Let me first start off by saying I truly believe Artefill is a great filler. It provides long-lasting if not permanent results and most patients are delighted with. However, no filler has an absolute pristine safety record. Granulomas can occur with Radiesse ™ and even with some "temporary" fillers such as hyaluronic acid-based ones (Juvederm ™, Restylane, etc.). After over seven years of use, I have encountered three granulomas, all around the lateral canthus. Two responded to Kenalog and 5-fluorouracil injections while one required excision. In your case, if your granulomas are recurring, the first thing to do is to seek professional help from the original practitioner who injected it. They might respond to another round of steroid injection and perhaps some antibiotics. The reason why they may be recurring is that A biofilm caused by dormant bacteria may be present which stimulates the body to form a granuloma to sequester the pesky entity. Ultimately, excision maybe necessary but only after all non-invasive treatments have been exhausted.