It was recommended to get Bellafill on boxcar scars. Why is this?

Question

I was recommended to have bellafill on my box scars (significant) I don’t quite understand. So a permanent filler? What about when my skin ages 20 yrs down the line then what happens with the filler sites? How does this work exactly

Raffy Karamanoukian, MD, FACS · Answer

Bellafill and Artefill are known to cause granulomas. Although used for soft tissue augmentation, they can, and are known to cause permanent nodules and swelling. This is not the case for everyone. 
My office specializes in the removal of Bellafill and Artefill injections, in addition to silicone biopolymers, from the face and body. Initially, treatments are non-surgical with corticosteroids and immune modulators. If unable to be corrected, we can also perform surgery in some cases. 
Lastly, our office is conducting ongoing studies of plasma-assisted corticosteroid application, which allows for diffusion of the treatment medication in superficial tissue without causing atrophy. 
Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Jason Emer, MD · Answer

"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. Generally speaking, 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, or IPL for redness or thick acne scars. 
- Lasers such as Fraxel, Erbium, CO2 or fractional radiofrequency (Venus Viva, Skinfinity, 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.

For darker skin types, it is important to avoid strong lasers such as CO2/Erbium and Fraxel as they can cause hyperpigmentation. Instead, scars in darker skin types can be improved with a combination of microneedling RF (Fractora, Intensif, Infini), Aerolase or Laser Genesis, microneedling with PRP, skin lightening, peels like Cosmelan, and a proper skin care protocol (hydroquinone, vitamin c, kojic acid, azelaic acid, retinol)​. Sun protection is essential. I recommend getting a formal evaluation with a board-certified cosmetic dermatologist and acne scarring expert. Best, Dr. Emer​"

Douglas Wu, MD · Answer

You are correct - Bellafill is a long-lasting dermal filler. While is is recommended for some types of acne scarring, it is not as common to use this filler for boxcar scars. I encourage you to schedule an in-person assessment with a board-certified dermatologist for a second opinion. If you are not comfortable with the Bellafill treatment, there are many other ways to address this issue and produce positive results.

Steven F. Weiner, MD · Answer

Most of the time, Bellafill is used for rolling, atrophic scars. If your boxcar scars need volume, it can be used as part of the correction for these. Lasers, RFM, PRP, TCA Cross might also be needed for rolling scars. Bellafill produces collagen in response to the PMMA particles. As your skin ages, further acne scar correction might be needed.

Roy A. David, MD · Answer

Bellafill is FDA approved and works very well for rolled and even boxcar shaped acne scars. However, it is a very long-lasting filler and that should be always be considered when injecting. Consult with an experienced injector.

It was recommended to get Bellafill on boxcar scars. Why is this?

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