Chronic Facial Abscess Mimicking Cervicofacial Actinomyces From Dermal Filler Migration: Case Report

Dermal fillers are commonly used for facial augmentation, but delayed complications such as granulomatous inflammation and filler migration can mimic chronic bacterial infections, such as cervicofacial actinomycosis, and lead to diagnostic misdirection. We present the case of a woman aged 56 years with a chronic, draining abscess on the right cheek that persisted for 3 years and was initially suspected to represent cervicofacial actinomycosis. Tissue cultures were negative, and histopathologic analysis following excisional biopsy revealed polymethyl methacrylate microspheres and hyaluronic acid surrounded by granulomatous inflammation and reactive lymphoid aggregates, consistent with a foreign body reaction to dermal filler. The patient experienced complete resolution after surgical excision. This case underscores the diagnostic challenges posed by delayed filler complications and highlights the importance of considering prior cosmetic procedures in patients with chronic facial abscesses.