Q: What are the pros and cons of Bellafill?

Pros Bellafill lasts up to five years, the longest of any dermal filler currently on the market. More time between treatments can make Bellafill more economical than other injectable fillers, even though it costs more up-front. Because it stimulates your own collagen production, results should look very natural. Bellafill is the only filler approved to treat acne scarring. One recent study (a retrospective review of Bellafill) reported a 99.0% patient satisfaction rate for the improvement of acne scars. Unlike some other acne scar treatments, Bellafill is safe for all skin types and tones. Cons Bellafill contains bovine collagen, which comes from cows. This can be problematic for vegetarians and vegans, as well as people who are allergic to bovine collagen. Your provider can do a skin test to make sure you don’t react before they inject the filler. If a skin test is not done, you could have an allergic reaction to the Bellafill injections that would last about as long as the bovine collagen component does, approximately 1 month. However, “most allergic reactions are easily managed with steroids and antihistamines,” according to Dr. Ho. Bellafill is a semi-permanent filler, which can be a pro or a con, depending on your outcome. Unlike hyaluronic acid-based fillers (like Juvéderm or Restylane ), it cannot be dissolved if you’re dissatisfied with the results or have a complication. It’s very important to find an experienced injector for this treatment. If you’re prone to keloid or hypertrophic scarring, Bellafill isn’t the best option for you. (Remember: scar tissue is composed of collagen.)

Question 1

What is Bellafill?

Accepted Answer

Bellafill is a FDA-approved injectable dermal filler that’s used to reverse volume loss, smooth deep smile lines, or treat indented acne scars. This biostimulatory filler contains a combination of bovine collagen and collagen-building particles. “The unique properties of Bellafill make it a very versatile treatment option,” says Dr. Vu Ho, a board-certified facial plastic surgeon in Plano, Texas.

Formerly called Artefill, Bellafill is made by Suneva Medical. It’s formulated with microspheres of polymethyl methacrylate (PMMA), a resin that has long been used in medical implants and is proven to be effective for acne scar treatment.

These PMMA microspheres provide a foundation for smoother skin, remaining in place after the initial bovine collagen gel has been absorbed to stimulate your own natural collagen production. This creates plumping effects shown to last five years or more.

For atrophic acne scar treatment, Bellafill injections are often paired with subcision, a procedure that breaks up tissue just beneath the scar that may be tethering the skin down. Subcision frees up space and allows the area to be occupied by the filler to lift the scar. As Dr. Ho explains, “Bellafill is very effective for treating acne scars, and patients love not having the downtime that can come with treatments such as laser resurfacing.”

Question 2

What are the pros and cons of Bellafill?

Accepted Answer

Pros

Bellafill lasts up to five years, the longest of any dermal filler currently on the market.
More time between treatments can make Bellafill more economical than other injectable fillers, even though it costs more up-front.
Because it stimulates your own collagen production, results should look very natural.
Bellafill is the only filler approved to treat acne scarring. One recent study (a retrospective review of Bellafill) reported a 99.0% patient satisfaction rate for the improvement of acne scars.
Unlike some other acne scar treatments, Bellafill is safe for all skin types and tones.

Cons

Bellafill contains bovine collagen, which comes from cows. This can be problematic for vegetarians and vegans, as well as people who are allergic to bovine collagen. Your provider can do a skin test to make sure you don’t react before they inject the filler. If a skin test is not done, you could have an allergic reaction to the Bellafill injections that would last about as long as the bovine collagen component does, approximately 1 month. However, “most allergic reactions are easily managed with steroids and antihistamines,” according to Dr. Ho.
Bellafill is a semi-permanent filler, which can be a pro or a con, depending on your outcome. Unlike hyaluronic acid-based fillers (like Juvéderm or Restylane), it cannot be dissolved if you’re dissatisfied with the results or have a complication. It’s very important to find an experienced injector for this treatment.
If you’re prone to keloid or hypertrophic scarring, Bellafill isn’t the best option for you. (Remember: scar tissue is composed of collagen.)

Question 3

How much does Bellafill cost?

Accepted Answer

The price you pay will depend largely on how many syringes you need and how much your provider charges per syringe, based on their level of experience and practice location. Learn more in our complete guide to Bellafill costs.

