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Ask Dr. Yang any questions about facial plastic surgery, including facelifts, necklifts, eyelid surgery (blepharoplasty), browlifts, otoplasty, and non-surgical treatments such as Botox and injectable fillers.
Dr. Yang, I have a question about infections from foreign implants. I have heard doctors say, even after the initial surgery, having foreign implants is a life time risk of infection. Does this mean that at any time, for no reason whatsoever, you can get an infection in that implant?
When it comes to silicone, whether in the nose, breasts, cheeks, chin, whatever, this is what I've comprehended. Please correct me if I am wrong. The insertion of silicone creates a capsule of scar tissue that "isolates" it from the blood system. The scar tissue capsule need to actually be broken by some sort of severe trauma(getting knocked in the nose, cheeks, breasts, chin), allowing blood and a potential infection from a body part completely unrelated to the nose, to flow into the scar tissue "island" where the implant resides. After the initial operation, this the only other way an infection in your implant can arise. If I am right about this, does this mean, even if you were sick to the bone, with every infection known to mankind, scar tissue bubble would still have to be punctured in order for the actual implant to get infected? If not, how else, and why else would a silicon implant get infected?
Can you tell me how a gortex or porex implant might get an infection years down the road?
Infection can happen anywhere on the body for various reasons. Just imagine a deep cyst from acne on your chin, or any type of skin infection that can happen anywhere from your toe to your scalp. Infections of the skin in itself are very treatable. Usually the infection is from bacteria from the skin (staph or strep), which can be easily treated with oral antibiotics and intravenous antibiotics for more severe infections.
The main problem with implants is that if the infection reaches or infects the implant itself, the infection of the implant itself may be very difficult to resolve. With regular soft tissues, any antibiotic that is taken orally or through an IV will get a certain level of antibiotic concentration throughout that soft tissue. The bacteria will be adequately treated by the therapeutic level of antibiotic within the soft tissue and kill the bacteria and eventually clear the infection.
The capsule of an implant could be compared to the capsule of an abscess. If a soft tissue infection worsens, it can become an abscess. Abscesses are filled with pus, and antibiotics have difficulty penetrating an abscess capsule. Therefore, the treatment for an infection complicated by an abscess is to incise and drain (I&D) the abscess. If this is not done, the abscess can continue to spread and antibiotics alone may not be able to cure the infection. For an infected implant that is not responding to antibiotics, the treatment would be the removal of the implant, which is similar to an incision and drainage. Once the infection has cleared, then the implant can be replaced. For some more aggressive surgeons, they may consider replacing the implant at the same time and money.
Imagine a silicone chin implant, which has a capsule of collagen surrounding it. The highest risk for infection is within the first few weeks after the chin implant. If it doesn't happen, then the ongoing risk for infection is low, but not zero. Skin infections close to the implant or possibly from a dental source (dental cleaning or dental infection) could potentially seed the implant and start an infection. The risk is very low, but not zero.
Medpor implants are made of porous polyethylene, or a type of plastic implant with very small swiss cheese-like holes in it which allows for soft tissue growth into the pores. If a patient is given antibiotics, the antibiotic should be able to get reach into the pores. The risk for infection that would require removal of the implant is higher than if it were natural tissue such as bone or cartilage.
Gortex implants would have a similar profile to silicone implants. The look and feel of gortex is different from silicone and gortex implants are usually hand carved by the surgeon where as the silicone implants standardized shapes from the manufacturers with perfectly tapered and rounded edges.
If it doesn't happen, then the ongoing risk for infection is low, but not zero. Skin infections close to the implant or possibly from a dental source (dental cleaning or dental infection) could potentially seed the implant and start an infection. The risk is very low, but not zero.
When you state that a nearby bacteria can "seed" the implant, would the bacteria have to have some sort of venue or pathway in order to get to the implant as it is supposed to be sealed by a wall of collagen? Would one need to actually produce enough trauma to the implant area to rupture the collagen wall to give the chance for the bacteria to invade and infest or can the bacteria just infest for absolutely no reason, without the assistance of trauma?
