Is there really is such a thing as PMMA removal? (Photo)

Question

I had Bellafill under both eyes and it's caused horrible issues. Why is there no consensus on what to do? I want to do surgery but I cannot find any information from satisfied patients who had complete removal of the product. I tried steroid injections but the areas just swell back up. I tried 5fu plus steroid and it just made it hard as a rock... it's really bad I beat myself up enough so would prefer to hear solutions and if there really is such a thing as pmma removal.

Nelson Lee Novick, MD · Answer

I am so , so sorry you are going through this. It is precisely why I have been advising against the use of permanent fillers, such as Bellafill, silicone, and Alkamid for years already in Realself, as well as elsewhere. Permanent fillers can translate into permanent complications that may result immediately or even five, ten or twenty years later.  Surgical excision of course is one possible option, however, this will leave surgical scars. Alternatively, subcision may be used to break up the bulky area and hyaluronidase in high concentration boluses (although not being used here for dissolving hyaluronic acid) may can help with dispersion of the intralesional steroids and/or 5 FU, allowing them to be more effective this time around. It may also help with lymphatic obstruction that may be playing a role here, as well.  Bottom line: make sure that you consult with a board certified aesthetic physician with experience in treating the undereye region. Best of luck.

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

there is no permanent solution, you can surgically remove, inject with 5fu/steroids/hyaluronidase, start RF treatments or consider plasma pen.  Best, Dr. Emer.

Anthony Farole, DMD · Answer

I wish I could provide you with a solution. I cannot. Bellafill is designed to be permanent. The only thing I can think of is a skin expander placed under the skin on top of the Bellafill to create more skin. Then a complete skin and Bellafill excision and closure. You will not like the look of the tissue expanders but it is a means to the end you’re looking for.

Amy Y. Paul, DO, FAAD · Answer

So sorry you are going through this!  PMMA is a completely different product than all other fillers and has been reconfigured several times over the years to try and make it more user-friendly, but this is the only filler I have had to surgically remove after someone developed little nodules all over the cheeks from another injector using Bellafill.  I do not carry it at my office and have no interest in doing so due to the risks of complications.  Steroid will not dissolve it, and neither will hyaluronidase, which is extremely useful for dissolving most of the HA fillers.  Under the eye fillers are inherently risky as they can cause long lasting problems and strange-looking outcomes, but perhaps seeing an oculoplastic surgeon would be of benefit to you.  An oculoplastic surgeon will have special knowledge of the anatomy of the area and may be able to offer a surgical option.  I wish you the best of luck!

Kristen Aliano Messina, MD · Answer

In my practice (Beyond Beautiful in Plano, Texas), we (as a practice) use Bellafill frequently. My colleague in the practice has been using it for many years. The main methods of non-surgical removal are 5FU and steroids. However, in more difficult situations, it may need to be directly excised. Please see a trained plastic surgeon for evaluation.

Is there really is such a thing as PMMA removal? (Photo)

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Answers (6)

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