Sterility of injectable fillers containing nonanimal stabilized hyaluronic acid, hyaluronic acid, or calcium hydroxylapatite after long-term storage

Injectable fillers containing Restylane (nonanimal stabilized hyaluronic acid, NASHA), Juvéderm (hyaluronic acid, HA), or Radiesse (calcium hydroxylapatite, CaHA) are commonly used for soft tissue augmentation and volume correction. Contents of the syringes often are used on patients and stored for subsequent visits with the same patient, despite manufacturer recommendations to discard unused filler. The primary objective of this study was to determine the incidence of infectious contamination in fillers stored after patient injection. Previously used and stored syringes of NASHA (n=23), HA (n=5), and CaHA (n=4) were obtained from physicians in 2 separate practices. The previously used syringes were stored with clean technique at 2°C and were intended for use within 2 weeks; however, they were never needed again. After being stored for an average of 30, 16, and 27 months, respectively, the remaining contents of the syringes were cultured under aerobic and anaerobic bacteria, acid-fast bacilli, and fungal growth conditions. There was no growth in bacterial, acid-fast bacilli, or fungal culture media. The results of this study support that injectable fillers of NASHA can be stored under clean conditions without evidence of contamination for over 2 years and suggest that HA and CaHA remain free of contamination after lengthy storage as well. Copyright Cosmetic Dermatology 2010.