Silicone and Bellafill Filler Removal in Santa Monica

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Kare Plastic Surgery & Skin Health Center  

Silicone Biopolymer Removal
Los Angeles

804 7th Street, Santa Monica, CA 90403  ·  Near Montana Avenue  ·  (310) 998-5533

Our double-board-certified plastic surgeon, Dr. Raffy Karamanoukian, is a leading authority on the removal of unwanted dermal fillers using Ultrasound-Guidance; including Bellafill, PMMA, Artefill, Artecoll, Dermagen, Bioplastique, Biopolimero & liquid silicone injections. 

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a
UCLASchool of Medicine Graduate
DoubleBoard-Certified Plastic Surgeon
WorldAuthority on Silicone Removal
PMMABellafill & Biopolymer Expert
ComplexReconstruction & Revision Cases

The Leading Authority in Silicone & Biopolymer Removal

 

Silicone & Biopolymer Removal in Los Angeles: The Surgeon Who Has Made This His Specialty

The decision to inject liquid silicone, PMMA microspheres, or other permanent biopolymer fillers into the face, lips, or body produces results that appear cosmetic in the short term and catastrophic in the medium and long term — progressive granuloma formation, painful nodularity, migration to regional lymph nodes, skin ulceration, immune system activation, and the irreversible disfigurement of facial and body anatomy that was the patient’s most important aesthetic asset. Reversing these consequences is among the most technically demanding operations in reconstructive plastic surgery — and it is a procedure that the vast majority of plastic surgeons in Los Angeles decline to perform.

At Kare Plastic Surgery & Skin Health Center at 804 7th Street in Santa Monica, UCLA School of Medicine graduate and double board-certified plastic surgeon Dr. Raffy Karamanoukian, MD, FACS has developed a nationally and internationally recognized expertise in the removal of liquid silicone, PMMA-based fillers (Bellafill, Artefill, Artecoll), silicone biopolymers (Dermagen, Bioplastique), and Latin American biopolymers (Biopolimero) from the face, lips, nose, periorbital area, nasolabial folds, body, and buttocks. Patients travel to Kare Plastic Surgery from throughout the United States and internationally specifically for Dr. Karamanoukian’s expertise in these technically demanding removal procedures.

His approach to silicone and biopolymer removal is grounded in his reconstructive surgery training, specifically in the principles of tissue dissection in a scarred, inflamed field, the management of foreign body granuloma reactions, the wound healing science required to achieve acceptable post-removal outcomes in tissues that have been anatomically disrupted by years of silicone-induced fibrosis, and the surgical judgment to know when complete removal is achievable and when partial removal with symptomatic management is the more appropriate and safer goal. This reconstructive framework distinguishes Dr. Karamanoukian’s outcomes from the results of surgeons who approach these cases without this training.

Silicone & Biopolymer Removal at Kare Plastic Surgery

  • Liquid silicone injection removal — face, lips, body, buttocks
  • PMMA (Bellafill) removal — face, nose, nasolabial folds, lips
  • Artefill & Artecoll removal — open surgical excision
  • Dermagen silicone filler removal — face and body
  • Bioplastique removal — open and ultrasound-guided
  • Biopolimero removal — Latin American biopolymer
  • Silicone buttocks removal (injected BBL)
  • Silicone lip reduction and filler removal
  • Silicone nose (rhinoplasty filler) removal
  • Periorbital silicone and filler removal
  • Ultrasound-guided filler removal — hyaluronidase
  • Granuloma management — steroid, 5-FU, surgical excision

Surgeon Expertise

 

Dr. Raffy Karamanoukian: A World Authority on Silicone & Biopolymer Removal

Dr. Karamanoukian’s expertise in silicone and biopolymer removal is not a service he added to a general plastic surgery practice — it is a subspecialty that has emerged from years of treating the most complex cases that other Los Angeles surgeons have referred to him or declined to treat. His case volume in silicone and PMMA removal is among the highest of any surgeon in California, and the technical refinements in his removal technique have been developed through direct operative experience with every category of problematic injectable material currently presenting in the Los Angeles patient population.

