March 10, 2020

Bacterial infection as a result of a dermal filler procedure is rare with some data reporting between 1 in 500 to 1 in 2500  people experiencing this complication.

It is key that aesthetic clinicians understand that bacterial infection, even though it is rare, has a variety of outcomes which spans across both ends of the spectrum in terms of severity.


A mild case of inflammation caused by dermal filler would mean mild inflammation while the body is killing off the offending bacteria.

On the other hand, clients may see an abscess formation or contract septicaemia.


Diagnosis of Bacterial Infection

The criteria which you can use to diagnose a bacterial infection is as follows:

  • Erythema
  • Oedemea
  • Warmth
  • Pain & Tenderness

Unfortunately, these symptoms are identical to most side-effects which create inflammation after an aesthetic procedure such as post-procedural swelling or allergic reactions.

The challenges for practising clinicians lies in understanding the difference between immune reaction, infection and normal post-procedural swelling.


How to retain accuracy when diagnosing Bacterial Infection

The earliest part of the inflammatory response from infection may occur within 2 to 24 hours, and isolated to one specific point on the face.

For example, I have experienced several cases where itching and redness at the oral commissure was a clear first sign of an infection.

The initial infected symptoms include pain along with tenderness and redness. These signs will typically occur within the first week between days 2 and 6.

The formation of an abscess occurs between day 6 and 14.


Normal post-procedural inflammation has some overlap but tends to peak at 6 hours and then start to reduce.

Allergy is more likely to react all over the face in the first 24 hrs and swell wherever the product resides.

Infection tends to swell a little later, more gradually and only in one localised place rather than in all sites of injection.

The overlap of these symptoms illustrates why it is common to treat for both allergy and infection.


The types of skin infection as a result of bacterial infection

The different layers of skin are associated with different types of skin infection and different strategies of side-effect management.

There is an anatomical relationship between the position of the infection and the nature of the infection.

Naturally, there is a significant overlap and a discrete diagnosis is not always possible as infections may have multiple different characteristics.

The 3 different types of skin infection you will see are:

    1. Impetigo
    2. Erysipelas
  1. Cellulitis

Overall the most common cause of skin infection is staphylococcus aureus. This bacteria is famous for its high risk of resistance.


Skin Infection Management

Impetigo – 

impetigo caused by dermal filler

On the top layer of skin the stratum corneum the infection appears as impetigo, resulting in crusty lesions with a golden colour.

The superficiality of this infection makes it best treatable with topical antibiotics. Oral antibiotics are less effective indicating the need for precise diagnosis.

Erysipelas –

erysipelas caused by dermal filler

Erysipelas affects the next skin layer down: the superficial epidermis – which can be recognised by three key features:

  • Very well-demarcated borders of infection
  • Raised bumps
  • Bright ‘salmon’ red skin colour.

It is usually caused by a beta-hemolytic streptococcus and lesions can spread quite rapidly and need urgent treatment.

One possible treatment could involve IV antibiotics depending on the presence of systemic effects and severity of the infection.


Cellulitis – 

It is a deeper subcutaneous infection and has a pink hue with less defined edges.

It is very hard to culture but usually arises from Staphylococcus aureus or streptococcus pyogenes.

Necrotizing fasciitis (NF) is an infection that involves the superficial or deep fascia in association with necrosis of tissue. In practice, this infection tends to involve all layers of tissue including muscle.


To Conclude

The overall risk of bacterial infection from a dermal filler treatment is low, but it can happen.

As a medical practitioner you have a duty of care to all clients.

It is vital you have the necessary knowledge & skill if this was to ever happen to you in your aesthetics practice.

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