PMMA filler complications. Is there anything that could reduce the volume that has occurred? Could just 5 FU injections help?

Question

Hi, I unfortunately had 1 syringe of bellafill (.5 cc per cheek) injected in my cheeks for acne scarring over a year ago. It was injected deep, despite me not having rolling acne scarring and not requesting generalized volumization. It did not help with my acne scarring at all. But it has changed my appearance. I am 27, so maybe I overproduced collagen. I take full responsibility for the decision to have this done (although it was quick and pressured and I was completely ignorant to all kinds of fillers) but it was largely willful ignorance on my end because I felt desperate for an improvement in the acne scarring and I ignored my instincts that a permanent filler was a bad idea. The aesthetic result is that my mid face is fuller, heavier, and I now have a more aged appearance. This is especially noticeable when I smile. When I smile, I look like a Muppet. So I don't do that anymore. My face looks wider, swollen, and more inflamed. I look like I've gained weight. I have not. I am healthy and I have always been healthy. I am also terrified of taking certain supplements, like collagen, that I used to enjoy, in fear that it will make this result worse. So in many ways, my quality of life has decreased. I should just rename myself at this point and go off and buy a cabin in the woods. Sorry, I am genuinely in significant distress. Questions - Is there anything that could reduce the volume that has occurred? Could just 5 FU injections help? I would like to try to avoid steroids.

Nelson Lee Novick, MD · Answer

I am truly sorry that you are suffering this way. Although treating the adverse effects of permanent fillers can admittedly be difficult, I have personally achieved gratifying results with individuals who have come to me with these kinds of problems having been treated elsewhere with permanent fillers. Treatment typically involves the use of varying combinations and concentrations of intralesional anti-inflammatory agents, including 5-FU, depending upon the circumstances. You would be wise to consult with an experienced, board certified cosmetic dermatologist injection expert and best of luck.

Anna Chacon, MD, FAAD · Answer

I'm sorry you're going through this. Changes to your appearance that you didn't anticipate can be incredibly distressing, especially when the original goal was to improve acne scarring rather than add volume to your cheeks. Please don't be too hard on yourself for the decision you made. You were trying to address something that bothered you, and you deserve to have your concerns taken seriously.

Bellafill contains polymethylmethacrylate (PMMA) microspheres suspended in a collagen-based gel. The gel component is gradually absorbed, while the PMMA microspheres remain in the tissue and stimulate collagen production. Because of this, the added fullness can persist, and Bellafill cannot be dissolved with hyaluronidase the way hyaluronic acid fillers can.

The first step is determining what is actually causing the increased volume. It could be related to the intended filler volume, collagen formation around the PMMA particles, or a delayed inflammatory reaction. These possibilities require different approaches, so an examination is important before considering treatment.

Regarding 5-fluorouracil (5-FU) injections, they are sometimes used off-label to treat certain filler-related nodules or areas of excessive scar tissue, often in combination with other medications. However, evidence supporting 5-FU alone for reducing diffuse cheek volume from Bellafill is limited. It is not a reliable way to dissolve PMMA or selectively reverse the collagen that has formed. It can also cause side effects, including irritation, ulceration, and tissue injury.

Since you'd prefer to avoid steroids, that is worth discussing with a dermatologist or plastic surgeon experienced in managing permanent filler complications. Depending on the findings, observation, targeted treatment for inflammation or nodules, or, in selected cases, surgical removal of accessible material may be considered. Removal can be difficult because PMMA particles may be distributed throughout the tissue, and surgery carries risks of scarring, contour irregularities, and further asymmetry.

I would avoid adding more filler or trying collagen-stimulating treatments until the cause of the fullness has been clarified. There is also no good evidence that ordinary dietary collagen supplements necessarily worsen Bellafill-related volume, so you don't need to assume that you have to avoid them permanently.

Most importantly, I hear how much this has affected your confidence and quality of life. You don't have to accept this distress as something you simply have to live with, but it is important to approach treatment cautiously and realistically. A specialist familiar with permanent fillers can help determine whether the fullness is treatable and which options offer the best balance of potential improvement and risk.

PMMA filler complications. Is there anything that could reduce the volume that has occurred? Could just 5 FU injections help?

Answers (2)

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