Actinomyces infection after permanent fillers lip augmentation: Diagnosis and treatment

Background:\r\nAlthough dermal filler injections are a widespread and secure practice, early or late complications may nonetheless occur.\r\nObjective:\r\nIn this paper, the authors report an unusual asymptomatic late filler infection caused by Actinomycetes in a patient having received liquid silicone\r\nand acrylate filler injections for lip enhancement, seeking treatment for upper lip macrocheilia.\r\nMethods:\r\nThe case report is about a patient who complained of recurrent lip region edema and denied any infective episodes. Preoperative analysis was in the\r\nnormal range. Sonographic exam showed two fillers in the upper lip, suggestive of silicone and polyacrylamide gel. A conservative macrocheilia\r\nreduction was performed; healing was uneventful.\r\nResults:\r\nHistology report confirmed the preoperative sonographic diagnosis, together with an actinomycetes infection, clinically unsuspected. Many\r\nmicroorganisms have been reported to cause abscesses or granuloma after dermal filler treatments, sterile abscesses were reported as well,\r\nsuggesting a biofilm infection as causative granuloma origin.\r\nConclusion:\r\nThis study differs from previous filler complication reports because of the occasional finding of a silent actinomyces infection, a commensal of the\r\noral cavity but responsible for suppurative diseases in the soft tissues. This occasional finding seems to support the biofilm origin of dermal filler\r\ngranuloma.