While this up-front cost is more expensive than HA fillers, Bellafill results can last years longer, so it may actually be more economical over time.

You can finance your treatment.

Question 4

Bellafill before and after pictures

Accepted Answer

The Bellafill photos in our gallery have been shared by the provider who performed the procedure, with the patient's consent.

Question 5

Bellafill vs. Juvéderm: What’s the difference?

Accepted Answer

Both Bellafill and Juvéderm fillers can smooth fine lines and wrinkles, contour the face, and restore lost volume.

These are the biggest differences between them.

The plumping/contouring effects of Juvéderm formulas generally last 6 to 24 months. Bellafill outcomes can last up to 5 years.
Juvéderm fillers contain hyaluronic acid (HA), a naturally occuring substance that attracts and retains up to 1,000 times its weight in water, while the microspheres in Bellafill work specifically by stimulating collagen production to plump skin over time. HA injections have also been shown to spark collagen synthesis to some degree, but this isn’t their primary mechanism of action, notes Dr. Ho.
Both types of fillers provide immediate results, but Bellafill results continue to improve for 3 to 6 months as new collagen forms.
If you don’t like your results or have a complication, Juvéderm can be dissolved with hyaluronidase. Bellafill gone wrong can’t be easily fixed—surgical excision is usually needed—so it’s critical to find a highly trained injector (like a board-certified dermatologist or plastic surgeon).
Juvéderm fillers can be used to treat most areas of the face, including the lips, glabella (between the eyebrows), nose, and tear troughs. Bellafill’s uses are more limited. It’s FDA-approved to treat nasolabial folds and indented acne scars, and is sometimes used off-label in the cheeks and chin, and even the nose (though this is a risky area to treat with a product whose effects can’t be reversed). Bellafill should not be injected into the lips or under-eye area.

Question 6

What happens during a Bellafill treatment?

Accepted Answer

An optional skin test can be done up to 30 days in advance to rule out a bovine allergy (0.5% of the population has it). Your injector will also ask about any medications you’re taking, if you’re prone to scarring, and if you’re pregnant.

The injections can be done relatively quickly in your doctor’s office. Here's what to expect:

They’ll start by mapping out the treatment areas.
Bellafill contains a local anesthetic to minimize discomfort, but your doctor may also numb the area with a topical anesthetic or ice beforehand.
Then your provider will meticulously inject the filler with a needle or cannula (a blunt-tipped instrument that can help minimize bruising), in accordance with your treatment plan.
Afterward, they’ll apply ice to the injection sites to reduce the chance of bruising.
You’ll be able to apply makeup soon after, to cover any lingering redness.

Question 7

What can you expect after a Bellafill treatment?

Accepted Answer

It’s common to have some bruising and swelling after your appointment.

Swelling is usually minimal and lasts 3 to 10 days.
Bruising can last anywhere from 5 to 21 days, but you’ll be able to cover it with makeup. You can mitigate it by avoiding alcohol and other blood thinners for a week before and after treatment.

Other than swelling and bruising, there’s no downtime. You can resume most of your normal activities immediately after your treatment, but hold off on facial treatments, intense workouts, and high-heat settings like tanning beds, saunas, and hot tubs for a few days to help minimize swelling and bruising.

You’ll notice an immediate improvement in your skin texture from the collagen in the formula, and your results will continue to improve for three to six months, as the filler stimulates collagen production.

If your results after six months aren’t as dramatic as you hoped, talk with your doctor about additional injections or other filler options.

Question 8

How long does Bellafill last?

Accepted Answer

Bellafill lasts for about 5 years, making it a much longer-lasting option than fillers without PMMA microspheres. A clinical study found that 87% of patients who had the treatment for smile lines were still happy with their results after five years.

The manufacturer also reports that a similar percentage of patients who used it to smooth atrophic acne scars were satisfied with their results after one year.

Question 9

What are the risks and side effects of Bellafill?

Accepted Answer

Bellafill injections are considered safe in the hands of an experienced injector.

Bellafill injections are considered safe in the hands of an experienced injector. A recent review of 417 Bellafill procedures performed between 2014 to 2017 noted six cases of adverse events (for a complication rate of 1.4%).

Common side effects include swelling, bruising, tenderness, redness, or slight bleeding at the injection site. It’s possible but rare to develop an infection at the injection site.

