Permanent Fillers For Acne Scars - What are the Risks? (Photo)

Question

Currently seeking treatment for temple acne scars that have not responded to multiple laser sessions. The recommended protocol by two scar specialists has been subcision with the placement of a collagen stimulator (one doc recommends Sculptra and the other recommends Radiesse?) and the one doctor is recommending Silikon 1000 micro droplets into each scar. I'm terrified of having a permanent filler placed in my temples, even though the before and after results look excellent. How much risk is involved in micro droplets of this going into the temples, I'm afraid of hardening, migration, possible blindness, all of it. But it's sounding like this is my only real option for major improvement if I want the maximize how my temples look. Is anyone reporting any major complications from micro droplets in the temples years after placement?

Nelson Lee Novick, MD · Answer

I have long been cautioning my regular followers that the use of permanent fillers can result in permanent problems that may arise not only immediately after treatment, but even five, ten or twenty+ years later, which can be disfiguring and very, very difficult to treat. 
I also gave up using Sculptra and Radiesse quite a few years ago, since adverse reactions from these semipermanent fillers can also be especially difficult to treat, since there is no enzyme that can dissolve these as there is hyaluronidase for HA fillers.
Subcision, on the other hand, which I have been performing for over thirty years is a natural process that breaks up the tethering scar tissue that binds down scars and stimulates new native collagen and elastic fiber synthesis. Although HA fillers may be used in conjunction with subcision, they need not be. In fact for many, many years subcision was a standalone procedure (with no additional filler added), and it worked quite well for elevating and smoothing Indented scars from all causes. 
You would be wise to make sure to consult with an experienced, board certified cosmetic dermatologist subcision expert. All too many aesthetic venues these days hawk the supposedly "next big thing," expensive light, laser or energy-based gizmos that are heavily marketed and social media-hyped out there. So, you will have to make expecially sure that you consult with a physician with extensive experience with subcision. Hope this helps and best of luck.

Anna Chacon, MD, FAAD · Answer

I understand why this feels overwhelming. You’ve already done a lot, and when someone brings up a permanent option, it’s normal to pause and question it.

For temple acne scars, combining subcision with a collagen stimulator like Sculptra or Radiesse is a very reasonable and commonly used approach. These help rebuild collagen gradually and can give meaningful improvement without being permanent.

Silikon 1000 is different. Even when used in very small microdroplets, it is still a permanent material. In the right hands, some patients do well, but the concern isn’t just the short-term result—it’s the long term. I have seen cases where patients develop firmness, nodules, or delayed inflammation years later. These are not easy to reverse.

The temple is also a sensitive area anatomically. Any filler placed there—temporary or permanent—carries a small risk of vascular complications, including very rare but serious issues like vision changes. That risk is low, but it’s not zero.

If you’re feeling this hesitant, I would not rush into a permanent filler. In many cases, you can still get noticeable improvement with subcision and a biostimulatory filler alone. It may take more than one session, but it gives you flexibility and a much safer margin.

You’re not out of options, and you don’t have to jump to something permanent to see improvement.

Permanent Fillers For Acne Scars - What are the Risks? (Photo)

Answers (2)

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