The complexity of silicone and biopolymer removal comes from the same wound healing and tissue biology that makes it a reconstructive rather than cosmetic challenge. Liquid silicone, once injected, does not remain as a discrete depot — it disperses through tissue planes, is phagocytosed by macrophages and giant cells that carry it to regional lymph nodes, and stimulates a progressive foreign body granuloma reaction that encases the material in dense fibrous scar tissue. This encased, scar-bound silicone is intimately adherent to surrounding neurovascular structures — the facial nerve branches in the cheek, the infraorbital nerve at the nasal base, the angular vessels of the nose, and the lymphatic channels of the face — making its removal a dissection that demands the anatomical knowledge of a plastic surgeon, not a medspa operator.

PMMA-based materials (Bellafill, Artefill, Artecoll) present a different but equally complex removal challenge: the PMMA microspheres (20–60 microns in diameter) stimulate a robust foreign body granulomatous response in which macrophages and giant cells surround each microsphere and form dense collagenous granulomas that encapsulate the material in discrete nodular masses. These granulomas can be individually palpable, visible as firm nodules under the facial skin, and progressively expanding as new granuloma formation occurs around previously quiescent microspheres. Their removal requires en bloc excision of the granuloma complex as a unit — not aspiration, not injection, not hyaluronidase (which has no effect on PMMA) — an open or ultrasound-guided surgical approach that removes the material along with its inflammatory capsule.

“Silicone and biopolymer removal is reconstructive surgery. The patient comes to us with tissue that has been chemically altered, anatomically distorted, and immunologically activated by a foreign material. Our job is to reverse as much of that damage as surgically possible while preserving the anatomical structures that were present before the material was injected. It requires reconstructive thinking, not cosmetic thinking.”

— Raffy Karamanoukian, MD, FACS — Kare Plastic Surgery, los angeles

UCLASchool of Medicine graduate
WorldRecognized authority in biopolymer removal
AllInjectable materials and filler types treated
National& international patient referrals

Materials Removed

 

Silicone, Biopolymers & Permanent Fillers Removed at Kare Plastic Surgery in Los Angeles

Each injectable material presents distinct removal challenges based on its physical properties, tissue interaction, and the granulomatous response it stimulates. Dr. Karamanoukian has developed specific removal protocols for each.

PMMA Microsphere Filler

Bellafill (Artefill / Artecoll)

Bellafill is an FDA-approved PMMA (polymethyl methacrylate) microsphere filler suspended in a bovine collagen gel — marketed as a permanent filler for nasolabial folds and acne scars. Its predecessors Artefill and Artecoll use the same PMMA microsphere technology under different brand names. The collagen carrier is absorbed by the body within weeks of injection, but the PMMA microspheres — ranging from 30–42 microns in diameter, specifically sized to prevent phagocytosis by individual macrophages — remain permanently in the tissue and stimulate a progressive foreign body granulomatous reaction that creates persistent, expanding nodularity months to years after injection.

Dr. Karamanoukian is recognized as a world authority on Bellafill, Artefill, and Artecoll removal — having performed open surgical excision, ultrasound-guided removal, and multimodal granuloma management for these materials from the nasolabial folds, nose, lips, cheeks, periorbital area, and forehead. His published blog cases on Bellafill removal are among the most comprehensive documentation of these procedures available online and have made Kare Plastic Surgery the destination practice for Bellafill removal patients from throughout the United States.

Liquid Silicone Injection

Liquid Silicone & Medical-Grade Silicone Oil

Liquid silicone — whether injected as industrial silicone, purported “medical grade” silicone oil, or the Dermagen and Bioplastique silicone preparations — is the most problematic injectable material in plastic surgery due to its biological properties: it does not form discrete granulomas that can be excised as a unit, but rather disperses through tissue planes, is transported by macrophages to regional lymph nodes, and stimulates a diffuse granulomatous siliconoma that is intimately adherent to all surrounding structures. The progressive, migratory nature of silicone disease means that the tissue affected grows over time and the surgical field for removal becomes progressively more complex and dangerous the longer the material has been in place.