When an alloplastic implant becomes infected, the mechanism or cause of the infection may not always be apparent. The obvious causes are when the patient had a recent dental work or aggressive dental cleaning, or an obvious skin infection overlying the implant area. Antibiotics prior to dental procedures, or early antibiotic treatments for skin infections could potentially prevent the infection from reaching the implant capsule. However, when a patient with a suspected infected implant is questioned, often they can't recall any incidents or infections which may have caused this. Those are the ones that we can't anticipate or control.
In general, the chances are low for the implant to become infected, but the chances are not zero. The only way to make the chance zero, is to not have the implant at all.
I'll use an analogy. If you always wanted to try skydiving (risk of dying from skydiving is about 1 in 100,000, while the risk of dying from a car accident is 1 in 6000), you should realize that there is a chance that the parachute and backup parachute may not open. Many people go skydiving for fun, and nothing happens to them. The only way to reduce this small risk to zero is to never go skydiving. In the case of skydiving the risk is small, and once the jump is over and you had a good time and survived the jump, the risk returns to zero for you. If you plan to go again, then that small risk is still there.
Once an alloplastic facial or body implant is in your body, that small risk is there as long as you have the implant in. So that would be like skydiving everyday, but each day the risk is really, really low, but it is always there while the implant is in.
If you are really worried about it, the worst case scenario is that you would need to have the implant removed, and the area where the implant was removed may look deflated. But, a replacement implant can be reinserted at a later time.
I would like to extend on this question a bit. Is it really true that once an infection is discovered in the area of a silicone implant, it's practically impossible to resolve completely with just antibiotics alone? It seems like most doctors talk as if the implants will ultimately have to be removed in a high percentage of cases. I imagine that the earlier you catch the infection, the higher the chance one will have to destroy the infection without having to remove the implant. What are these percentages or high, low chances based on?
Also, if a person has an infection within the first week, basically before an implant is encapsulated in scar tissue, is it harder to remove the infection completely because the bacteria is not only around the implant area, but it most likely nesting ON the implant as well because implant has not had a chance yet to create its scar tissue "barrier" to keep out the infection. On the other hand, if a person gets an infection three or four weeks in when a scar tissue capsule has been formed, is there a higher and more fortunate chance that the antibiotics would be able to clear the infection more completely because there is a chance that the infection is not necessarily on the implant itself because the scar tissue capsule keeps it out, but rather, just in an adjacent wounded, still swollen and healing area away from the implant not able to penetrate into the implant because of its capsule envelope?
Every case is individual. I would not jump the gun and simply assume the infection will not clear. I would still try to treat it with antibiotics until that option is exhausted, and becomes obvious that it won't clear the infection.
Yes, if the infection is caught early, then the chance of clearing the infection without removing the implant is higher. For these patients, they may benefit from antibiotic prophalaxis prior to dental procedures. The percentages are low, but in real life, it for an individual person, it is all or nothing. Even if 999 people never get an infection, if you happen to be that 1 person who gets it, then it is 100% for you, and 0% for the other 999 people.
The chance of infection is highest around the time of the implant placement, which is why most surgeons will give a weeks worth of antibiotics after implant placement. For the other questions, I don't know the answers, nor are there any studies to determine the differences in clearing the infection for the individual situations.
The best way to make the risk 0% is to have have any implant. If you don't have a procedure, the risks become zero, and that is a guarantee. Other than that the risk is more than 0%, and there are no guarantees.
There is not just one antibiotic that is used, because different patients potentially may be allergic or sensitive to different antibiotics. So the doctor or dentist needs to choose the right one for that individual patient. Giving antibiotics is common dental practice, so your dentist will know which antibiotic to give to you. My guess is that you did not inform your dentist that you have a chin implant, so how would he or she know to give you antibiotics. I'm sure some dentists get the information, but choose not to give you any antibiotics, but if you are worried about it (better safe than sorry) then you should insist on getting something to take a couple of hours prior to your procedure.
The antibiotics that your medical and dental provider will prescribe to you is based on your doctor patient relationship. I can not make treatment recommendations to anonymous online posters who I are not my patients (no consultation or review of medical history with an examination.)
I gave you a link to the general dental guidelines as general information which you can use when discussing which antibiotic to use with your own doctors and dentists. This empowers you, so you can discuss the risks of implant infection with your health providers.
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