Biofilms are responsible for adverse reactions that occur after cosmetic injections. Earlier it was assumed that these adverse effects are due to allergic reactions, but some recent studies demonstrated the association between bacterial biofilm and these adverse reactions. The occurrence of these bacterial biofilms may compromise the safety of patients and the effectiveness of cosmetic treatments at the injection site.
What Is a Biofilm?
A biofilm is a cluster of microorganisms in which the cells are attached to each other or to a surface and are enclosed in a self-secreted extracellular protective and sticky network of a polymeric material. Biofilms are typically found on solid surfaces that have been immersed in or exposed to aqueous solutions. In nature, they are widely dispersed.
In the human body, biofilms can occur in a lot of situations, such as attaching to a surface or following exposure to antibiotics in sublethal doses. Such surfaces may be produced by artificial devices, such as breast implants and prosthetic valves, or by dermatological procedures, such as fillers and cheek implants.
What Are the Disadvantages of Biofilm?
A new study suggests that many complications after cosmetic injections like hyaluronic acid filler injections are caused by biofilms rather than allergies or other inflammatory reactions.
Bacterial biofilms may inhibit wound healing of skin by decreasing the effectiveness of topical antibacterials, which are applied to the skin.
Usually, a polymeric material that provides antibiotic resistance covers the biofilm. These biofilms are in a dormant condition (low-grade infection), but trauma, hematogenous infection, or iatrogenic manipulation can result in an active infection.
How Does Biofilm Form After Cosmetic Injection?
Although biofilms can contain a wide range of microorganisms, including bacteria, protozoa, and fungi, a biofilm model colonized by Pseudomonas aeruginosa has been extensively studied. The different stages of development of a biofilm are:
1. Bacterial Attachment to the Surface:
The formation of a biofilm starts with the localization, concentration, and attachment of free-floating bacteria around a surface, which is usually across an infective focus.
2. Formation of Microcolony:
The bacteria become trapped in the adhesive matrix of polymeric substance along with cells (leucocytes), producing microcolonies that are resistant to antibiotics. The matrix of polymeric substances is made up of Deoxyribonucleic acid (DNA), proteins, and polysaccharides. This matrix protects the cells inside it and also allows them to communicate with one another by biochemical signals. These chemical signals contribute to the transfer of nutrients to the developing bacteria in the biofilm.
3. Maturation of Biofilm:
The bacterium subsequently enters the biofilm formation phase, where a large number of genes are differentially regulated. The biofilm develops and matures through a conjunction of cell division and recruitment. The development phase is the final stage of biofilm production, during which the biofilm is fully formed and can only alter in shape and size. Antibiotic resistance is a common feature in such fully formed bacterial colonies. During these phases of development, the bacteria also acquire flagella, pili, DNA, and a matrix of a polymer substance.
4. Dispersion of Biofilm:
The bacteria in the biofilm produce some bioactive compounds that non-aggregated bacteria of the same species do not produce. This results in the dispersion of biofilm. During the dispersion phase, the biofilm secretes a protective barrier made of carbohydrates. Increased antibiotic resistance has been observed in this barrier. The biofilm's dispersion may result in the spread and creation of new colonies.
In addition, depending on the external triggering factor, the biofilm can be dormant or active. When a cell's metabolism stops, it goes dormant (sleeping). As a result, it is no longer treatable with antibiotics and difficult to culture too. Any interruption in its local environment, such as trauma, injection, or manipulation, causes it to become active, resulting in symptoms such as local low-grade infection, abscess, local lumps, foreign body granuloma, nodule, or systemic infection.
What Are the Complications Caused by Biofilm?
Biofilm formation can cause some side effects or complications after cosmetic injections. These side effects are:
How Can Biofilm Formation Be Prevented?
Prevention of biofilms is essential in cosmetic procedures. Cosmetic injections of fillers are frequently administered in an office environment to target areas like the lips and acne-prone facial skin that have a lot of residing bacteria. As a result, appropriate pre-and post-procedure aseptic precautions should be taken to prevent infection. The precautionary measures to be taken to prevent biofilms are:
Before injecting the filler, the target area must be thoroughly cleaned with an antiseptic solution such as povidone-iodine.
Following the injection of fillers, it is advised to use Mupirocin (topical antibiotic) ointment locally.
The patient should be instructed to report any discomfort, tenderness, or pain appearing after the injection in the treated region, and it should be treated immediately with antibiotics.
Although prophylactic antimicrobial therapy with a single dosage of a broad-spectrum antibiotic has been advocated for the prevention of biofilm, its function is not yet completely established.
Multiple injection locations, as well as injections through the oral mucosa, should be avoided to prevent biofilm formation.
How Are Biofilm Complications Treated?
Earlier it was thought that the symptoms of adverse reactions were caused by allergy to the filler material, so the treatment included antihistamines, steroids, and Nonsteroidal anti-inflammatory drugs (NSAIDs). However, after new research, it is accepted that these adverse reactions are caused by biofilm. Therefore, broad-spectrum antibiotics, such as Ciprofloxacin, Amoxicillin, or Clarithromycin, are included as an effective treatment strategy for up to six weeks.
Steroids and NSAIDs should be avoided.
Removal of the filler material. For example, hyaluronidase is used to remove hyaluronic acid.
What Is the Outcome of the Biofilm Infected Cosmetic Injections Procedure?
Unfortunately, patients may not be very satisfied with the aesthetic results following the recovery of an activated biofilm formation. It may result in contractile scars or facial asymmetries that require plastic surgery or dermato-cosmetic treatments.
Cosmetic injections can cause serious complications sometimes. The proper dermal antiseptic solution should be used, and all the precautions should be administered before proceeding with the injections to prevent biofilm formation.