Dr. Karamanoukian performs liquid silicone removal from the face, lips, nose, and body using the most conservative and anatomically precise dissection possible — removing the grossly visible silicone deposits and their granuloma capsules while meticulously preserving all identifiable neurovascular and lymphatic structures. Complete removal of dispersed liquid silicone is frequently not achievable — an honest assessment that Dr. Karamanoukian provides at every consultation — but meaningful reduction of the silicone burden and the active inflammatory tissue produces significant improvement in symptoms and halts the progressive disfigurement of untreated disease.

European Silicone Biopolymer

Dermagen & Bioplastique

Dermagen and Bioplastique are textured polysiloxane (silicone) biopolymer preparations developed in Europe and used for body augmentation and facial volume restoration in the 1990s and 2000s — marketed as alternatives to hyaluronic acid fillers with more durable results. Both contain silicone particles in a carrier gel, with Bioplastique specifically formulated as a cross-linked silicone in a polyvinylpyrrolidone (PVP) carrier that was supposed to be resorbed, leaving the silicone particles embedded in the tissue as a permanent augmentation.

The clinical problems with these materials follow the same pattern as other silicone-based injectables — progressive granuloma formation, nodularity, migration, and inflammatory response — but are compounded by the cross-linked and particulate nature of the silicone that makes it technically different from pure liquid silicone in its tissue encapsulation pattern. Dr. Karamanoukian has developed specific approaches to Dermagen and Bioplastique removal that address the particulate silicone complex while managing the PVP carrier degradation products that contribute to the inflammatory reaction around these materials.

South American Biopolymer

Biopolimero 

Biopolimero — also known as Biopolimero Venezolano, biopolymer, or simply “el polimero” in Latin American communities — is an unregulated injectable substance widely used in Venezuela, Colombia, Brazil, Mexico, and throughout Latin America for body augmentation, particularly buttock and breast enlargement without surgery. The exact composition of biopolimero varies by the practitioner and source — it may contain silicone, mineral oil, industrial oils, acrylamide, or a mixture of undefined substances — and is almost universally injected by non-physician practitioners in clandestine settings using non-sterile technique and contaminated materials.

The consequences of biopolimero injection are devastating: severe local inflammatory reaction, abscess formation, skin ulceration and necrosis, septicemia from contamination, migration to the abdomen, pelvis, and lymph nodes, and the progressive disfiguring fibrosis that makes the affected body area unrecognizable compared to its pre-injection anatomy. Dr. Karamanoukian treats biopolimero patients from Los Angeles’s large Latin American community and from throughout Southern California, coordinating with infectious disease specialists when active infection is present and with vascular surgeons when lymphatic or vascular involvement requires subspecialty management beyond plastic surgery alone.

Permanent Injectables

Hydrogel, Bio-Alcamid & Industrial Oils

Bio-Alcamid is a polyalkylimide hydrogel that was marketed in Europe and Latin America as a removable permanent filler but has proven significantly more difficult to remove than its marketing suggested — the gel migrates away from the injection site, becomes colonized by biofilm bacteria producing chronic low-grade infections, and forms a fibrous capsule that is adherent to surrounding tissue. Industrial oils — baby oil, cooking oil, and transformer oil have all been injected for body augmentation in non-clinical settings — produce severe lipogranulomatous reactions that are among the most challenging tissue environments for surgical management in plastic surgery.

Dr. Karamanoukian evaluates patients with all categories of problematic permanent injectables and provides an honest assessment of what surgical intervention can realistically achieve for each specific material and each specific anatomical location — including the frank acknowledgment, when appropriate, that complete removal is not achievable and that the goal is maximal symptomatic relief and reduction of the active inflammatory burden rather than anatomical restoration to the pre-injection state.

Hyaluronic Acid reversal

Tyndall Effect, Migration HA Filler Complications

While hyaluronic acid (HA) fillers (Juvéderm, Restylane, Sculptra, Radiesse) are theoretically reversible with hyaluronidase, chronic overinjection of HA — particularly in the periorbital zone, lips, and nose — produces tissue stretching, delayed granuloma formation, the Tyndall effect (bluish discoloration from superficially placed HA), and nodularity that does not adequately respond to standard hyaluronidase treatment. Similarly, calcium hydroxylapatite (Radiesse) and poly-L-lactic acid (Sculptra) complications require specialized removal approaches beyond simple hyaluronidase injection.

