Although the concept of a biofilm is well established in other fields such as dentistry and chronic infections,1-3 it is a relatively new concept in medical aesthetics and dermatology. The role of biofilms in adverse reactions post injection of dermal fillers is attracting increasing attention. Reported adverse reactions include nodules, abscesses, delayed reactions, vascular compromise and infection.4-9 Although rare, these may occur, in particular with long-acting dermal fillers, partially or completely non-resorbable polymers,4,10 and may persist for months causing anxiety for the patient and the practitioner.1 Due to the culture results being negative and a lack of successful identification of the causative bacteria, adverse events were in the past thought to be allergic or foreign body reactions.6 However, some of these reactions are now believed to be caused by the formation or as…
