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In a 35-year-old female HIV-negative patient a facelift was followed by a Pseudomonas aeruginosa wound infection. The infection persisted despite treatment with ciprofloxacin, and an additional bacteriological wound examination revealed Mycobacterium smegmatis as the causative agent. Combination therapy with ciprofloxacin, doxycycline and amikacin led to a slow healing process without the need for further surgical intervention. A relapse 6 months after initial therapy was successfully treated with local measures. Infection with M. smegmatis might have come about by contaminated intraoperative liquids or the application of lipid creams to the open wound. However, microbiological examination of potential sources remained negative. Infection caused by M. smegmatis following plastic surgery should be considered in patients with spontaneous ulceration and violaceous discoloration of the skin adjacent to the surgical wound. Prolonged antibiotic therapy and possibly repeat surgical interventions may become necessary to treat this rare infection.