Dr. Karamanoukian treats chronic HA complication cases with ultrasound-guided hyaluronidase injection at high concentrations, microcannula dissolution and aspiration, and surgical excision for refractory HA nodules and the Tyndall effect. His ultrasound-guided approach allows precise identification of filler deposits in the periorbital and perinasal zones where blind injection of high-concentration hyaluronidase risks vascular and neural injury.

Understanding Silicone Disease

 

Silicone Disease: Consequences of Injected Foreign Materials

Silicone disease — also called Human Adjuvant Disease, silicone-induced granulomatous disease, or siliconosis — is the spectrum of local and systemic immune responses triggered by the presence of injected silicone or other biopolymers in the body. It represents one of the most important and most underrecognized conditions in aesthetic medicine, affecting a significant but poorly quantified number of patients who received silicone or biopolymer injections from non-physician practitioners in medically unsupervised settings throughout Los Angeles, the rest of California, and internationally.

The Symptoms of Silicone Disease

Inflammatory Reaction

Progressive firmness, swelling, redness, and pain at the injection sites — beginning months to years after the initial injection and progressively worsening as the granulomatous reaction expands. The injected area feels hard and nodular rather than the soft, pliable tissue of the pre-injection anatomy.

Skin Discoloration & Ulceration

As silicone granulomas expand toward the skin surface, they produce visible skin discoloration, surface irregularity, and in advanced cases, breakdown of the overlying skin into open ulceration that requires wound care management before any surgical intervention is safe.

filler Migration

Liquid silicone and biopolymers migrate through tissue planes away from the original injection site — tracking along fascial planes to distant anatomical locations. Buttock-injected silicone has been found in the abdomen, retroperitoneum, and pelvic lymph nodes. Facial silicone has been found in cervical and axillary lymph nodes.

Lymph Node disease

Regional lymph nodes draining the injection site may enlarge as silicone-laden macrophages accumulate in the node, producing palpable lymphadenopathy that can be mistaken for malignancy on imaging. This silicone lymphadenopathy is not surgically correctable without lymph node excision but is informative about the extent of silicone migration in the affected body region.

autoimmune disease

In the most severely affected patients, injected silicone triggers systemic immune dysregulation producing symptoms that overlap with autoimmune disease: chronic fatigue, arthralgias, myalgias, hair loss, skin rashes, and cognitive changes consistent with a systemic inflammatory syndrome driven by the chronic foreign body burden.

swelling and edema

Without intervention, silicone disease produces progressive anatomical distortion as expanding granulomas, fibrosis, and skin changes transform the originally injected area beyond recognition — producing the grotesquely distorted lips, noses, buttocks, and faces that represent the late consequences of untreated silicone injection complications.

If you have received injections of liquid silicone, biopolymer, Bellafill, Artefill, or any permanent filler and are developing firm nodules, skin changes, pain, or progressive distortion: These are early signs of silicone disease or foreign body granulomatous reaction. Early intervention produces better outcomes than waiting until the disease progresses to ulceration or widespread migration. Call Kare Plastic Surgery at (310) 998-5533 immediately for a consultation with Dr. Karamanoukian. Do not receive additional injections at the affected site.

Removal Techniques

 

Silicone & Biopolymer Removal Techniques  Los Angeles

The appropriate removal technique depends on the specific material injected, its anatomical location, the degree of granuloma formation, and the extent of tissue involvement. Dr. Karamanoukian selects and combines techniques based on the specific presentation at consultation.

Primary Technique — PMMA & Discrete Granulomas

Open Surgical Excision

Open surgical excision is the definitive approach for the removal of PMMA-based granulomas (Bellafill, Artefill, Artecoll), discrete silicone deposits with well-formed fibrous capsules, and biopolymer masses that have consolidated into palpable, excisable tissue units. The procedure involves making precisely planned incisions in natural skin creases or along anatomical boundaries to provide direct access to the granuloma complex, dissecting the granuloma from surrounding tissue in an en bloc fashion that removes the foreign material along with its inflammatory capsule, and closing the wound in anatomical layers with fine absorbable sutures.

