Can lips be rebuilt after surgical removal of Artecol/Artefill? (photos)

15 years after injection of Artecol in my lips I developed huge granulomas. Surgery was the only option and my lips are now horrible. Last week I had temp filler to lift the corners and give the top lip more projection. The injector struggled due to the scar tissue and it was v.painful so dont think temp fillers are the answer. Is there a surgical option to repair my lips - to pull up the corners, correct the space between nose and lip and restore fullness? I could have work done in UK or US.

Doctor Answers 5

Lip deformity after fillers. What are your options?

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Bellafil ®, formally known as Artefill®, is they tried and true permanent filter with which I have had over 12 years of experience injecting. As with all fillers, results depend on the methodology with which the filler is injected.  In my experience, granulomas are few and far between mainly resulting from injections on or near bone.If lips have been deformed from  permanent fillers (including fat, silicone and PMMA) with lumps and bumps, surgical removal is the only option should conservative measures such as Kenalog injections fail.  Additionally, the weight of the fillers can often be the "straw that breaks the camels back"  exacerbating already long lips, downward pointing corners, etc. That occur normally with age.  Lip lifts, including upper, corner and lower can be performed with discrete, near invisible scars to  dramatically improve and rejuvenate the shape of the peri-oral region. Indeed, lip rejuvenation through any of these aforementioned techniques can  easily take away 5 to 7 years from one's appearance.

Los Angeles Plastic Surgeon
4.6 out of 5 stars 56 reviews

Restylane filler after Artecol removal

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I would suggest a soft HA filler such as Restylane to help improve the look of your lips. Also, we would evaluate the remaining Grade of tissue inflammation. 


Dr. Karamanoukian

Los Angeles

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 95 reviews

Repair of Lips

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I am sorry to hear that you have had these problems.  If you had your injections 15 years ago, the product would have been Artecoll.  It did have problems with granuloma formation.  The new iteration of that product.  Bellafill has very few of these concerns and the 5 year study shows none of the long term concerns that you had (the 10 year data will be out next year with continued excellent results and no volume loss). 
In your case, the best solution is to have a temporary filler placed with a cannula.  This will deliver a much more accurate result with less swelling and bruising.  More importantly, it will be much safer to inject the filler since there is less chance of injecting into an artery.  This is a concern when using needles if there is a lot of scarring in place as in your case.
I hope that helps.
Best regards.

Brian Windle, MD
Kirkland Plastic Surgeon
4.9 out of 5 stars 64 reviews

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There are various options to improve the appearance of your lips resulting from the surgery and aging.

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Hello, I am sorry you had artefill injected into your lips in the first place.  I suppose some injectors may still practice this technique but I personally do not use Artefill (now called Bellafill) in the lips.  While it is common for injectors of dermal fillers to use dermal fillers for off-label purposes, using Bellafill in the lips is just asking for trouble.  Bellafill is not a good option for the lips and unfortunately you now understand why.  All hope is not lost however and there are procedures available to improve the appearance of your lips.  I personally would create a procedural plan that was staged.  It may be prudent for you to find a good surgeon in Miami to do this for you because you are going to require multiple visits. I do not think you need to travel outside of Miami because there are many perfectly qualified surgeons right there.  Whether you choose a general plastic surgeon or a facial plastic surgeon, it is most important to find a surgeon you connect with, understands your condition, creates a reasonable plan of action and performs fat grafting well.  Also, while your current lip appearance has much to do with the artefill and subsequesnt surgical removal and resulting scar tissue, the natural aging process has also contributed to your down turned mouth after fifteen years.  Also, temporary fillers are not necessarily a poor choice to assist with your situation and the excessive pain you felt will occur with every treatment because of the current scar tissue.  It is therefore recommended that you receive at minimum a dental block (local anesthetic injected in the mouth) near the sensory nerves, if you have awake procedures performed on your lips again.  I would reconstruct your lips and perioral area (around the mouth) using various techniques, performed over time, that includes but not limited to; fat transfer aka (fat grafting), most likely lip lifting surgery as well and possibly some tattooing.  Also, you want to make sure your teeth are in good shape because poor dentition leads to loss of lip support.  You are going to have to be patient with this endeavor.  You will likely need three or more fat grafting treatments over time.  The surgeons familiarity with fat grafting is paramount along with his or her fat transfer instruments.  I currently use the Tulip cannulas and I think they are excellent.  If lip lifting techniques are agreed upon you will have more scars as a trade off for larger lips and an upturned smile.  These scars however should fade quite well over time.  Good luck with your endeavor, you should be able to make this better.    

Ryan Mitchell, DO, FAOCO
Henderson Facial Plastic Surgeon
4.6 out of 5 stars 23 reviews

Lip Augmentation with Fillers or Lip Implant or Fat -- Go Slow, Use Cannulas

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For non-surgical treatment I find that fat is better over implant, or fillers. Surgically, a lip lift could be done for full improvement. I suggest you see an expert for treatment options that fit your individual goal. Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 207 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.