Who wants to look “mah-vel-ous, dahling”? Lots, apparently. Nearly two million visits to cosmetic dermatologists are made each year for dermal filler gel injections for fuller, luscious lips or smooth, wrinkle-free skin. But as dermal filler gel injections become more popular, dangerous side effects become more common, too. In fact, serious side effects from dermal filler gels have tripled since 2005, according to the FDA.

To make matters worse, some estheticians and dermatologists are in denial about the cause of some of these side effects. Rather than admitting that they are caused by bacterial infection—as research is showing—they are blaming them on allergic reactions and treating with them corticosteroids, which can interfere with the skin’s ability to fight off infections, making the situation worse. But when the right precautions are taken, bacterial infections associated with dermal filler gel use can be avoided.


A group of Danish researchers have taken up the task to prove that bacterial buildup is what’s causing some of the bad reactions, such as swelling and the appearance of pustules or subdermal bumps, that sometimes happen at the site of the gel injection. This group recently confirmed earlier research that some dermal filler gels are the perfect breeding ground for biofilms, bacteria that clump together to live and thrive when they find the ideal environment.

First, the researchers examined what happened when three different popular dermal filler gels—one meant to have relatively temporary effects (Restylane, which lasts less than 12 months), one semipermanent (Radiesse, which lasts from one to seven years) and one permanent (Aquamid)—were mixed with three different common skin bacteria—Pseudomonas aeruginosa, Staphylococcus epidermidis and Propionibacterium acnes, and left to incubate. Within 24 hours, all three gels showed dense bacterial colonies that only grew bigger over the next 24 hours…showing that the gels were a good habitat for biofilm growth.

The researchers then tested whether the gels might not only be good media for bacterial growth but also might help the bacteria grow resistant to antibiotics—a potential double whammy for people unlucky enough to have this bacterial party injected under their skin. And what they found was that after 72 hours of growth in the cosmetic gels, two of the bacterial strains—P. aeruginosa and S. epidermidis—were reduced but not completely cleared up when exposed to antibiotics.

When the researchers then injected mice with gels that had either P. aeruginosa or S. epidermidis added to them, bacteria grew only in mice that were injected with the permanent filler. When this experiment was repeated, but with some mice receiving antibiotics two hours before the injection and others seven days afterward, the pretreated mice were spared from infection but the mice treated seven days after being infected were dealing with an antibiotic-resistant infection. To quickly get a handle on how these results in mice translated to what might happen in humans, researchers studied the medical records of 657 people who had received dermal filler gel injections at one cosmetic dermatology center. The researchers compared records from 2001 to 2006, which was before the center began to pretreat patients with antibiotics, with records from 2007 to 2011, when pretreating became the standard protocol. The results…incidence of signs of infection after the procedure dropped from 7% to 2%.


The take-home message is that simply piercing the skin with the dermal filler injection needle can potentially allow normal skin bacteria to mix with the filler gel and grow into a problem. To combat this, the study researchers strongly recommend that folks going in for dermal filler gel injections receive antibiotic therapy in preparation for the procedure or have antibiotics injected with the filler as a preventive measure.

While commercials often present dermal filler injections as little more than lunchtime spa treatments, it’s wise to not forget that they are medical procedures that carry risks—some known and some perhaps not known yet. If you are considering having dermal filler injections, go to a medical doctor for the procedure—preferably a board-certified cosmetic dermatologist or plastic surgeon—and discuss your concerns about possible bacterial infection with him or her. A well-trained physician will know what type of antibiotic treatments are best to prevent skin infections.