For Bellafill and PMMA removal from the nasolabial folds, nose, and lips — the most common sites in Dr. Karamanoukian’s practice — open excision is typically performed under local anesthesia with sedation as an outpatient procedure. The dissection must be performed with meticulous care around the infraorbital nerve, the angular vessels, and the superficial muscular aponeurotic system in the cheek to avoid the facial nerve branches that traverse the operative field. Dr. Karamanoukian’s reconstructive anatomy training and his experience with these specific anatomical relationships in the inflamed, scarred tissue environment of chronic PMMA granuloma are the clinical foundation of his outcome quality in these cases.

The nasal approach for PMMA or silicone removal from the nose requires familiarity with the rhinoplasty anatomy of the nasal skin, subcutaneous tissue, and the relationship of the injected material to the underlying nasal framework — an advantage that Dr. Karamanoukian’s rhinoplasty expertise provides directly.

Precision Technique — Periorbital & Delicate Zones

Ultrasound-Guided Removal & Dissolution

Ultrasound guidance uses high-frequency sonographic imaging to visualize filler deposits, granulomas, and vascular structures in real time during the removal procedure — allowing precise needle or cannula placement into the target tissue under direct imaging guidance rather than relying solely on surface palpation or anatomical landmarks in a tissue environment that has been distorted by years of inflammatory change. Ultrasound-guided removal is particularly valuable in the periorbital zone, where the angular vessels and supratrochlear vessels are at highest risk during blind hyaluronidase injection, and in the nose, where the dorsal nasal and lateral nasal arteries must be visualized and avoided during silicone or filler removal.

For hyaluronic acid complications in the periorbital and perinasal zones, Dr. Karamanoukian performs ultrasound-guided high-concentration hyaluronidase injection with real-time visualization of the filler deposit and the surrounding vascular structures — the safest approach for dissolution in anatomically high-risk zones. For liquid silicone in areas with discrete palpable deposits, ultrasound guidance allows microcannula placement into the silicone deposit for aspiration of more liquid material before open excision of residual encapsulated granulomas.

The combination of ultrasound-guided preoperative mapping of silicone and granuloma distribution with open surgical excision of the identified deposits is Dr. Karamanoukian’s preferred approach for complex, multi-nodular silicone presentations in the face — the imaging providing the surgical road map that allows the most complete removal within the safest anatomical boundaries.

On the expectations for silicone removal: Complete removal of dispersed liquid silicone or biopolymer from all tissue planes is frequently not achievable — and Dr. Karamanoukian provides this assessment honestly at every consultation. The goal of silicone removal is maximal reduction of the foreign material burden, elimination of the most actively symptomatic granuloma deposits, and arrest of progressive tissue destruction — not anatomical restoration to the pre-injection state, which is not surgically achievable when material has dispersed through multiple tissue planes, migrated to lymph nodes, or produced extensive fibrosis. Patients who understand this goal are the most satisfied with their removal outcomes; those who expect complete restoration to pre-injection anatomy are counseled carefully before any procedure is scheduled.

Anatomical Sites Treated

 

Silicone & Biopolymer Removal by Anatomical Site at Kare Plastic Surgery

Face — Nasolabial Folds, Cheeks & Periorbital

The nasolabial folds and cheeks are the most common sites of Bellafill and PMMA injection for cosmetic volume restoration — and the most common location of the expanding granuloma nodules that bring patients to Kare Plastic Surgery for removal. Dr. Karamanoukian performs open excision of PMMA granulomas from the nasolabial folds through incisions placed within the fold itself or through transoral access, and from the cheeks through small incisions placed in the preauricular or alar crease. The periorbital zone — tear trough and infraorbital area — requires the most delicate and anatomy-aware approach, as the infraorbital nerve and angular vessels must be protected throughout the removal procedure.

