2017-18 HSC Section 4 Green Book

Reprinted by permission of Dermatol Surg. 2017; 43(7):967-970.

The Sterility of Partially Used Hyaluronic Acid Fillers After Long Storage

Mohammed Al-Haddab, MD,* Amr Abduljabbar, MD,* and Ali Al-Somaily, MD †

BACKGROUND Hyaluronic acid (HA) gel fillers represent most soft tissue augmentation procedures currently used, because they have lower rates of complications compared with other materials. Many patients do not consume an entire syringe of filler but may require a retouch or intermittent augmentation after some time. The remaining material is commonly stored in a specific environment for reuse by the same patient. OBJECTIVE There are an insufficient number of recommendations concerning the safety of storing and reusing dermal fillers in the literature because of the paucity of studies. The aim of this study was to investigate the potential infectious contamination associated with the storage of HA fillers after patient treatment. METHODS Hyaluronic acid from previously used syringes was stored at room temperature under sterile conditions for varying durations beginning from 2009. Later, the material was submitted for panculture, including gram-positive and gram-negative bacteria, mycobacteria, and fungi.

RESULTS No fungal or mycobacterial agents were cultured from any of the samples. There were a few positive bacterial cultures, but they were predominantly contaminated with normal skin surface flora.

CONCLUSION Although it is commonly practiced, the storage of HA fillers after initial patient injection carries a real but small risk of contamination.

The authors have indicated no significant interest with commercial supporters. The study was performed at the Medical City of King Saud University in Riyadh.

H yaluronic acid (HA) gel fi llers are the major dermal fi ller materials currently used for soft tissue augmentation because of their many advantages over other fi lling materials. These advantages include a good safety pro fi le with low immunogenicity, a long duration of tissue correction, and the reversibility of these agents with hyaluronidase. Infections associated with fi llers could be a major fault, whether because of the material itself or to negligence in maintaining sterile conditions by practitioners. After tissue augmentation procedures, the remaining contents of fi ller syringes are commonly used for a retouch after a few weeks or for re-treatment when the augmentation effect begins to subside after many months. Because of this, many practices routinely label these syringes and store them for future retouch or re-treatment. The microbial contamination of fi lling material is a major concern when reusing stored syringes, as it may increase the risk

of infection in patients reinjectedwith the contaminated material. However, because of fi ller product expense, many physicians carry out the practice of storing fi ller for subsequent use in the same patient despite the recommendation by the manufacturer to discard any remaining fi ller because sterility may be compromised in the open product. 1 The objective of this prospective study was to investigate the potential in vitro microbial contamination associated with storing HA fi llers for different periods of time after the initial patient injection, beginning in 2009, and whether the length of storage time correlates with the risk of contamination. With the information obtained, we aim to provide a recommendation regarding the safety of reusing HA fi ller without adding potential risk to patients. To our knowledge, this is the fi rst prospective study investigating all possible organism contaminants of material stored at room temperature.

Departments of *Dermatology and † Microbiology, King Saud University, Riyadh, Saudi Arabia

© 2017 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved. ISSN: 1076-0512 · Dermatol Surg 2017;43:967 – 970 · DOI: 10.1097/DSS.0000000000001091

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