Evidence of Biofilm and Persister Cell Formation in Revision Rhinoplasty

Kao WK, Faddis B, Chole RA, Davis RE.

What this paper says

Examining nasal tissue from 14 rhinoplasty patients, three samples contained bacterial biofilm or dormant persister cells, and all three came from revision patients with no implant in place.

Overview

Infection after rhinoplasty can cause serious deformity, loss of nasal support and breathing problems, so understanding what contributes to it matters. Bacterial biofilms and persister cells are known to play a part in infections associated with health care. This study set out to identify whether such biofilms and persister cells are present in the soft tissue of the nose in patients having revision rhinoplasty.

Sections of note

Laboratory study of tissue from 14 rhinoplasty patients.
Nasal soft tissue removed during surgery was preserved in paraformaldehyde and glutaraldehyde.
High resolution images were obtained from those tissue samples.
Three samples were positive for microbial persister cells or biofilms.
All three positive samples came from patients having revision rhinoplasty.
Those patients had between one and six previous rhinoplasty procedures.
One of them had previously had injectable nasal filler.
The authors conclude biofilms and persister cells can form in revision patients' nasal tissue even with no implant present.

What it means for a patient

A biofilm is a community of bacteria protected in a layer of their own material, which makes antibiotics less effective.
Persister cells are dormant bacteria that survive antibiotic treatment and can reactivate later.
The finding that these form without an implant suggests infection risk in revision surgery is not limited to implanted material.
Fourteen patients with three positive samples is a very small study and shows presence, not that infection followed.

Why this paper matters

Revision rhinoplasty carries a much higher infection rate than first time surgery and the reason is not established. This study offers a biological explanation that does not depend on an implant being present. Whether these organisms actually cause the observed infections has not been shown.

Terms

Biofilm: a community of bacteria encased in a protective layer they secrete.
Persister cell: a dormant bacterium that survives antibiotic treatment.
Revision rhinoplasty: surgery on a nose that has already been operated on.
Nasal soft tissue: the skin, fat and muscle covering the nasal framework.
Health care associated infection: an infection acquired in connection with medical treatment.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

From the abstract

“Postoperative rhinoplasty infection can lead to serious cosmetic deformity, loss of structural integrity to the nose, and functional deficiencies. Understanding the factors contributing to postoperative infection is important. Microbial biofilms and persister cells play an important role in health care-associated…”

Excerpt; the full abstract is on PubMed.