Lips — Silicone, PMMA & Biopolymer

Lip augmentation with silicone, Bellafill, biopolimero, and other permanent fillers produces the characteristic “overdone” lip appearance that progresses to nodularity, firmness, and ultimately grotesque distortion as granuloma formation replaces the soft tissue pliability of normal lip anatomy. Dr. Karamanoukian performs lip filler removal through intraoral and mucosal incisions that are hidden within the oral cavity, excising the PMMA granuloma nodules or aspirating liquid silicone deposits while preserving the orbicularis oris muscle integrity that determines lip function and natural movement. Simultaneous lip reduction is performed when the accumulated filler volume has stretched the lip beyond the patient’s aesthetic goal.

Nose — Rhinoplasty Filler Complications

Nose augmentation with liquid silicone, Bellafill, or other permanent fillers produces complications unique to the anatomical constraints of the nose: skin thinning over the dorsum from chronic granulomatous pressure, vascular compromise from high-pressure injection into the dorsal nasal arteries, and the progressive nodular distortion of nasal anatomy that becomes increasingly visible and increasingly fixed over time. Dr. Karamanoukian’s rhinoplasty expertise makes him uniquely qualified to approach the nose for filler removal through rhinoplasty access incisions — open or closed — removing the granuloma deposits and residual filler material while simultaneously assessing and managing any structural nasal change produced by years of tissue distortion.

Buttocks & Body — Silicone BBL & Biopolimero

Buttock injection of liquid silicone, biopolimero, and other substances by unlicensed practitioners has produced a public health crisis in the Latin American and transgender communities of Los Angeles, with devastating consequences including death from systemic silicone embolism during the injection procedure, life-threatening infections, skin necrosis, and the progressive inflammatory disease that produces the misshapen, painful, infected buttocks that present to Dr. Karamanoukian years after the original injection. Buttock silicone removal is one of the most physically demanding operations in plastic surgery — requiring general anesthesia, large-volume tissue resection in a field contaminated by years of inflammation and infection, and the wound management expertise to achieve acceptable healing in tissue that has been profoundly damaged by silicone disease.

Buttock silicone patients: Complete removal of extensively injected buttock silicone is rarely achievable in a single procedure and typically requires staged operations over 12–24 months. Some patients require skin excision and buttock reconstruction in addition to silicone removal when the skin has been irreversibly damaged by chronic ulceration or necrosis. Dr. Karamanoukian provides a frank, complete assessment of the achievable outcome at consultation, including the realistic staging plan and the expected appearance after maximal removal.

The Removal Process

 

Expectations: Silicone Biopolymer Removal Los Angeles

 

Comprehensive Clinical Assessment

Dr. Karamanoukian performs a thorough clinical evaluation of every silicone/biopolymer removal patient — characterizing the material injected (if known), the anatomical extent of involvement, the degree of granuloma formation, the presence of active infection, skin integrity at the affected sites, and the patient’s systemic symptom burden from silicone disease. Imaging is reviewed if available (MRI or ultrasound are the most informative modalities for mapping silicone distribution). Prior operative records from any previous removal attempts are reviewed. A frank, complete assessment of what surgical intervention can realistically achieve is provided at every consultation — including the honest acknowledgment of what is not achievable and what the patient’s anatomy is expected to look like after maximal removal.

 

Pre-Operative Imaging & Planning

High-resolution ultrasound mapping of filler deposits is performed before facial removal procedures to identify the precise location, depth, and relationship of granuloma nodules to surrounding vascular structures. For complex facial cases, MRI may be ordered to characterize the extent of silicone infiltration in multiple tissue planes. Infectious disease consultation is arranged if active infection is suspected at any site. For patients with systemic silicone disease symptoms, coordination with rheumatology or internal medicine is offered to address the immunological component of the disease while surgery addresses the foreign material burden.

