Bellafill injection displaced fat pad? Can anything be done to fix it? (photo)

Filler migration and granuloma formation can cause longterm problems with Bellafill and Artefill fillers. This is similar in patients who have Artecoll and PMMA fillers. Longterm filler complications include migration, edema, chronic swelling, and nodularity. If patients have filler migration or nodules, 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 likely not HA material or 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.

Surgical removal of Bellafill is possible and we have a wide ranging experience with the treatment. Some areas of the face can be treated because the Bellafill removal scars are barely visible. We have found that Bellafill nodules, if palpated, can be removed from the tissue. Undereye Bellafill, nasolabial fold Bellafill, and lip filler can be treated successfully. Diffuse Bellafill is difficult to treat.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Hello Bren305,
By looking at your photos, it perhaps seems to be a "too superficial" placement of product near the eye.  I would suggest, to slowly inject the filler near the eyes with a low dose Triamcinolone series or 5FU in multiple sessions.  Then deep injections of filler to the cheek (malar pad) and temple area to create a more uniform facial contour.

These results are from poor injection technique. It is not related to fat pad displacement. What you are seen is a collection of filler in a superficial plane. These aren't your final results because that will take about 6 months to appreciate. However, I don't think the long term results will look cosmetically pleasing. I'm concerned about the experience of this injector and would seek out a surgeon's opinion because this probably will need excision.

Hello and thanks for posting.
Sorry to see you had a bad experience with the Bellafill injection. I assume that fat pad displacement possibility was offered by the injector?

I can’t say that I have ever seen fat pad displacement produced by injection of a facial filler, although I suppose it would be possible if one injected under the fat pad and caused it to become more noticeable.

Injection into the under eye region is considered an advanced injection zone. This is because any misplacement of filler may result is contour irregularity which may actually be worse than the under eye volume loss the injector was trying to address. Also, malar edema (also known as festoons or malar bags) may develop as a temporary of long-term complication of under eye facial fillers.

Without seeing in person, and seeing the before treatment photos, it is difficult to determine why you have the contour irregularity under your eye. If the lump or bump is a Bellafill nodule, it can be reduced in size by the injection of triamcinolone with or without 5-FU.  Often, additional filler to smooth in the area is required as well.

The first step would be to follow up with the original injector to see if he or she can fix this. If unsuccessful, then seek a second opinion to see what can be done.

Good luck!  

Good Day. Thank you for your question and photographs.Simple Answer: there is a treatment.Your photographs show the following:lateral (temporal) lower eyelid fullness, apparently due to excess Bellafill, festoon formation (malar skin inelasticity with underlying edema), facial skin inelasticity and fine wrinkles, volume loss at adjacent tear trough area to areas of filler fullness and along the nasojugal groove down to the submalar area.A comprehensive in-person examination assists in refining the recommendations.One option is to inject either 5-FU and/or Kenalog (low dose like Kenalog 10) into the area of fullness, waiting 3-4 weeks before another injection, consider a repeat injection of the same dose or increasing to Kenalog 20 into the same area.Volume replacement into the lower eyelid and facial areas (nasojugal groove) to both improve the area of filler fullness and to improve the appearance of the festoon. Skin tightening and skin resurfacing procedures may add to the improved appearance. A key to Bellafill injection, especially in the tear trough area, is to inject less than more. I inject about 80% of the amount I believe someone requires aesthetically and about 80% of the volume present within 5 minutes of the injection remains long-term. Thus, there is a 20-40% safety zone to avoid over-injection.Best of luck.