Complications from Bellafill (12 months post) - is surgical excision possible? What can I do?

Question

Hello, I received two syringes of bellafill in my cheeks about 12 months ago to treat moderate acne scars, and I regret this decision very much. I understand now that PMMA is an acrylic polymer that cannot be degraded or dissolved. It is a permanent product, not a 5 year filler. This was glossed over and oversimplified by my treating physician, who just described it as a long lasting filler that stimulated collagen. My desperation to improve my acne scarring didn't help this situation. I agreed to this filler, but I was not as informed as I should have been. But certainly, my trust in medical professionals has now been a little bruised. My problem is that I am still experiencing quite a bit of pain and irritation in the area that I had the bellafill performed (it feels like irritation/the presence of something under the skin/mild pain/swelling). I would describe it as the feeling of the body reacting to a foreign object or an injury that cannot be resolved. It is painful. Aesthetically, I am shocked and horrified by the outcome, and I do not recognize myself when I look in the mirror. What can I do? Is surgical excision possible in the cheek area? There are not any granulomas, just overfilling. Perhaps I am among the few that overproduced collagen. Not that it matters to me at this point, but if anyone is curious, bellafill did not improve my acne scars at all. Second question: is the irritation/pain I am feeling likely to eventually self-resolve. Or will this be lifelong?

Anna Chacon, MD, FAAD · Answer

Thank you for sharing such a detailed and honest account of your experience. I want to first acknowledge how distressing this must be—it’s completely understandable to feel frustrated, disappointed, and even betrayed after undergoing a treatment that was meant to improve your skin but instead has caused discomfort and emotional stress. Your feelings are valid.

Here’s a breakdown of what’s happening and your options:

Pain and Irritation After Bellafill:
Bellafill contains PMMA microspheres, which are permanent. The discomfort you’re feeling is not typical for most patients, but it can occur. Pain, swelling, or a “foreign body” sensation may be due to chronic low-grade inflammation or the tissue adjusting to the filler. Because there are no granulomas, it’s not an active immune reaction, but persistent irritation can still occur.
Will the Pain Self-Resolve?
Unfortunately, because PMMA is permanent, there is no guarantee that the discomfort will fully resolve on its own. Some patients experience gradual improvement over months to years, but for others, mild irritation may persist indefinitely. Pain that is significant or worsening should be assessed in person by a dermatologist experienced with permanent fillers.
Surgical Excision:
Surgical removal of Bellafill is possible but challenging. The microspheres integrate with the tissue and are surrounded by collagen, so excising them entirely often requires careful surgical planning. There’s a risk of scarring, contour irregularities, or asymmetry after excision. This is usually considered only when the filler is causing persistent pain, severe aesthetic issues, or complications that cannot be managed conservatively.
Other Approaches:
Conservative management: Anti-inflammatory treatments or corticosteroid injections may reduce irritation, but these do not remove the filler.
Targeted revision procedures: In some cases, small areas of overfilled tissue can be reduced surgically or with microcannula techniques, but complete removal is rarely simple.
Next Steps:
Given your symptoms—persistent pain, irritation, and dissatisfaction with the cosmetic result—it would be important to be evaluated by a dermatologist or plastic surgeon who has experience with permanent fillers. They can assess the extent of filler integration and discuss realistic expectations regarding excision, risk, and potential improvement.

I know it’s upsetting to feel “stuck” with a permanent filler, but there are professionals who specialize in managing these situations and can guide you toward the safest and most effective solution.

Nelson Lee Novick, MD · Answer

I am truly sorry that you are experiencing this problem. Issues, such as yours, are precisely why I have cautioned my regular followers for years to exercise extreme "buyer beware" caution when considering treatment with them. The allure of "permanent" is understandable, but permanent fillers can translate into permanent problems, not just immediately following treatment, but even five, ten or twenty+ years later. 
Fortunately, I have found that an algorithm of varying combinations, concentrations and amounts of intralesional anti-inflammatory agents can be very helpful in improving both the disfiguring aspects and the swelling and discomfort from permanent fillers. Surgery, on the other hand, to remove the unwanted filler can be expensive, engenders signficant posttreatment downtime, and can itself postentially result in disfiguring scars. You would be wise to consult an experienced, board certified cosmetic dermatologist. Hope this helps, and once again, so sorry for your enormous distress..

Complications from Bellafill (12 months post) - is surgical excision possible? What can I do?

Answers (2)

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