Had 2 syringes of Bellafill for marionette line through the cheeks? (Photo)

Question

I had two syringes of bellafill for marionette lines but the doctor Injected in my cheek area to do a "lift" instead of on the lines because it will look too heavy. I'm two weeks in and i don't see much of a difference, also I feel like my one cheek (left) looks bigger then my right side. I'm trying to be patient and see if does more "lifting" after time or was I filled in the wrong place ?

Raffy Karamanoukian, MD, FACS · Answer

Bellafill filler can cause nodules and chronic edema, soft tissue reaction, and longterm problems. We specialize in the removal of Bellafill on the face and see patients with old and new PMMA filler problems. Bellafill will eventually form scar tissue around the permanent filler. 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 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. We remove Bellafill filler from the lips, nasolabial folds, and eyelids. Cheek Bellafill is difficult to remove surgically.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Cameron Chesnut, MD, FAAD, FACMS · Answer

Without question, this is an issue best addressed with the physician who injected you -  he or she surely wants to see you happy.  Combination approaches are a staple in my practice and tend to yield far superior results.  That being said, it is not out of the ordinary to do midface injections in an attempt to lift the lower face. This just has to be done very skillfully and in the properly selected patient. To ensure you are receiving the highest level of care, seek out a modernly trained, new-school dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these "core four" cosmetic specialties. Membership in organizations like the American Academy of Facial Plastic and Reconstructive Surgery help to identify a highly trained surgeon.
Cameron Chesnut
#realself500 Physician

Elham Jafari, MD · Answer

Hi and thank you for your question! Unlike the common belief that to correct an issue, the best approach is to make the injection right at the site of the issue, more experienced cosmetic doctors know that an injection done skillfully at a relatively distant area can often have better results. For example, to treat nasolabial folds I commonly do injections in the cheeks. The lift generated in the cheeks following filler injection may also help with marionette lines, but it is hard to tell without seeing you in person. Keep in mind that Bellafill is a stimulatory filler and the results tend to improve over time. This being said, I highly recommend that you wait for 2 weeks following the injection and if still concerned, go back to your doctor for a follow up. Comparing before and after pictures can objectively show the points of improvement and also help with guiding your physician to see if there is need for further touch ups. I hope it helps and good luck!

Jason Emer, MD · Answer

Keep in mind, it can take several months for final results with Bellafill. And, you will most likely need more than one treatment to get the final outcome as bellafill builds collagen over the long term. For marionette lines, a combination approach will get the most improvement. I recommend fillers for the lines themselves but also lifting around the mouth and cheeks to build underlying anatomical support. In our practice we combine sculptra with other fillers "layered" on top and lasers, rf treatments, ultherapy and peels to get the most conservative natural look and provide lift. Please see a facial sculpting expert. Best, Dr. Emer

Michele Zormeier, MD · Answer

Thank you for your question. 
Bellafill contains PMMA microspheres which provide a scaffold that supports your own natural collagen production as it develops over time. 
83% of patients were still satisfied with their results 5 years after improvement. Your results will continue to improve; however, more syringes will likely be required. If you use a hyaluronic filler like juvederm, the results are greater initially, but decrease over time, whereas, bellafill results improve over time. 
Swelling can last for several weeks and repeat injections can be done in 4-6 weeks. 
Please consult a local board certified facial plastic surgeon for more information and a comprehensive consultation

Steven F. Weiner, MD · Answer

The results you see immediately are a good indication of how the end results will be after about 6 months. I wouldn't anticipate much change from what you have right now. I understand what you doctor is saying but I believe you could handle some injections around the mouth, marionette, and prejowl sulcus. However, marionette lines are tough to eradicate and injections elsewhere are often needed such as the cheeks, jawline, and preauricular area. I haven't seen much results with using threads for this and don't advocate them for this.

Faraz Valaie, MD · Answer

Hi,
Thanks for the question. 
First and foremost for Bellafill it is way too soon to judge, however when it comes to marionette lines couple of main factors are important:
1. Pulling up from cheeks is not possible in everyone, specially if the tissue is too heavy
2. If pulling up from cheeks is done too aggressively can lead to weird looking face with way too puffy cheeks. 
3. Injecting directly into marionette lines can definitely help, however should be done with an experienced physician, otherwise can end up in wide jaw and masculine look. 
I hope all these can help :)

Robert J. Troell, MD, FACS - Account Suspended · Answer

Good Day. Thank you for your question, narrative and photograph.Since Bellafill stimulates collagen synthesis and interlaces with the adjacent collagen, the risk of migration after the first 2-3 months is virtually zero.The initial injection of filler may have been in an anatomical site that is not optimal.Treatment of facial jowls with fillers is very common. Injecting into the pre jowl sulcus (marionettes lines or mesolabial folds) is one anatomical location to camouflage the jowl appearance.Injection into the submalar volume loss can both camouflage the jowl and treat the jowl by lifting ptotic mid face soft tissues. Smooth volume during injection increases the incidence of a smooth filler outcome.Swelling due to injection trauma takes 1-3 weeks to resolve. Some fullness short term may be due to this cause. Best of luck.

Brian Windle, MD (retired) · Answer

Bellafill is a great filler for the marionette area.  The beauty of Bellafill is that, while it may cost more than other fillers, your correction will last a long time.  However, Bellafill placed in your cheeks to give you a lift will not in any way improve your marionette lines.  
  
It is common for many injectors to claim that a filler in the cheek will give a lift but unfortunately, this is not the case.  I have added a video that shows you exactly how much volume is in a syringe of filler and you will see that the tiny amount that was added to your cheeks cannot possibly make a change way down in the lower part of your face.  
  
Do not worry about the differences in your cheek volume as this is very likely residual swelling from the injury of the injection, especially if a needle was used to do you injections,
  
I hope that helps.
  
Best regards.