Chronic facial abscess mimicking cervicofacial actinomyces from dermal filler migration

Summary: Abstract Body: Dermal fillers are widely used for facial aesthetics, offering a minimally invasive solution for volume loss, wrinkles, and facial asymmetry. Composed of materials such as hyaluronic acid, calcium hydroxylapatite, and polymethylmethacrylate (PMMA), these fillers provide long-lasting results with minimal recovery time. While complications like filler migration and granulomatous reactions are well-documented, the development of a chronic filler reaction mimicking a cervicofacial actinomycetoma as a result of filler migration is rare and has not been described to our knowledge. A 56-year-old female presented with a chronic draining sinus on the right cheek, persisting for approximately three years. Initial diagnostic concerns included chronic infections such as actinomyces, cervicofacial fistulous abscess, nocardia, or a chronic fungal wound. Tissue culture was negative for bacterial, fungal, and atypical mycobacterial growth. Pathology revealed foreign body granulomas with reactive lymphoid tissue, consistent with PMMA microspheres and hyaluronic acid, components typically found in semi-permanent fillers like Bellafill or Artefill. The patient underwent excision of the foreign material, with complete removal of the affected tissue. The post-operative course was uneventful. This case highlights the importance of early recognition and consideration of rare side effects of iatrogenic procedures such as filler injections. It also denotes the long-term risks of semi-permanent fillers and the inclusion of iatrogenic factors in the differential diagnosis of facial abscesses. Treatment for PMMA-based filler reactions relies on adequate excision as noted in this case, but may respond to intralesional steroids. Although PMMA-fillers are not widely used, the need to consider reactions to these could provide valuable insight into the recognition and management of chronic, non-healing wounds of the head and neck. Monika Ziogaite¹, Sarah Mannlein², Scott Mahlberg² 1. Kansas City University College of Osteopathic Medicine, Kansas City, MO, United States. 2. Colorado Center for Dermatology & Skin Surgery, Centennial, CO, United States. Stem Cell Biology, Tissue Regeneration and Wound Healing