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How would I know if I have a biofilm infection?

Dr. Dean Kane Q & A

Q. How would I know if I have a biofilm infection? I am 28 years old and 2 years ago I had Restylane under my eyes (I can feel the product.) At the same time, I don’t want to try vitrase because am afraid to do anything with my face again . I have half moon edges and they are unsymmetrical under my eyes …and wrinkles just keep increasing. I can wait a little longer, but will it eventually fade? And how do I know that I don’t have a biofilm infection. I am so afraid. I have just edges, no bumps and no pain. Is it possible to have biofilm after 2 years (delayed)?

A. ​Biofilms are a interesting chapter in the understanding of infection. It is best understood that skin surface bacteria are introduced under the skin with injections or devices. The bacteria change character and do not produce the active infection process we understand but develop a protective coat and “hibernate”. If these bacteria are visible to our immune system they will be broken down but due to their protective cocoon, they may sleep for months and years particularly around a foreign body such as a injectable or device.

​In the case of hyaluronic acid gels fillers, the normal process of breakdown by human hyaluronidase will eventually rid the site of the filler molecules, thus leaving the biofilm and bacteria without a attachable surface. This more exposes the bacteria to immune exposure and breakdown. At any time, the bacteria may revert back to their free form and generate the infective process as we normally know it with redness, swelling, heat and pain. Antibiotics will help at this time but not during the dormant stage.

​The use of Vitrase (exogenous hyaluronidase injection) will more quickly breakdown the filler and possibly create an environment for the bacteria to inflame the tissues. If you and your injector are considering this for a biofilm concern, you should be followed closely for an infection to flare.

​The length of time you have had your fillers injected, 2 years, makes me suspicious that without signs of injection, the filler and any biofilm concerns are gone. The concerns regarding asymmetry and wrinkles may simply be natural variations and aging and should be again re-evaluated by a Board Certified Plastic Surgeon or Dermatologist for their recommendations.

​I hope this was helpful! All the best!


This information is not meant as medical advice. It is provided solely for education. Our practice would be pleased to discuss your unique circumstances and needs as they relate to these topics.

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