Is Bellafil a good option for filling in the hollow spaces in the cheeks and marionette lines?

Bellafill filler can cause nodules and chronic edema, soft tissue reaction, and longterm problems. We specialize in the removal of Bellafill on the face and see patients with old and new PMMA filler problems. Bellafill will eventually form scar tissue around the permanent filler. We recommend a combination approach of filler reversal with enzymes, corticosteroids, and scar tissue modulators. Our HIDEF approach can break down filler scarring and granulomas so that they are less apparent. If the filler material itself does not dissolve, it either means the filler is unresponsive to conservative therapy. This technique may be followed by surgical removal of the filler if there is a suitable target for removal and the chance of scarring is low. We remove Bellafill filler from the lips, nasolabial folds, and eyelids. Cheek Bellafill is difficult to remove surgically.

Best,
Dr. Karamanoukian
Realself100 Surgeon

This is where Bellafil does well. I recommend Bellafil for patients who have already had HA (Hyslauronic acid) fillers and want something longer lasting. If you have never had a filler injected, you may do better with one of the shorter lasting fillers (1 yr or so) and see if you like the result. If you do, then move to Bellafil. Bellafil cannot be easily removed, do you want to make sure that you will be comfortable with the results.

Volume of the face can be improved with well-placed fillers (Voluma, Radiesse, Bellafill) and Sculptra. Fat or implants are alternatives. I recommend getting a formal evaluation with a facial sculpting expert. Best, Dr. Emer

In regards to filling in hollows of the cheeks and marionette lines, Bellafill is a good option.  Although Bellafill is FDA approved only for the nasolabial lines (smile lines) and for correction of acne scars, it is safe to use in other “off-label” areas, with the exception of the lips.  I use Bellafill as a volume enhancement in the cheeks, chin, temples, and forehead, and as a wrinkle filler in most areas.
Bellafill is a great option for those who want a dermal filler that is longer lasting.  Most of my patients are tired of coming back every 1-2 years for other kinds of fillers.  Also, over the long run, it turns out to be less costly.  Usually my patients start out with the shorter acting fillers.  After having good results, and gaining confidence in my skills as an injector, they consider switching to Bellafill.
One of the reasons I am comfortable with Bellafill is that a large part of my practice is injecting dermal filler.  I do not do plastic surgery, medical dermatology or medical anti-aging treatments.  I do only noninvasive medical cosmetic treatments.  In addition, I train other physicians in the use of Bellafill.

Thank you for your question. 
Bellafill contains PMMA microspheres which provide a scaffold that supports your own natural collagen production as it develops over time. It is a great choice for cheek augmentation and marionette lines.
83% of patients were still satisfied with their results 5 years after improvement. More than one treatment may be needed, but results are excellent and long lasting. 
Please consult a local board certified facial plastic surgeon for more information and a comprehensive consultation 

Bellafill is a unique product in that it is a very safe and longl lasting fillers. It can't be dissolved and therefore the injector must be highly skilled. It has a 5 year FDA study showing it's safety, less than 1% granuloma rate. When injected in the cheeks and marionette area, it provides a very long lasting fill. I have it in my face in those areas. 

Hi, Bellafill is definitely an option in improving hollowness of the cheeks and appearance of marionette lines. The advantage of Bellafill specifically is that it is a collagen stimulator. Filling in hollow cheeks may require a lot of product and getting help from your own body to make some more collagen will help. 
There is an issue of granuloma formation with Bellafill, however it is quite rare. I've been using this product for many years without complications.

Hello and thanks for posting.
I think that the main reason that many providers do not offer Bellafill
is because of the risk of late granuloma formation. 
Granulomas are delayed development of nodules in the areas of
injection.  When Bellafill was approved, the FDA mandated a 5 year
post-marketing safety study to determine the risk of late complications.  This study was completed and showed that
there was a 1.7% risk of granuloma formation over 5 years (17 of 1000 patients
developed granulomas in this study).
In my experience, granulomas are not fun, but represents a
manageable problem. This involves a series of injections of triamcinolone and
5FU and this treatment reliably shrinks the nodules down.
There are also data from Europe and China suggesting that deep
injection of PMMA onto bone further lessens the risk of granuloma because of
the paucity of immunologic cells in this anatomic location.
In my opinion, as long as one is willing to accept this level of
risk of granulomas, Bellafill is a great treatment option for long-term facial volume
restoration.
I hope that this information helps and best of luck to you!

This is a great question.  While there will always be opinions one way or the other, let’s examine the facts.  Bellafill has been available as an FDA approved medical device for 12 years now and it was the most highly studied filler to gain FDA approval because it is so long lasting.

The formal FDA approval study was 3 years longer than any other filler study.  It was 5 years long and 1008 patients were entered.  At the end of the study there was no loss of volume meaning that the filler was still working very well.  The significant problems seen in the study that everyone seems to worry about with Bellafill are lumps or granulomas.  These lumps are not really a problem if they cannot be seen but nonetheless, of the 1008 patients in the study, 15 developed lumps that could be felt or seen. In 13 of these 17 patients the lumps all resolved or improved to the point that they were of no concern at 18 months.  2 patients developed lumps that needed to be treated with simple injections of a steroid called Kenalog 10 or a similar injection protocol like 5FU plus Kenalog.

What is interesting about this study when compared to other filler studiesis that there was an unprecedented retention rate of 96% at 18 months and a 94% satisfaction rate at 18 months!

When compared to any other filler Bellafill is the clear winner.  It is safer, has a higher satisfaction rating and lasts much longer making it far more economical in the long run despite being more expensive to start with.

Your question about why more surgeons or dermatologists do not use Bellafill is also a good one.  Since Bellafill lasts so long, most providers are worried that you will not come back to see them.  In addition, most physicians pass the filler injections to a nurse or physicians assistant in their office.  Many midlevel providers feel very uncomfortable injecting something that will last so long.  Thankfully, Bellafill has not been widely adopted because there is very little room for error with it. 
With all of that said, Bellafill is a wonderful filler in the right hands.  On RealSelf, the worth it rating for Bellafill is 91% and for Juvederm Voluma the worth it rating is 87%.  Fat grafting or fat transfers have a worth rating of 82%. 
I have added a video about filler problems for you as well as a link to more information about Bellafill  (many before and after photos can be found there as well).
I hope that helps.

Best regards.