Published: February 23, 2015

Dr. Sue Ellen Cox mentions an International Journal of Nanomedicine article that touches on an issue being discussed among some of the nation’s leading cosmetic dermatologists. Could HA fillers, dental work and biofilm (infections) be related?

I take great pride in helping patients look and feel younger as a dermatologic surgeon. Among the more popular treatments at Aesthetic Solutions, hyaluronic acid (HA) fillers offer an effective treatment for moderate to severe wrinkles, as well as volume loss in the mid-face and other areas. Hyaluronic acids are complex sugar molecules that naturally occur in the body, and recent estimates indicate over 2 million Americans received HA fillers for cosmetic use in 2014.

There have been rare reports of biofilm, a type of localized infection, occurring coincident with filler treatments. We take great care to assure sterile injection sites, and in what may be an overly cautious approach, I’ve long suggested patients avoid dental work shortly before and after filler treatment. That’s because fillers are essentially implants, and implants are susceptible to biofilm. Anything injected with the filler, or migrating to the filler after injection can become a problem. Dental work may shed bacteria into the bloodstream, and that’s something we want to avoid around the time we’re implanting a filler.

A recent article in the International Journal of Nanomedicine caught my eye. The article, titled “Probable Biofilm Formation in the Cheek as a Complication of Soft Tissue Filler Resulting From Improper Endodontic Treatment of Tooth 16,” examined the case of a 37-year-old patient who experienced an abscess in the cheek more than a month after filler injections. The infection was successfully treated, but I’m sure it was something both the patient and physician would rather not have happened.

While there isn’t enough data to establish a definitive correlation, it’s simple enough to take precautions. If you’re planning to get a filler treatment, don’t schedule dental work a month before or after the treatment. Select an experienced and informed cosmetic physician, with well trained staff and proper facilities. HA fillers are a safe and effective mainstay in cosmetic dermatology. Complications are rare, and treatable. I’ll let you know as more data become available.

— Sue Ellen Cox, MD