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Removal of Bellafill Nodules in Los Angeles with Dr. Karamanoukian

Bellafill Removal Options

Some patients are faced with the difficult task of removing Bellafill from the nose and perinasal areas of the face. Bellafill is a semi-permanent to permanent filler that is FDA-Approved for facial dermal augmentation and has been used on all parts of the body and face. If you are suffering from the consequences of Bellafill that was placed into the nose and perinasal areas, you may benefit from the surgical experience of Dr. Raffy Karamanoukian, a board-certified specialist plastic surgeon who has an understanding of PMMA removal and mitigation. There are options for removal.

Treatment of filler complications and nodules and granulomas in Los Angeles
The most common dermal fillers in the United States are based on an active ingredient known as hyaluronic acid. Hyaluronic acid is naturally found in the body and is thus a compatible filler for dermal augmentation of the face. FDA-Approved products containing hyaluronic acid can help re-contour and volumize soft tissue in the upper and lower face. Plastic surgeons and dermatologists in the United States employ hyaluronic acid fillers such as Juvederm and Restylane as a minimally invasive approach to anti-aging.
Bellafill, on the other hand, is classified as a semi-permanent filler and does not contain hyaluronic acid as its main ingredient. This filler is known to last for many years and can incite soft tissue reactions such as granuloma formation and scarring around the microspheres of Bellafill placed into the skin. Granulomas and soft tissue scarring can distort the original intent of Bellafill injections into the dermis. Patients are known to have chronic swelling, edema, lumpiness, nodularity, granulomas, redness, inflammation, and burning associated with Bellafill injections.
Dr. Karamanoukian usually classifies Bellafill complications as chronic or acute depending on whether the Bellafill has been injected in the short or long term. Short-term complications include bruising, swelling, asymmetry, and acute granuloma formation. Long-term swelling and nodularity is a very common concern and can drastically distort the contours of the soft tissue, especially if it was placed in a more superficial zone of the dermis and skin.

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Options for removal of Bellafill depend on the technique used for injection and also the location of the filler. Some people have isolated nodules of Bellafill which can be removed surgically if there are no associated sensory or motor nerves which could be damaged during surgical excision. In some patients, the Bellafill is diffusely spread, presumably in a more dilute form using a cannula technique to inject the Bellafill within different layers of the soft tissue. Diffuse facial filler is a challenging problem for surgeons as there is no identifiable nodules of Bellafill that can be removed in one surgical treatment. Secondarily, the diffuse positioning of the Bellafill compromises the nerves and arteries of the face because Bellafill often wraps around the perivascular networks within the deep soft tissue.
Surgical options for Bellafill removal require meticulous attention to detail; and a knowledgeable and experienced plastic surgeon such as Dr. Raffy Karamanoukian can help you explore whether Bellafill can be removed surgically. Removal of permanent fillers can help reduce the cause of chronic swelling and edema. Surgical approaches for Bellafill removal may require general anesthesia or sedation in some cases, but this decision is usually made after a careful physical examination to determine the position of the Bellafill. We are often asked to evaluate patients for surgical removal based on a photograph sent by email and this is a very difficult decision to make by surgeons because the quality of the soft tissue cannot be determined solely by photography. We advise all patients to schedule a consultation with Dr. Karamanoukian to evaluate the soft tissue and diagnostically determine the volume of permanent or semi-permanent filler, gauge the degree of inflammation, and recommend options for surgical versus non-surgical removal.

