Got Venus Viva with subcision and Bellafill. 3 days later my scars are still showing. Should I continue this treatment? (photos)

Question

I would like to know if I should go to my second round of Bellafill and subcision after 5 weeks of my first session? I am still seeing my scars. My doctor, I was so blessed to have a fantastic, I'm not complaining about him I'm just worried that I still see the scarring and I'm wondering if in 5 weeks when I go back to see him if I should get another subcision and more bellafill?

Raffy Karamanoukian, MD, FACS · Answer

Filler migration and granuloma formation can cause longterm problems with Bellafill and Artefill fillers. This is similar in patients who have Artecoll and PMMA fillers. Longterm filler complications include migration, edema, chronic swelling, and nodularity. If patients have filler migration or nodules, 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 likely not HA material or 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.

Surgical removal of Bellafill is possible and we have a wide ranging experience with the treatment. Some areas of the face can be treated because the Bellafill removal scars are barely visible. We have found that Bellafill nodules, if palpated, can be removed from the tissue. Undereye Bellafill, nasolabial fold Bellafill, and lip filler can be treated successfully. Diffuse Bellafill is difficult to treat.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Surgical removal of Bellafill is possible and we have a wide ranging experience with the treatment. Some areas of the face can be treated because the Bellafill removal scars are barely visible. We have found that Bellafill nodules, if palpated, can be removed from the tissue. Undereye Bellafill, nasolabial fold Bellafill, and lip filler can be treated successfully. Diffuse Bellafill is difficult to treat.

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Elham Jafari, MD · Answer

Hi and thank you for your question! 3 days is an extremely short period of time to allow any of your treatments reach optimal results. For treatments such as Bellafill, the collagen making process will take several months and hence, it's too early to judge the results. I recommend that you do your 5-week follow up with your provider and at that time, hopefully before and after pictures can objectively show some improvements. I hope it helps and good luck!

Jason Emer, MD · Answer

Hi Ms. Diva, the truth is that acne scars require a combination approach and a series of treatments to obtain long-term improvement. Your trusted doctor is hopefully an experienced cosmetic dermatologist and acne scarring expert who has created a tailored treatment plan specifically for you. Generally speaking, we use:- Injectable fillers like Bellafill and Sculptra (with or without subcision) for atrophic, indented scars- Subcision for depressed, tethered scars- Vascular lasers like Yellow laser, Aerolase, excel V, or IPL for redness or thick acne scars- Lasers such as Fraxel, Erbium, CO2 or fractional radiofrequency (Venus Viva, Skinfinity, Intensif microneedling RF) for textural issues and superficial scarring- TCA CROSS and punch excision for deep ice pick scars and narrow box car scars- All lasers are combined with microneedling/PRP to improve results and accelerate healingSee an expert and keep up with the treatments to get the results you're looking for. Best, Dr. Emer.

Johnson C. Lee, MD · Answer

Thank you for your photos. Bellafill continues to work for several months after injection to stimulate your body to fill the scars in with collagen. There are also some studies showing volumization even after a year. 3 days is too soon for your final results to show. You can continue treatment or hold off to see if you continue to improve. Bellafill can be done at any time and over multiple treatments. Hope this helps!

Johnson C. Lee, MD
Board-Certified Plastic Surgeon

Johnson C. Lee, MD 
Board-Certified Plastic Surgeon

Davin Lim, MBBS, FACD - Account Suspended · Answer

You have shallow box car scars and possibly some atrophic and rolling scars. The original papers with subcision in 1995 showed that one needs 2-8 session for acne scar improvement - the number of sessions needed are extremely variable, depending on the insight of the patient, their expectations and end goals, the SKILL SETS OF YOUR PLASTIC SURGEON or DERMATOLOGIST and the type of scars, along with patient co-morbidities (active acne, race, smoking etc.). Follow your specialist recommendations, knowing that maximal collagen stimulation needs 2-3 months at least. Dr Davin S. Lim. Brisbane. Australia.

Got Venus Viva with subcision and Bellafill. 3 days later my scars are still showing. Should I continue this treatment? (photos)

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