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Cold plasma in the correction of involutional skin changes: clinical experience
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Biofilms after the introduction of fillers. What does a cosmetologist need to know?

Biofilms can be formed by various microorganisms, for example, bacteria, protozoa, or fungi.

Biofilm formation steps include:

Attaching bacteria to the surface
Colony formation
Biofilm ripening
Dispersion.
At the first stage, bacteria wandering around the surface of the site of inflammation are concentrated and attached to its surface, and then captured by a protective adhesive polymer mass released from the cells, resulting in microcolonies that are not susceptible to antibiotics. ZPM consists of DNA, proteins and polysaccharides. This composition protects cells and promotes their interaction. Biochemical signals transmitted by ZPM also accelerate the transmission of nutrients to growing bacteria in the biofilm. At the last stage of its formation, the biofilm can only change shape and size. A fully formed colony is not susceptible to antibiotics.

Such bioactive mass at different stages of development acquires its own DNA and ZPM, and its dispersion can lead to the spread and formation of new colonies.

A biofilm can be dormant depending on the presence of activating external factors. When cell metabolism freezes, the biofilm falls into a passive state. A biofilm is activated when its internal environment is disturbed, for example, injuries, injections, physical pressure.

Such actions usually cause local infections, abscesses, bumps, granulomas on foreign bodies, nodules, or systemic infections.

Biofilms in dermatosurgery
The importance of biofilms in radical surgery was realized not so long ago. It was found that they interfere with wound healing and significantly reduce the effectiveness of external antibacterial agents.

The same applies to the introduction of fillers. Many side effects are associated with these operations, for example, the formation of nodules, fistulas and abscesses. Such phenomena, although not often, but, nevertheless, can occur, especially with the introduction of “long-playing” fillers

Currently, specialists prefer biodegradable fillers, but still there remains a group of patients who were once introduced synthetic and semi-synthetic drugs and these patients require close attention of a cosmetologist.

Adverse reactions usually develop within a few weeks after administration of a foreign substance and are erythematous slightly painful nodules. They often do not pass for months and cause significant discomfort to the patient. Previously, it was assumed that this was an allergic reaction to the introduced filler, but no evidence was received. The resulting nodules are always small, locally located and do not carry antibodies. Moreover, many of them resolve with antibiotics. Now it is assumed that such adverse reactions that occur most often after the introduction of hydrophilic fillers are the result of the formation of biofilms. Their infectious origin was proven in 7 out of 8 laboratory samples.

Biofilms with the introduction of fillers
Preventive measures
Precautions have an important role in aesthetic surgery. Filler injections are often carried out in areas with constantly present bacteria, such as the lips or skin of a person affected by acne. Therefore, there are rules that must be followed to avoid infection before and after surgery:

Thoroughly rinse the injection site with an antiseptic solution;
Local application of 2% dermatological ointment of mupirocin 2-3 times a day to prevent infectious complications
Any painful sensation, a few days after the injection, is an occasion to consult a doctor.
The results of studies (Kravvas G, Veitch D, Al-Niaimi F.) show that in the presence of even a very small number of bacteria, fillers contribute to the formation of biofilms.

Broad-spectrum antibiotics are able to treat such infections if they are administered within 24 hours after inoculation, but their effect decreases when administered after 72 hours after inoculation. In a study by Saththianathan et al. It was found that all types of fillers (hyaluronic acid, polyacrylamide gel and poly-1-lactic acid) can support the growth of S. epidermidis biofilms. The infection pathway is thought to be bacterial contamination during filler injection; whereas significant commensal bacterial colonies are present on human skin.

Repeated passage of the needle through the surface contaminated with biofilm led to a significant increase in the contamination of the filler material by 10,000 times (p <0.001). Six clinical samples from five patients showed bacterial biofilm. It was found that the average number of bacteria is 2.2 × 107 bacteria / mg of tissue (range from 5.6 × 105 to 3.7 × 107 bacteria / mg of tissue). Microbiome analysis revealed the predominance of Pseudomonas, Staphylococcus and Propionibacterium present in these samples.

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