 

Surgical Removal Under Appropriate Anesthesia

The anesthesia approach is selected based on the volume and anatomical location of the planned removal: local anesthesia with sedation for limited facial PMMA removal; general anesthesia for extensive facial silicone removal, lip removal, nasal removal, or buttock/body removal. The surgical technique — open excision, ultrasound-guided aspiration, or combined approach — is executed as planned, with intraoperative assessment at each step of the completeness of granuloma excision and the integrity of surrounding anatomical structures. All removed tissue is submitted to pathology for histopathologic characterization of the granuloma type, the identity of the foreign material when technically feasible, and screening for any malignant transformation within the chronic inflammatory tissue.

 

Post-Operative Care & Wound Management

Post-operative wound care after silicone/biopolymer removal is more complex than standard cosmetic surgical recovery because the tissue being healed has been compromised by years of chronic inflammation, reduced vascularity from granulomatous replacement of normal tissue, and reduced immune competence from systemic silicone disease. Dr. Karamanoukian provides written post-operative wound care protocols tailored to each patient’s specific sites and tissue quality. Compression or specialty dressings are applied when appropriate. Post-operative antibiotic coverage is continued when intraoperative contamination is encountered. Wound healing is monitored closely at post-operative visits to identify and promptly address any healing complications before they progress.

 

Granuloma Management & Long-Term Surveillance

For patients with residual granulomatous disease after removal — either because complete removal was not achievable or because new granuloma formation develops around residual microscopic material — Dr. Karamanoukian manages the ongoing granulomatous inflammation with intralesional triamcinolone, intralesional 5-fluorouracil (5-FU), and Vbeam pulsed-dye laser to reduce vascularity and collagen formation in the granuloma tissue. Long-term surveillance for disease progression, new nodule formation, and any signs of malignant transformation within chronic inflammatory tissue is recommended at 6–12 month intervals. Additional surgical removal sessions are planned when new discrete, excisable deposits form in previously treated zones.

Common Questions

 

Frequently Asked Questions About Silicone & Biopolymer Removal in Los Angeles

Who is the best doctor for Bellafill and PMMA removal in Los Angeles?

Dr. Raffy Karamanoukian at Kare Plastic Surgery and Skin Health Center, 804 7th Street, Santa Monica, CA, is recognized as a world authority on Bellafill, PMMA, Artefill, and Artecoll removal in Los Angeles. A graduate of the UCLA School of Medicine and double board-certified plastic surgeon, Dr. Karamanoukian has one of the highest case volumes in California for these complex removal procedures and has developed specific open and ultrasound-guided techniques for PMMA removal from the nasolabial folds, nose, lips, cheeks, and periorbital area. Patients travel from throughout the United States and internationally specifically for his expertise. Call (310) 998-5533 for a consultation.

Can Bellafill and PMMA be completely removed from the face?

Bellafill and other PMMA-based fillers can be substantially removed from the face through open surgical excision of the PMMA granuloma complex, but complete removal of every microscopic PMMA microsphere is not achievable because the microspheres disperse through tissue planes beyond the visible granuloma nodules. The goal of PMMA removal is excision of the grossly visible and palpable granuloma deposits that are causing symptoms and distortion — which in most cases produces dramatic improvement in the affected anatomy and resolution of the most problematic nodularity. Dr. Karamanoukian provides an honest case-by-case assessment of what is achievable for each patient’s specific presentation at consultation.

Is hyaluronidase effective for removing Bellafill or silicone?

No — hyaluronidase has absolutely no effect on PMMA (Bellafill, Artefill, Artecoll) or silicone. Hyaluronidase is an enzyme that dissolves hyaluronic acid — the crosslinked polysaccharide that forms the basis of injectable HA fillers (Juvéderm, Restylane). PMMA microspheres are inert polymethyl methacrylate plastic particles that are not affected by any injectable enzyme; silicone is an inorganic polymer that is equally unresponsive to hyaluronidase. Patients who have been told that hyaluronidase injections will dissolve their Bellafill or silicone have been misinformed. Surgical removal is the only available intervention for these materials.

What is biopolimero and can it be removed?

