What to do when you have a really serious filler problem and doctors don’t seem to help.

Restylane filler 6 months ago left me with swelling and pain after weeks. My dermatologist administered Hyaluronidase to dissolve it. She also started me on antibiotics. By the second month, no improvement on the filler problem. I saw an infectious disease specialist. He had no suggestion. I continued to receive Hyaluronidase shots weekly (sometimes several times a week) to try and dissolve the filler. Biopsy in May was inconclusive and did not show biofilm, which I understand is difficult to culture. At this writing, It's been 6 months since fillers and I still have a large hard, very tender lump on my right cheek. I've just finished a round of prednisone which did nothing. I've been through three long rounds of anti-biotics which ruined my gut. My dermatologist changed dissolving compounds and is now trying Vitrase (sp?) and it does not seem to be working either. Over the 6-month time frame, we have eliminated all apparent filler, swelling, and infection on my left cheek, however the right cheek filler, infection, and swelling is still there. My doctor seems to be doing everything she can think of - but I made an appointment to see a plastic surgeon. Trying to stay hopeful. If you have any suggestions, I would greatly appreciate it.

I’m really glad you wrote, and my heart goes out to you. These types of situations are discouraging and scary. I get so many questions from people with a dermal filler problem. I’d like to answer your question with some specific ideas for you personally, and then more generally for our broader audience. On a side note, I really like though that your dermatologist is trying and going through the right steps. She hasn’t abandoned you and is really trying to help you.

The key sentence in your account above is “Biopsy in May was inconclusive and did not show biofilm, which I understand is difficult to culture.” For those who don’t know, there is a type of infection called a biofilm. This is a low-grade infection (kind of like an inflammation in your gums or an ingrown toe) where the bacteria are sitting in the filler (really just a temporary implant right?) and not spreading, but also not going away.

Here are some thoughts for you to consider with your doctors:

  • In my opinion, the most accurate diagnosis possible is the key to effective therapy.  Right now, you don’t have a definitive diagnosis.
  • Why was the biopsy inconclusive?   Was it deep enough?   Was it enough tissue (say a 4mm punch biopsy versus a 2 mm)?  Was it strained for special strains for bacteria, fungi and AFB (acid fast bacteria)?
  • Was the biopsy sent for regular pathology (called H&E)?  Was it also sent for actual tissue culture in the lab to have two different methods of trying to get an accurate idea of whether there is a biofilm?   You’re correct that they can be difficult to prove.
  • Consider a third opinion in a larger city (not sure where you live).   For example, is there a Mayo clinic or Cleveland clinic somewhere near you?

What to do (and not do) when your doctors don’t seem to be able to figure something out?

  • Educate yourself as much as you can by reading, but understand that much of what you read on the web will not be helpful for your situation.
  • Bring a list of about 3-6 questions for your doctor. If you have a lot more than that, understand your doctor may not be able to get to all of them in one visit.  Depends on how complicated they are.
  • Be respectful, but direct. It’s reasonable to ask if there are other doctors in the community who might be able to help you.
  • Consider going to a larger city with a larger, more well-known medical center. Medical doctors who specialize in rare or difficult problems, are often found in these larger centers.
  • Try to keep copies of key reports like biopsies and cultures, to save time when you are getting other opinions.
  • Good doctors will never mind the request for another opinion. It’s a warning sign, if a doctor is defensive about this.
  • Don’t be hostile, rude, insulting or eye roll. Like every other human interaction, that won’t get the results you are looking for.

Hope this helps and good luck, Dr. I


More on dermal filler problems, how to treat and avoid them here.

Dr. Brandith Irwin, MD

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Hi, I’m Dr. Irwin. I believe that consumers deserve a medically trained and unbiased skin care advocate.

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