Bellafill nodules and granulomas removal with Dr. Raffy Karamanoukian
Patients who are candidates for surgical excision of Bellafill may benefit from this procedure as it can remove the granuloma tissue, scar tissue, and PMMA volume that is compromising the integrity of the skin and soft tissue. Practitioners often inject Bellafill into the skin and dermis and this is a difficult presentation to evaluate and treat as it requires excision of compromised skin which may lead to scars.
Of utmost importance in the surgical evaluation of Bellafill Removal is the position of the biopolymer volume relative to the nerves in arteries of the face. Although en-bloc removal of Bellafill is a possibility, it may compromise the sensory or motor nerves of the face and may damage the soft tissue, that's making it an unreasonable option for most patients.
Infections, chronic inflammation, nodularity, and granuloma formation may undermine the soft tissue and make it less healthy and less reliable in the postoperative healing process. These are all risks that should be evaluated during your discussion about filler surgical removal with Dr. Karamanoukian.
There are real risks to Bellafill Removal and a patient must weigh the pros and cons of the surgical procedure versus keeping the inflammatory semi-permanent filler in place. The goal of treatment is to surgically remove the filler without compromising soft tissue integrity, vascularity, perfusion, or skin health. Seeking the best Bellafill removal surgeon in the world is of utmost importance in order for you to improve or eliminate the complications of these fillers.
There are many patients with diffuse PMMA or intradermal Bellafill that are not candidates for surgical removal. In fact, the vast majority of patients with filler complications are victims of improper technique and inadequate discussion of informed consent prior to Bellafill placement. Many of these patients had no knowledge or clue that Bellafill was a permanent or semi-permanent filler and that there is a high risk of inflammation and soft tissue reaction with injection. These patients may benefit from mitigated techniques to reduce the damage caused by Bellafill. Widespread Bellafill is diffusely spread throughout the soft tissue, it may be impossible to remove it altogether.
Mitigation is an appropriate option for non-surgical removal of Bellafill and this is performed by using anti-inflammatory mediators to control the inflammation and soft tissue reaction caused by the biopolymer. These non-surgical options have been developed by Dr. Karamanoukian and are proprietary. We advise patients to begin with a consultation to determine whether these options are suitable based on your medical condition. Anti-inflammatory mediators can control the scarring, nodularity, granuloma formation, and soft tissue reaction or thus beneficial for patients with Bellafill.
There are many different types of fillers that mimic Bellafill and it's a central to understand the provenance of your filler injection so that we may best treat your condition. In general, hyaluronic acid fillers are easiest to dissolve with an enzyme, while PMMA and Silicone biopolymers are harder because they may become permanently embedded within your soft tissue. Often, permanent fillers cause severe reactions and may result in both cosmetic and also functional problems with movement and sensation. The treatment decisions made by Dr. Karamanoukian to surgically remove or mitigate your fillers are derived from proper diagnostic examination and assessment.

Facial Bellafill Removal

Suitable candidates for filler removal treatment require an appropriate examination and diagnostic investigations such as MRIs or CT scans in some cases. Proper medical health and realistic expectations are important in the perioperative and postoperative care of patients with this severe medical problem. It is often important to note that there are limitations to PMMA and permanent filler removal and that not all fillers can be removed from the soft tissue. Bellafill and Biopolymer fillers that wrap around essential neurovascular bundles and nerves may be difficult if not impossible to remove. These patients may benefit from a surgical procedure but complete removal may be impossible. In some of these circumstances, Dr. Karamanoukian may require multiple procedures for effective removal or a combination of surgical and non-invasive approaches.

Bellafill removal surgery in Los Angeles with Dr. Karamanoukian
It is also essential to understand the options for post-surgical removal reconstruction including fat transfer and hyaluronic acid injections. During your consultation and your follow up visits, Dr. Karamanoukian will assess your cosmetic concerns and address them with recommendations for facial fat augmentation, nanofat transfer, hyaluronic acid restoration of soft tissue, or long-term anti-inflammatory agents. Asymmetry is a common problem with facial fillers that are permanent and these areas of asymmetry may never be corrected completely. Nanofat transfers are a specialty of Dr. Raffy Karamanoukian and he can recommend specific treatments in your postoperative reconstruction.
Common side effects of Bellafill injections include chronic swelling, bruising, skin redness and erythema, itching and soft tissue inflammation, skin rash, skin discoloration, hyperpigmentation, granuloma formation, lumps, nodularity, asymmetry, inflammation under the skin.
Suboptimal injection technique by your PMMA injector may cause granulomas and also nodularity under the skin. Granulomas are an inflammatory soft tissue reaction and studies have shown that granuloma formation is a significant concern after PMMA injections. Granulomas are a cellular reaction and can be treated with combination mitigation-therapy by Dr. Karamanoukian including corticosteroids and other anti-inflammatory mediators. Histologically, granulomas can be diagnosed under the microscope by a dermatopathologist and Dr. Karamanoukian may recommend a biopsy with histologic examination to further assess your outcome and milestones for management.
A long-term cross-sectional analysis of adverse events after permanent fillers have noted an increased incidence of complications associated with permanent fillers such as Bellafill and Aquamid. Database analysis is an important means of assessing complications for fillers and clinicians, including Dr. Karamanoukian, who manage sequela of permanent filler complications and analyze long-term outcomes from clinical trials. Volumizing soft tissue injectable fillers for facial rejuvenation have become highly popular and the provenance of some of these fillers is questionable. Potential risks include nodularity and soft tissue reactions from all fillers including the safer hyaluronic acid fillers and those that contain polymethylmethacrylate. Silicon Biopolymer complications are widespread and pervasive. Swelling, infection, presence of nodules, and pain were among the most common complications associated with PMMA and Bellafill. Although Bellafill is an FDA-Approved option with a proven safety record, we are reporting and managing patients that represent a unique subset who have complications or sequela after injection. The most common areas for soft tissue augmentation include the cheek, lip, nasal labial fold, tear trough, forehead, and nose. Dr. Karamanoukian can address complications from filler in all of these anatomic areas.

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Silicone and Bellafill Removal in Los Angeles