Silicone and Artecoll Filler Removal in Santa Monica


Complications from liquid silicone injections have reached epidemic proportions. Our office sees patients from around the world who have undergone silicone injection in various parts of the body.  The lips, hips, thighs, and buttocks are common areas of injection. Patients with silicone in their bodies may desire removal of the silicone because of unwanted swelling, redness, infection, inflammation, pain, discomfort, and ulceration.  These are very difficult problems to solve and a regimented protocol is necessary to achieve acceptable results and maintain aesthetic contour.  

Patients seek treatment at Kare Plastic Surgery in Santa Monica and Beverly Hills when symptoms arise from silicone injections. The most common signs and symptoms that are reported to our office include the following:
  • Erythema (Redness) and Cellulitis are signs that there may be a subclinical or true infection within the soft tissue. Patients may experience warmth in the area, redness, and signs fo infection. 
  • Generalized firmness of the soft tissue, or hard lumps underneath the skin. 
  • Unrelenting pain, itching, and burning that does not subside with position. 
  • Numbness in the area of injection, or down the legs. 
  • Red or brown skin discoloration. 


Silicone is often injected into the upper and lower lip areas.  Unlike temporary lip augmentation with Juvederm or Restylane, liquid silicone does not dissolve with time.  On the contrary, silicone is a permanent filler that not only stays in the body, but often develops into bigger inflammatory nodules that are known as granulomas.  Some patients will also develop non-nodular swelling, itching, burning, and pain that is directly attributed to the silicone itself.
The treatment of lip silicone or lip nodules is difficult.  Treatment begins with the injection of corticosteroids to decrease the inflammatory effects of the silicone itself.   These injections should be performed by a physician who is familiar with the treatment of silicone in the lips, as complications can occur.  In practice, silicone that is minimally-responsive to corticosteroids can be surgically removed using a variety of techniques.   These procedures are usually performed in an outpatient surgical suite under anesthesia.  
Dr. Raffy Karamanoukian is an expert in the treatment of silicone injection complications. He performs surgery for silicone nodules, lumps, and silicone complications using surgical and non-surgical methods. 


Silicone injections are commonly injected into the soft tissue of the buttocks and hips in order to enhance the contour and volume of the lower torso, buttocks, and thighs. Women who desire a Brazilian Butt Lift may opt for silicone injections if there is no available fat to harvest as donor tissue for fat transfer; but fail to appreciate the longterm risk of soft tissue inflammation and granuloma formation. 

The removal of liquid silicone from the buttocks is possible if there is limited fibrosis of the soft tissue. Prolonged inflammation may damage the underlying vascularity of the soft tissue, making it increasingly difficult to safely remove the liquid silicone after extended periods of time. If you have liquid silicone injections in the buttocks or hips, it is imperative to seek early treatment to mitigate the longterm effects of chronic inflammation, soft tissue fibrosis, granuloma formation, and scarring. 

Dr. Raffy Karamanoukian is renowned for his surgical protocols to remove silicone from soft tissue. He has developed the Karamanoukian Soft Tissue Grading Scale for soft tissue reaction following the administration of silicone injections. If you are experiencing problems associated with liquid silicone injections into the buttocks, a consultation can help you understand your options for treatment. 


Although silicone oils (Biogel, Biopolimero, Bioplastique, and Biosil) can be injected anywhere on the face and body, it becomes more and more complicated to remove the silicone from aesthetically-important areas such as the nose, eyes, cheeks, and chin. Surgical removal of silicone is further complicated by the anatomic restrictions imposed by important neurovascular structures that can be injured if the silicone is removed. 

Dr. Karamanoukian is a leading expert in the removal of silicone from the face and body. During your consultation, he will evaluate the Karamanoukian Grading Scale for soft tissue reaction to determine if there are surgically-feasible options for silicone removal. In some cases, the risk of silicone removal may outweigh the benefits; making it exceedingly difficult to justify the removal of silicone in an elective setting. In cases of symptomatic granuloma formation, ulceration, chronic tissue fibrosis, and infection, there may be a medical justification for emergent removal. 


