title: Relationship between delayed reactions to dermal fillers and biofilms: facts and considerations.
abstract: BACKGROUND
  Delayed reactions associated with dermal fillers have often been attributed to hypersensitivity reactions; however, the evolving literature suggests that biofilms may represent an underrecognized cause and a difficult diagnosis to establish. As implanted devices become more popular, biofilms present an increasing risk to patients.
  
  
  OBJECTIVE
  The mechanism of action for biofilm formation, diagnostic challenges, and methods to recognize biofilms will be reviewed. These are increasingly important for physicians who implant these devices and for those who see patients with implanted devices.
  
  
  METHODS
  We review the relevant literature and explore some of these issues.
  
  
  CONCLUSIONS
  Preventative measures may decrease delayed reactions and biofilm formation after injection of dermal fillers. Infection through biofilms should be considered and carefully evaluated to ensure timely treatment.
authors.affiliation: *General Surgical and Aesthetic Dermatology, University of Miami, Miami, Florida; †Allergan Medical, Santa Barbara, California.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Beer
authors.forename: Rui
authors.initials: R
authors.lastname: Avelar
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001672:Biocompatible Materials / Q000009:adverse effects; D018441:Biofilms; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000139:chemically induced* / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy*; D019736:Prostheses and Implants / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents; D001672:Biocompatible Materials