Stiff smile after Bellafill nasolabial fold injection. How can I get rid of it? (Photo)

Question

I had about two syringes of Bellafill injection (2 month apart) in my nasolabial folds. It's been a year after my 2nd injection and I realized that the area of the injection site is a bit hard to the touch and my smile became pretty stiff. Am I having a granular reaction to the PMMA in the product? How can I get rid of it? Please see the pictures of my smile before and after.

Raffy Karamanoukian, MD, FACS · Answer

Our treatments use combination therapy to improve complications associated with Bellafill, a filler with permanent attributes that can cause granulomas, uneven contour, and soft tissue reaction. Our office focuses on granuloma reversal in cases where an incision may leave permanent scars. The reversal is performed with Kenalog IIT combination therapy, fibrous release, and HIDEF fractional RF to help break up the nodularity. Schedule a consultation for surgical removal if the Bellafill is located in the eyelids, lips, and lower face. Midface Bellafill is difficult to surgically remove.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Nelson Lee Novick, MD · Answer

So sorry you are having this problem. Issues like yours are the reason I constantly warn that permanent fillers, like Bellafill, silicone, and alcamid, can translate into permanent complications that may not just occur immediately following treatment, but as long as five, ten or even twenty years later, and can be very difficult to treat and surgical removal leaves scars. That being said, I have personally had success in treating permanent filler complications in patients treated elsewhere with permanent fillers with the use of subcision to physically break up the material, accompanied by the intralesional injection of antiinflammatory agents, such as triamcinolone and/or 5-FU in varying combinations. Make sure that you consult a board certified aesthetic physician with experience in treating this kind of issue. Best of luck.

Jason Emer, MD · Answer

this is normal for bellafill, if you want to improve it you need steroid/5FU injections and morpheus or fractora MNRF in the office. at home twice weekly dermarolling helps (see link). Best, Dr. Emer.

Timothy Abrahamson, MD · Answer

Bellafill is not a soft filler and hyaluronic acid fillers such as RHA or Restylane or Juvaderm are better option if wanting a soft filler. However, if bellafill used and feels still local steroid injection can be helpful. Better to do repeat sessions than over-inject. In extreme cases, focal incision and cutting out of tissue an option but likely will require RHA filler to make up for tissue loss.

Ideally, focal injections of triamcinolone acetonide likely will soft tissue. Over injection thought can require RHA like filler replacement.

Ideally, focal injections of triamcinolone acetonide likely will soft tissue.  Over injection thought can require RHA like filler replacement.

Stiff smile after Bellafill nasolabial fold injection. How can I get rid of it? (Photo)

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Answers (4)

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