Silicone Biopolymers can migrate from one zone of the body to another. Understanding permanent filler migration patterns is not simple, because there are many different types of permanent fillers and many different viscosities of filler that must be analyzed. In most cases, we see silicone hydrogel and silicone biopolymer migration across tissue planes on the buttocks and body. These fillers can move across tissue planes, but generally are found within the subcutaneous fat and peri-fascial planes.

Dr. Karamanoukian is an expert in the removal of permanent filler from the body and can help you understand and predict patterns of soft tissue filler migration. . Learn more



We are often asked to remove Artecoll products from the face, especially around the eyes and the marionette lines of the lower face. Artecoll filler can incite a dense inflammatory reaction leading to granulomas, or hard nodules within the skin. It is often difficult to differentiate Artecoll granulomas from normal tissue because there is a less defined interface between the two. In some cases, hard nodules can be removed by Dr. Raffy Karamanoukian using defined protocols for granuloma clearance. Surgical options remain the gold standard for treatment. 

Cases of symptomatic granulomas from Artecoll or Artefill can be managed with non-surgical options, including intralesional therapy. A consultation at Kare Plastic Surgery + Skin Health Center can help you define your options. 


Bellafill is an FDA-approved filler formulated to treat nasolabial folds and moderate to severe atrophic facial acne scars. Our Santa Monica plastic surgery office specializes in the removal of Bellafill and Bellafill granulomas from the face using a surgical approach. Bellafill is composed of collagen and polymethylmethacrylate (PMMA) and can cause granulomas and scarring. Dr. Raffy Karamanoukian can help formulate a surgical plan that removes the filler with minimal complication and risk. Unwanted Bellafill may cause nodules and persistent edema. 

There are several types of fillers that can react similarly to Bellafill and these include Artefill, Artecoll, PMMA. The filler polymethyl methacrylate contains microspheres that can contain varied amounts of collagen and are used to fill volume into soft tissue and skin. According to the manufacturers of Bellafill, the "collagen gel in Bellafill® provides immediate volume and lift to correct wrinkles and acne scars. Once injected, these microspheres stay in place and create a base that provides structural support for smoother-looking skin." Although this is true, it may also cause reactions in a small subset of patients.


Our office has had several patients who have undergone successful removal of Bioplastique from the soft tissue of the lips and face. This particular filler is often of questionable provenance and thus has variable complication profiles. Bioplastique silicone can be removed from the lips using Dr. Raffy Karamanoukian's pioneering techniques. Surgical removal of Bioplastique from the soft tissue of the face is limited by anatomy, particularly neurovascular structures that may be at risk during surgical excision. 


Biopolimero, Biopolimer, Biogel, and Biopolymers are a group of non-FDA approved fillers that are used for soft tissue volume augmentation on the lips, face, and body. Our office consults on Biopolymer injections to the buttocks and face; and our expert plastic surgeon, Dr. Raffy Karamanoukian, has developed a protocol to remove unwanted Biopolymers from the soft tissue. 

Removal of Biopolymers from the lips and buttocks with Dr. Karamanoukian in Los Angeles


Dermagen is a mineral oil/silicone polymer that has been used for soft tissue augmentation of the face and body. Removal of Dermagen should be initiated early, as longterm exposure to Dermagen within the soft tissue can lead to chronic inflammation, granulomatous reaction, and soft tissue fibrosis. Dr. Raffy Karamanoukian is an expert in Dermagen removal, if possible, from the face and body. Surgical removal of Dermagen is limited to those areas where critical nerves are not compromised during treatment. Although Dermagen and Biopolymers have been used in soft tissue augmentation, longterm symptoms of pain, discomfort, infection, foreign body reaction, and inflammation have been reported. 


Juvederm and Restylane Hyaluronic acid facial fillers can be readily removed using Hyaluronidase enzymes Vitrase and Hylenex which dissolve the injected material using enzymatic activity. Unlike silicone and Artefill injections hyaluronic acid is reversible without surgery. A small subset of our patients, however, do not respond to treatment because the material is a more viscous form of hyaluronic acid or not Juvederm or Restylane at all. 

Removing Juvederm and Restylane with Hylenex or Vitrase in Los Angeles