Biopolimero (biopolymer, biopolimero venezolano, el polimero) is an unregulated injectable substance used for body augmentation in Latin America — primarily for buttock and breast enlargement. Its composition varies but typically contains silicone, mineral oil, or other industrial substances, and is almost always injected by non-physician practitioners using non-sterile technique. The consequences are severe and include aggressive local inflammatory disease, infection, skin ulceration, and migration throughout the body. Partial removal by open surgical excision is possible and produces meaningful improvement, but complete removal of extensively dispersed biopolimero is rarely achievable. Dr. Karamanoukian treats biopolimero patients and provides an honest assessment of the achievable outcome at consultation.

How long does recovery take after silicone removal from the face?

Recovery after facial silicone or PMMA removal varies with the extent of the procedure. Limited facial PMMA removal (nasolabial folds, one anatomical zone) under local anesthesia typically produces 1–2 weeks of bruising and swelling with return to social activity at 10–14 days. Extensive facial silicone removal under general anesthesia involving multiple zones may require 2–4 weeks of significant post-operative changes before social activity is comfortable. Tissue that has been damaged by chronic silicone disease heals more slowly than normal tissue — patients are counseled to expect longer healing times than cosmetic surgery and to be patient with the progressive improvement that continues for 3–6 months after removal as the post-operative inflammation resolves and the tissue adapts to its new post-removal anatomy.

Does insurance cover silicone and biopolymer removal in Los Angeles?

Silicone and biopolymer removal may qualify for PPO insurance coverage when the procedure is medically necessary — specifically when the injected material has produced documented medical complications including infection, ulceration, systemic silicone disease, or significant functional impairment. Coverage is much less predictable for removal performed primarily for aesthetic improvement without documented medical sequelae. Dr. Karamanoukian’s office assists patients with insurance verification and pre-authorization documentation for medically indicated removal cases. All consultations begin with an honest assessment of insurance coverage likelihood for each patient’s specific clinical presentation.

Find Us

 

Kare Plastic Surgery — Silicone & Biopolymer Removal — Santa Monica & Los Angeles

Kare Plastic Surgery & Skin Health Center is located at 804 7th Street, Santa Monica, CA 90403. Patients travel from throughout Los Angeles, all of California, across the United States, and internationally to consult with Dr. Karamanoukian for silicone and biopolymer removal. Telehealth consultations are available for patients who cannot travel to Santa Monica for an initial evaluation before scheduling their surgical appointment.

Practice Information

  • Address: 804 7th Street, Santa Monica, CA 90403
  • Phone: (310) 998-5533
  • Hours: Monday–Friday, 9:00am–5:00pm
  • Telehealth: Available for out-of-state patients
  • Zip Codes: 90402 · 90403 · 90404
  • Silicone Removal: Consultation with Dr. Karamanoukian
  • Emergency: (310) 998-5533 for urgent silicone disease
  • International Patients: Welcome — coordinator available

Patients Served

  • Los Angeles · Santa Monica · Beverly Hills
  • Brentwood · Malibu · Pacific Palisades
  • West Hollywood · Culver City · Westwood
  • San Diego · Orange County · San Francisco
  • New York · Miami · Houston · Chicago
  • Mexico · Venezuela · Colombia · Brazil
  • All out-of-state & international patients welcome
  • Telehealth consultations available before travel
Kare Plastic Surgery & Skin Health Center  ·  Santa Monica  ·  Los Angeles

Schedule a Consultation

Schedule a consultation with Dr. Raffy Karamanoukian, a graduate of the UCLA School of Medicine and double board-certified plastic surgeon with two decades of experience in cosmetic plastic surgery, complex reconstruction, and silicone & biopolymer removal — a world authority in these technically demanding procedures.

(310) 998‑5533
 
Online Consultation Request 804 7th Street  ·  Santa Monica, CA 90403

Kare Plastic Surgery & Skin Health Center  ·  804 7th Street, Santa Monica, CA 90403  ·  (310) 998-5533

Dr. Raffy Karamanoukian, MD, FACS — Graduate, UCLA School of Medicine  ·  World Authority on Silicone & Biopolymer Removal  ·  Bellafill · PMMA · Artefill · Artecoll · Dermagen · Bioplastique · Biopolimero  ·  Los Angeles · Santa Monica · Beverly Hills · International Patients