Bellafill migration/lumps - would a mini facelift sooth out these lumps? (Photo)

Your problem with Bellafill is one that I see often in my Los Angeles plastic surgery practice. I would begin with IIT treatments to break down the fibrosis of the Bellafill, thus reducing the lumpiness of the area. I would agree that HA fillers are not the solution. Surgical removal of Bellafill is something that can be done in some cases; although your candidacy for this would depend on your exam.

Dr. Karamanoukian
Realself100 Surgeon
Los Angeles

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin - Winnetka & Chicago. This is a great question. It’s completely understandable to feel stuck, especially with older Bellafill since it’s permanent and can form firm nodules years later. I recommend CO2 laser resurfacing as one of the options that may help soften the surface irregularities and improve the appearance of lumpiness by stimulating collagen remodeling around the area. It won’t remove the Bellafill itself, but in some cases it can help blend texture and reduce how visible the unevenness looks.

I can hear how upsetting and discouraging this has been, especially after living with Bellafill for several years and now feeling like you’re stuck with the results. Bellafill is unique because it contains PMMA, a permanent filler, so unlike hyaluronic acid fillers, it can’t be dissolved—this is why management requires a more careful approach.

What you’re describing—firm, palpable nodules in the nasolabial and marionette areas years after injection—can happen due to the product settling or being placed too superficially. It’s not uncommon for patients to notice these changes as facial fat and tissue shift with age.

Here are realistic options that specialists typically consider:

1. Steroid or 5-FU injections
These can sometimes soften or shrink nodules without surgery. They are not a guarantee, but in some cases they reduce prominence and firmness.

2. Subcision or minor surgical removal
If the nodules are distinct and well-defined, a surgeon experienced with Bellafill revision may be able to break up or excise them through small access points. This is a more targeted and direct approach.

3. Mini facelift or surgical lifting
A mini facelift alone generally won’t eliminate the nodules themselves. It may tighten the overlying skin and improve the visual contour, but the filler will still be present underneath. For the best surgical outcome, many surgeons will combine a lift with direct removal or subcision of the Bellafill deposits at the same time.

4. Fat grafting or other contouring options
In some cases, adding subtle volume around the area—not more filler in the same spot—can help camouflage unevenness, but it needs to be done by someone experienced with permanent filler correction.

5. Finding the right specialist
It can be challenging, because not every provider is familiar with Bellafill revision, but facial plastic surgeons, dermatologic surgeons, or oculoplastic surgeons who work with PMMA fillers regularly often have strategies to manage this.

You’re not out of options, even though it may feel that way. Bellafill revision is more involved than dissolving standard filler, but with the right approach it is possible to smooth and improve the contour and help you feel more comfortable with your appearance again.

I have been cautioning my regular followers for years to avoid the use of permanent fillers. Sure, the allure of a permanent result is powerful. But, the reality is that given the inevitable age-related changes in fat, muscle, and bone that occur with the passage of time, even immediate great results may not necessarily look so great five years or so down the line--typically necessitating additional treatments and essentially making the original promised permanent improvement in appearance not so permanent.
What's more, as in this case, permanent fillers can translate into permanent complications, five, ten or even twenty+ years down the line.
That being said, I have had very gratifying results treating permanent filler-related (and semipermanent-filler related) nodules and fibrosis resulting from prior permanent filler use by employing an algorithm of verying combinations, concentrations and amounts of intralesionally injected anti-inflammatory agents. You would be wise to consult with an experienced, board certified cosmetic dermatologist. Hope this helps and best of luck.