title: The management of biofilm formation after hyaluronic acid gel filler injections: a review.
abstract: OBJECTIVE
  One of the most popular procedures of facial fillers in recent years has become the use of hyaluronic acid (HA). However, this method may be associated with local side effects of different severity. Many of them are not due to allergies, as previously believed, but to the formation of biofilm. We review the current knowledge on biofilm after HA.
  
  
  METHODS
  All pertinent full text papers retrieved from PubMed under search words: "biofilm", "hyaluronic acid", "dermal fillers", "hyaluronic acid complications" and "hyaluronic acid side effects" were analyzed; 29 of 60 articles were selected fro analysis.
  
  
  RESULTS
  Local infections were reported: 13 cases are attributable to the activation of the biofilm. Clinical evolution is generally mild. Therapy should avoid NSAID and is based on the administration of antibiotics, oral corticosteroids, or 5-Flourouracil. Removal of HA with hyaluronidase has also been proposed.
  
  
  CONCLUSIONS
  The use of HA in cosmetic procedures might be accompanied by local adverse effects attributable to biofilm formation. This usually has a mild evolution, but in special cases requires specific therapy.
authors.affiliation: Dept. of Plastic Surgery and Reconstructive Microsurgery, Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, Romania.
authors.forename: Dinu I
authors.initials: DI
authors.lastname: Dumitraşcu
authors.affiliation: Dept. of Plastic Surgery and Reconstructive Microsurgery, Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, Romania.
authors.forename: Alexandru V
authors.initials: AV
authors.lastname: Georgescu
keywords: biofilm; complications; fillers; hyaluronic acid