I want to know why removal of PMMA is rarely talked about (I need to remove Bellafill in my nose and have rhinoplasty)? (Photos)

Question

WHY: It has ruined my supratip break so now I don’t have one and has made my nose look so wide. I've been shopping for a rhinoplasty and most surgeons have straight up said they refuse to touch my nose until I remove the filler. WHAT: Less than 1 syringe of Bellafill ( previously known as artefill or PMMA semi-permanent filler) was placed in the radix of my nose and a tiny bit in the dorsal hump & tip. Injected in August of 2020. I want to know why removal of PMMA is rarely talked about.

Raffy Karamanoukian, MD, FACS · Answer

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

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Jason Emer, MD · Answer

if you want this improved you need to get a rhinoplasty by a revision specialist.  you can try steroid/5fu injections non surgically. I suggest seeing an expert. however, FYI, the injections done on you were exactly what would have been anticipated if the doctor would have explained this procedure properly to you.  Best, Dr. Emer.

Nelson Lee Novick, MD · Answer

I have been warning readers for years of the potential risks of treatment with permanent fillers, like silicone, alkamid and Bellafil. Permanent fillers sound attractive because they entice people with the promise permanent results and not results that require periodic maintenance treatments. The huge downside is that if anything goes wrong, there is no easy way to reverse or dissolve these permanent fillers. What's more, problems, such as bumps and nodules, may appear not just immediately, but five, ten or even twenty or more years later should the permanent filler get razzed up by trauma or, in this case, rhinoplasty surgery. The latter is the likely reason no one wants to enter with surgery into this potential permanent filler minefield. I have had success in treating patients with unwanted permanent fillers using injections of anti-inflammatory agents often also coupled with hyaluronidase (even though this does not directly dissolve permanent fillers). Make sure that you consult with an experienced cosmetic dermatologist who has dealt with this troublesome issue before. Hope this helps.

Amy Y. Paul, DO, FAAD · Answer

Thanks for your question.  I'm sorry you are having these problems.  One of the reasons removing Bellafill is rarely talked about is because there is no way to dissolve it like you can with the hyaluronic acid fillers.  It would be very difficult to remove it without scarring the skin, as it needs to be physically cut out.  There is a recent case series in the dermatologic literature in the Journal of Drugs in Dermatology entitled "Laser in the Treatment of Granulomas on the Nose Produced by Polymethylmethacrylate".  It is in the current issue.   I don't think you need a subscription to read it.  If you can find an experienced plastic surgeon with the proper type of laser who is willing to try that technique on you, that might be an option.  I would caution you about having Bellafill injected anymore - it can be something people regret in the future.  Please see an expert, and best of luck!

I want to know why removal of PMMA is rarely talked about (I need to remove Bellafill in my nose and have rhinoplasty)? (Photos)

Answers (4)

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