As with any injectable filler, Bellafill can cause a vascular occlusion or compression, cutting off blood flow to the skin and/or retina and potentially leading to skin death, scarring, and/or blindness. With non-dissolvable fillers, such consequences can be dire. (It bears repeating: Unlike treatment options using hyaluronic acid–based fillers, which can be dissolved early with hyaluronidase injections, Bellafill is not reversible.)

The microspheres in Bellafill can also cause lumps, known as granulomas, by forming scar tissue under the skin. “This is an unusual complication,” notes Dr. Windle, but when granulomas do form, they sometimes respond well to steroid injections.

The newest generation of Bellafill includes PMMA microspheres that are more uniform in shape and size than previous iterations, and have been “purported to decrease the incidence of granuloma formation,” according to a 2021 study.

It’s also not recommended for people who:

Are under age 21
Are susceptible to keloid or hypertrophic scarring (according to the FDA.
Have a history of severe allergies and/or an allergy to bovine collagen or lidocaine

Anyone planning to get Bellafill should strongly consider having an allergy test about a month in advance, to rule out an allergy to bovine collagen. “However, it is reasonable to skip this test because the risk of having an allergic reaction is low,” Dr. Ho explains.

Related: Hyaluronic Acid vs. Biostimulatory Fillers: What to Know Before You Get Injected

Question 10

Is it safe to get pregnant after Bellafill treatment?

Accepted Answer

Doctors on RealSelf agree that previously injected PMMA is not harmful to an unborn baby, though it’s wise to avoid any type of filler injections during pregnancy or breastfeeding. There’s little research on the effects of Bellafill or other fillers during pregnancy.

Question 11

Which Bellafill alternatives are worth considering?

Accepted Answer

Hyaluronic acid–based fillers like Juvéderm and Restylane are popular choices, especially for people who are new to fillers. They cost less upfront, they can be dissolved with hyaluronidase, and their range of formulas can be used in areas of the face where Bellafill isn’t recommended.
Radiesse dermal filler also stimulates collagen, and it doesn’t contain the bovine collagen in Bellafill that can trigger allergic reactions.
Sculptra filler can be used to boost collagen production and volumize the face or body for about two years.
Botox isn’t a filler, but this injectable can smooth facial wrinkles by temporarily blocking signals to the nerves that cause muscle movement.
Energy treatments such as ablative lasers, RF microneedling, and Sofwave can treat certain types of acne scars via collagen remodeling.

If your primary concern is acne scars, explore all the top treatment options.

RealSelf Tip: Steer clear of Silikon-1000, a permanent silicone filler that’s FDA-approved for retinal surgery that’s sometimes used off-label in the face. It’s nearly impossible to remove.

Question 12

Sources & studies

Accepted Answer

Solomon P, Ng CL, Kerzner J, Rival R. Facial Soft Tissue Augmentation With Bellafill: A Review of 4 Years of Clinical Experience in 212 Patients. Plast Surg (Oakv). 2021 May;29(2):98-102.

Bruce S., Callender V., Cohen S., Eaton L., Grimes P., et al., Polymethylmethacrylate Collagen Gel-Injectable Dermal Filler for Full Face Atrophic Acne Scar Correction (2019)

Cohen S., Dover J., Karnik J., Monheit G., Narins R., et al., Five-Year Safety and Satisfaction Study of PMMA–Collagen in the Correction of Nasolabial Folds (2015)

U.S. Food & Drug Administration, Bellafill - Instructions for Use (n.d.)

BELLAFILL

Vu Ho, MD

Jolene Edgar

Vu Ho, MD

Jolene Edgar

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	Bellafill nonsurgical	Juvéderm nonsurgical	Restylane nonsurgical	Radiesse nonsurgical	Sculptra nonsurgical	Botox nonsurgical
Worth It Rating	50%	92%	87%	62%	83%	97%
Average Cost	$3235	$950	$1168	$1371	$1744	$586
Downtime	No downtime	No downtime	No downtime	Minimal downtime	Minimal downtime	No downtime
Anesthesia	No anesthesia	Topical anesthesia	Topical anesthesia	Topical anesthesia	Topical anesthesia	No anesthesia

Vu Ho, MD

Jolene Edgar

Vu Ho, MD

Jolene Edgar

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