Infected facial tissue fillers: case series and review of the literature.

Since 2007, 21 female and 1 male patient aged 25 to 55 years, who either did not have any obvious causative infection source or, despite the presence of nonvital teeth, did not display typical symptoms of odontogenic infection, were treated for acute facial inflammation. All these patients admitted previous application of injectable soft tissue fillers (ISTFs) performed in either private plastic surgery and dermatology practices or cosmetic salons. The period between injection and infection varied from 1 week to 6 years. The injected substance remained unknown in many cases. Of the 22 patients, 3 were diagnosed with facial cellulitis, 4 with periorbital abscess, and 15 with a buccal space abscess. ISTFs provide an attractive option in facial rejuvenation. With their increasing use, the prevalence of complications is also expected to increase. Infectious complications of ISTFs were previously unknown in Kuwait. Although these products are primarily meant for treatment of the aging face, the age pattern of our patients suggests their frequent misuse and spurious indications. Especially worrisome is the recently observed application of fillers in cosmetic salons. We believe that the use of ISTFs should be regulated and their administration in nonmedical facilities prohibited. Patients with an atypical course of facial inflammation should be questioned about a history of cosmetic procedures.