Why was I told Bellafill is not good for atrophic acne scars but Sculptra is better? (Photos)

Our treatments use combination therapy to improve complications associated with Bellafill, a filler with permanent attributes that can cause granulomas, uneven contour, and soft tissue reaction. Our office focuses on granuloma reversal in cases where an incision may leave permanent scars. The reversal is performed with Kenalog IIT combination therapy, fibrous release, and HIDEF fractional RF to help break up the nodularity. Schedule a consultation for surgical removal if the Bellafill is located in the eyelids, lips, and lower face. Midface Bellafill is difficult to surgically remove.

Best,
Dr. Karamanoukian
Realself100 Surgeon

"​Acne scars need a combination approach for long-term improvement. Everyone has a unique pattern of acne scarring, and most people have various types of scars, so we create a tailored treatment plan for each patient. We often use:
- Injectable fillers like Bellafill and Sculptra (with or without subcision) for atrophic, indented scars.
- Subcision for depressed, tethered scars.
- Vascular lasers like Yellow laser, Aerolase, excel V, BBL, or IPL for redness or thick acne scars.
- Lasers such as Fraxel, Erbium, CO2, Halo or fractional radiofrequency (Venus Viva, Skinfinity, Morpheus, PiXel8, Fractora, Intensif microneedling RF) for textural issues and superficial scarring.
- TCA CROSS and punch excision for deep ice pick scars and narrow box car scars.

All lasers are combined with microneedling/PRP to improve the results and accelerate your healing time. Keep in mind that a personalized combination treatment by an expert physician will give you the improvement you're looking for. I recommend getting a formal evaluation with an experienced cosmetic dermatologist and acne scarring expert. Best, Dr. Emer. ​"

I personally do not use any permanent fillers in my practice (and gave up the use of silicone many years ago when natural fillers were developed and approved). Complications subsequent to the use of permanent fillers of all kinds, such as granulomas and diffuse swellings are well-described and may develop immediately following treatment or five, ten or even twenty+ years later, especially following some kind of manipulation of the cheeks, such as during dental work. Just do your due diligence of RealSelf or other sites to see how many people are suffering with these very-difficult-to-treat complications, which cannot simply be dissolved away, as can be done with HA fillers. Even surgery to remove the permanent filler can leave disfiguring scars. So, while the word "permanent" is admittedly enticing, permanent disfigurement is certainly not. As to the energy-based devices, the fraxels, etc. there is no surprise that these were not effective. I have been cautioning my readers for years that these expensive gizmos are far more backed by marketing hype than any hard science. As for general TCA peels for the face., in lower concentrations, they are unlikely to be effective for acne scarring. In higher concentrations applied to the whole skin, there is a significant risk of causing dyspigmentation problems that can be difficult to treat. However, a series of relatively inexpensive TCA CROSS treatments for the ice pick scars and dilated pores can be quite effective. Make sure that you consult an experienced cosmetic dermatologist with experience in acne scar treatments. Best of luck.