Problems after receiving a PMMA-based cheek filler - non-surgical and surgical options?

Question

Hi there. I've unfortunately developed some complications after receiving Bellafill cheek filler to treat my acne scars. It's diffuse, and the problem is mostly inflammatory. There are no nodules. What are some non-surgical and surgical treatment options for this? I have already tried a Kenalog series. Really, this has escalated to the point that I am considering surgical options, but I would really appreciate hearing as many opinions on this as possible from medical professionals. Thank you!

Anna Chacon, MD, FAAD · Answer

Hi there,

I’m sorry you’re dealing with this. Persistent inflammation after a PMMA-based filler such as Bellafill can be particularly frustrating, especially when the reaction is diffuse rather than presenting as discrete nodules.

Because PMMA is a permanent filler, management can be more challenging than with temporary fillers. The appropriate approach depends on whether the inflammation is primarily inflammatory/granulomatous, infectious, or related to another process.

Non-surgical options

Since you’ve already tried a series of Kenalog injections without adequate improvement, I would be cautious about simply continuing steroid injections, particularly if there are no defined nodules to target. Depending on the clinical findings, physicians may consider:

Systemic anti-inflammatory or immunomodulatory treatment when a delayed inflammatory or granulomatous reaction is suspected.
Antibiotic therapy in selected cases where an infectious component or biofilm is suspected. This is generally based on the clinical picture rather than treating every filler reaction as an infection.
Combination medical therapy may sometimes be used for persistent granulomatous reactions, but this needs to be individualized and monitored closely.
Imaging, particularly high-frequency ultrasound or MRI in selected cases, can sometimes help determine the location and extent of the filler and distinguish diffuse involvement from focal collections or nodules.
Surgical options

When symptoms remain significant despite appropriate medical treatment, surgery can be considered. The challenge with PMMA is that it cannot simply be dissolved with hyaluronidase the way hyaluronic-acid filler can.

Surgical treatment may involve excision or debulking of areas containing the filler and chronically inflamed tissue. However, when the PMMA is diffuse throughout the cheek, complete removal may not be realistic without creating contour irregularities, scarring, or other cosmetic problems. In some cases, staged or limited removal is considered rather than attempting to remove everything at once.

The decision to proceed surgically is therefore a balance between the severity of the inflammation and the potential morbidity of surgery.

Given that your reaction is described as diffuse inflammation without nodules and has not responded adequately to Kenalog, I would first want to establish exactly what is causing the ongoing inflammation and where the PMMA is distributed before deciding that surgery is the next step. A careful examination and, when appropriate, imaging can be very helpful in making that determination.

Most importantly, because PMMA is permanent, treatment should be individualized rather than assuming that the same approach used for other fillers will work here.

Problems after receiving a PMMA-based cheek filler - non-surgical and surgical options?

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