill (collagen gel/polymethylmethacrylate, Suneva Medical), may respond only to a very high dose of Kenalog (triamcinolone acetonide, Bristol-Myers Squibb), but the patient should be warned of the risk of atrophy, she says.
Proceed with caution
Fortunately, biofilms are very rare with most filler products used in the United States, Dr. Narins says, but it's important to take precautions to prevent infection when injecting fillers. Clinicians should follow normal infection-prevention procedures, such as injecting the product as sterilely as possible and making sure the face is as clean as possible.
When signs of a biofilm are evident, however, the proper treatment is critical. "When you see a reaction to fillers, don't start with steroids immediately," Dr. Narins says. "Think about using an antibiotic first."
Disclosures: Dr. Narins has been an investigator and consultant for many filler companies.
New York — Experts believe many side effects of fillers are caused by biofilms, but these infections are difficult to document because biofilms are hard to culture, says Rhoda Narins, M.D., of the Dermatology Surgery & Laser Center, New York, and clinical professor of dermatology, New York University Medical Center, New York.
Once a biofilm is suspected, however, choosing the right course of action is critical in effectively managing the condition.
Community of bacteria
Biofilms are complex collections of bacteria that behave differently than single bacteria, excreting a protective and adhesive matrix, Dr. Narins says.
"As biofilms progress, they become more antibiotic and culture resistant," she says. The matrix allows the community of bacteria cellular protection. "They can communicate through different biochemical signals and the bacteria ... cooperate."
Biofilms live in a quiescent state, but an active infection can be triggered by dental manipulation, trauma or other factors.
"It's a low-grade smoldering infection with a low response from the host," Dr. Narins says. "The bacterial activity is very low."
But biofilm can cause a local infection, a systemic infection or a granulomatous or inflammatory response.
"There are lots of things that can happen once you activate a biofilm," she says.
Treating the infection
While the physician plans a course of action, antibiotic treatment is the first step in treating a patient with suspected biofilm, even if the culture is negative. Dr. Narins says intralesional steroids should not be used before antibiotics; doing so can prolong the problem.
If a patient with a hyaluronic acid filler calls about a bump that is pain-free and not inflamed, Dr. Narins says the clinician can check the patient in a couple of weeks. If the bump is painful, red, or both, the doctor should see the patient for treatment.
After beginning treatment with an antibiotic in a patient with a hyaluronic acid filler, Dr. Narins suggests using hyaluronidase, making a nick in the skin and trying to press the substance out, or using a 16-gauge needle attached to a syringe with negative pressure on the plunger to extract the substance.
"With any biofilm, whether it's a permanent or a shorter-acting filler, once you get rid of the substance, you get rid of the biofilm," she says.
For polymethylmethacrylate fillers, she says, Daniel Cassuto, M.D., of Milan, has a laser that can melt the plastic of the substance so that it pours out of the area; however, the laser is not available in the United States.
Clinicians also can excise the material to get rid of the filler, which eliminates the biofilm.
Warning signs
In the long term, biofilms can cause a persistent nodule or granuloma or recurrent infection or abscess.
"Sometimes you have no choice. If you have a patient on one or two antibiotics and you can't excise or use hyaluronidase on the area, you might have to chronically treat it with antibiotics or treat it with intralesional steroids just to get it down," Dr. Narins says, "but you would not do that until after the patient is on an antibiotic and you've tried to get rid of it another way."
In some cases, filler problems may not be caused by a biofilm but by the body's response to the product.
"For instance, something like Sculptra (poly-L-lactic acid, Medicis) is a substance that causes the body to make collagen and occasionally it makes too much collagen in an area," she says. "The nodule, which is not red but just a firm nodule, may be due not to a biofilm, but just to overproduction for some reason of collagen."
Some filler materials, such as Artefill (collagen gel/polymethylmethacrylate, Suneva Medical), may respond only to a very high dose of Kenalog (triamcinolone acetonide, Bristol-Myers Squibb), but the patient should be warned of the risk of atrophy, she says.
Proceed with caution
Fortunately, biofilms are very rare with most filler products used in the United States, Dr. Narins says, but it's important to take precautions to prevent infection when injecting fillers. Clinicians should follow normal infection-prevention procedures, such as injecting the product as sterilely as possible and making sure the face is as clean as possible.
