Cosmetic surgery: which bacteria favor a successful injection?

Actu GP Chirurgie esthétique : quelles bactéries pour une injection réussie ?

Who has never thought of giving their skin a helping hand to regenerate? In addition to other procedures, injections of hyaluronic acid are a tool used in cosmetic medicine, and they are generally well tolerated. But complications can arise, even in a delayed manner. And the flora of our skin is thought to be involved in this process.


It is by retaining water like a sponge that hyaluronic acid gives our skin such a dashing appearance. With age, its daily production is reduced, drying out the aforesaid sponge appreciably. Hence its status as the number one wrinkle-filler. It is actually injected in a modified form: a more viscous and thicker gel able to resist its natural degradation in the skin for longer. But as nothing lasts forever
—even less in cosmetics world—patients have to visit their practitioner regularly to preserve the “filled” face of their twenty-year-old self. The effect of hyaluronic acid gels last between 6 and 18 months.

A potential nest of bacteria

The other side of the coin: once in the skin, the gel provides a breeding ground for surrounding bacteria. This then becomes a delayed bacterial infection with the development of a biofilm, which may arise one month to two years after an injection. Although rare, this complication is difficult to treat as Staphylococcus aureus is the main microorganism responsible. These bacteria have developed strong resistance to conventional antibiotics, particularly because they bind firmly to any foreign body or medical device that penetrates the skin… such as the modified hyaluronic acid gel.

Two types of staphylococci with opposing effects

A team of Polish and British researchers investigated whether the skin flora could prevent this complication, or conversely predispose to its development. They studied the nasal flora—very similar to that of the skin—of women who had received hyaluronic acid injections, over a period of three years. Patients who developed a complication had a flora that contained higher levels of pathogenic bacteria (particularly Staphylococcus aureus) and that was deficient in Staphylococcus epidermidis, a good bacterium of the skin microbiota known to have antimicrobial actions against Staphylococcus aureus. In patients who had no infection, the S. epidermis bacterium was dominant. The researchers thus wonder if patients pursuing a youthful appearance who are Staphylococcus aureus carriers should be routinely identified and given a preventive antibiotic treatment, or a cream containing high levels of protective bacteria? Should the skin be cleaned more effectively before any injection? More research is necessary to reach a conclusion. But we would wager that in beauty as in everything, better safe than sorry…



I Netsvyetayeva et al. Skin bacterial flora as a potential risk factor predisposing to late bacterial infection after cross-linked hyaluronic acid gel augmentation. Infect Drug Resist. 2018; Feb 12