When signs of a biofilm are evident, however, the proper treatment is critical. "When you see a reaction to fillers, don't start with steroids immediately," Dr. Narins says. "Think about using an antibiotic first."
Disclosures: Dr. Narins has been an investigator and consultant for many filler companies.
aquamid- polyacrylamide disaster update!!! permanent filler removal
update
since a few days ago i started having lumps appear inside of my lips that aren't noticeable to the naked eye but i can feel the tingling sensation and i feel it with my tongue and to the touch. its been very stressful. I contacted Dr Ellis in Toronto he said he has no experience removing aquamid but could try the same method as bio-alcamid and artecoll and see if it works. i went ahead and made a consultation with him and I'm going to make a decision based on the consutation but i feel like it would be a waste of time to be honest as he has no experience with aquamid.
i had the fillers done in my lips at a young age i was stupid and naive i wish i could go back to that day and reverse this damage i did to myself. my friend at the time had fillers done with him and her lips looked fine without any complications and i was told the fillers last 2 years. here i am 7 years later with my lips deformed.
i have been doing extensive research and most people that had successful results removing permanent fillers had it removed by a laser in main theres 3 sourgeons that do them Dr Daniel Cassuto (well known professor that has cured many permanent filler cases from the face), Dr Raffaele siniscalco ( facial reconstructive surgeon very popular in europe you can find his videos on youtube and website dannidafiller.com)Dr nicola zerbinati (all from Itally i think Milan he also has treated successful cases with permanent filler)
i feel like at this point i have no choice but to go try this laser procedure in Italy a lot of women were very happy with the results some require 2 or 3 sessions 2 months apart each depending on the type of filler and the amount. it suppose to liquify the filer and it just pours out of the whole i contacted Dr raffaele he said 500 euro a session.
since a few days ago i started having lumps appear inside of my lips that aren't noticeable to the naked eye but i can feel the tingling sensation and i feel it with my tongue and to the touch. its been very stressful. I contacted Dr Ellis in Toronto he said he has no experience removing aquamid but could try the same method as bio-alcamid and artecoll and see if it works. i went ahead and made a consultation with him and I'm going to make a decision based on the consutation but i feel like it would be a waste of time to be honest as he has no experience with aquamid.
i had the fillers done in my lips at a young age i was stupid and naive i wish i could go back to that day and reverse this damage i did to myself. my friend at the time had fillers done with him and her lips looked fine without any complications and i was told the fillers last 2 years. here i am 7 years later with my lips deformed.
i have been doing extensive research and most people that had successful results removing permanent fillers had it removed by a laser in main theres 3 sourgeons that do them Dr Daniel Cassuto (well known professor that has cured many permanent filler cases from the face), Dr Raffaele siniscalco ( facial reconstructive surgeon very popular in europe you can find his videos on youtube and website dannidafiller.com)Dr nicola zerbinati (all from Itally i think Milan he also has treated successful cases with permanent filler)
i feel like at this point i have no choice but to go try this laser procedure in Italy a lot of women were very happy with the results some require 2 or 3 sessions 2 months apart each depending on the type of filler and the amount. it suppose to liquify the filer and it just pours out of the whole i contacted Dr raffaele he said 500 euro a session.
Aquamid is Poison
i had aquamid injected in my lips for the first few years it looked
fine, but its a ticking time bomb its not a matter of if its a matter of
when the side effects will start to show. i have been doing extensive
research on this and thankfully found out that there is a way to remove
it without surgery by laser in Italy and apparently there have been a
lot of successful cases so if you do already have it injected don't give
up hope. stay away from any kind of permanent filler!!!! i wish someone
would have warned me before i did it too
fine, but its a ticking time bomb its not a matter of if its a matter of
when the side effects will start to show. i have been doing extensive
research on this and thankfully found out that there is a way to remove
it without surgery by laser in Italy and apparently there have been a
lot of successful cases so if you do already have it injected don't give
up hope. stay away from any kind of permanent filler!!!! i wish someone
would have warned me before i did it too
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