Written by Karen Vieira, PhD MSM
What is Bellafill?
Bellafill (known as Artefill prior to 2015) is an injectable dermal filler FDA approved for the correction of nasolabial folds (smile lines) and for the treatment of acne scars.
This unique innovation is based on sub-microscopic beads of polymethylmethacrylate (PMMA), a compound with a novel mechanism of action for producing long-term soft tissue augmentation. Bellafill is a third-generation product, the result of more than 25 years of research, development, and clinical trials.
How does it work?
Bellafill’s mechanism of action is unique among dermal filers. It consists of sub-microscopic spheres of PMMA suspended in bovine collagen. The PMMA spheres induce rapid natural collagen production by your own body, which forms a dense matrix around the spheres.
Unlike other fillers, which are completely absorbed by the body within 6-12 months, the PMMA is biologically inert, so it stays in place, providing a scaffold for natural collagen production for a long duration; studies have shown that its effects usually last more than five years for rejuvenation treatments and up to one year for acne scars.
Bellafill is often referred to as a “permanent dermal filler,” but it’s important to keep in mind results have only been studied for five years.
What areas can Bellafill treat?
Bellafill is used for the correction of nasolabial folds (the deep creases that form between the nose and the edges of the mouth), and for moderate to severe acne scarring. Bellafill is sometimes also used “off-label” (without FDA approval) for:
- Non-surgical nose jobs to correct small to moderate bumps or deviations on the nose
- Cheek and chin augmentation
- Wrinkled or saggy earlobes
Are you a candidate?
To be a good candidate for treatment with Bellafill, certain conditions must be met, such as:
- You must be over 21 years of age
- The injection site must be clear of any active acne, rashes, or infections
- You must be free of certain health conditions, such as bleeding disorders; the injecting physician will review these with you
- You must not be allergic to bovine collagen products, and you must have a satisfactory result on a screening allergy test
- You must not be susceptible to keloid or hypertrophic scarring
Bellafill cannot be used in or around the lips, and is meant for use in treating deeper lines and scars. It is not appropriate for more superficial lines or wrinkles, such as crow’s feet.
Cost of Bellafill
The average cost of Bellafill is around $1,000-$1,500 per syringe. More than one syringe may be needed depending on the size and depth of the acne scars or wrinkles that are being treated which can bring the average cost to $2,500 per treatment session.
While this cost is higher than many other dermal fillers the results typically last much longer, and the treatment effect is usually much more dramatic. This makes Bellafill a bargain, because it would take numerous treatments with other fillers to achieve the same treatment effect and duration. The overall cost of the procedure will depend on a number of factors:
- The number of syringes used
- The duration of the treatment session
- Your geographic area
- The skill level and fee schedule of the treating physician
- The number of treatment sessions required
As with most cosmetic procedures, the cost is not usually covered by health insurance. However, many doctors offer payment plans or financing to make it affordable.
What to expect during treatment
Bellafill injections are done on an outpatient basis, usually in a physician’s office.
At least four weeks before a treatment with Bellafill, you should have an allergy test to ensure that you have no allergic hypersensitivity to Bellafill. A tiny bit of Bellafill is injected into the skin of the forearm and observed for four weeks to make sure that there is no immunological reaction. If the Bellafill skin test shows no significant allergic reaction, you can proceed with the treatment.
The injecting physician will take a complete medical history to make sure that there are no medical reasons that would preclude you from getting a Bellafill treatment. The physician will also review all the information about the procedure, such as precautions, contraindications, potential side effects, and expectations of the outcome. “Before” pictures should be taken.
To begin the treatment, the target area is cleaned, and a local anesthetic, usually a simple numbing cream, is applied to minimize any discomfort. Then, the Bellafill solution is injected through a very thin needle. Bellafill also contains lidocaine, a local anesthetic numbing agent for improved comfort during the procedure. The treatment typically takes fifteen minutes to an hour, depending on the number of injection sites.
After the procedure, most people can return to their normal daily routine immediately, with no downtime. Injectable dermal fillers are often known as “lunchtime facelifts” because of the limited time required for treatment and recovery.
You can expect some swelling and bruising in the treated area for the first 12-24 hours after treatment, as this is part of the normal tissue response to the Bellafill. Ice packs should not be applied.
There may be some pink discoloration around the treatment area for 2-5 days, and this can be covered with makeup.
For the first few days, you should avoid rubbing or touching the treated area, which can cause the Bellafill to migrate out of place. Also, it is important to minimize other facial movements such as smiling for three days when the nasolabial folds have been treated.
When will you see results?
You will see noticeable results immediately after the injection, although some post-treatment swelling may obscure the treatment effects. The final results of your Bellafill treatment will be seen in approximately 3-5 months.
How long does Bellafill last?
Results can last up to five years or more.
How many treatments will you need?
About half of patients require only one treatment session to achieve the desired results, but you should be aware that touch-up treatments at least two weeks apart may be required to achieve optimal results.
Can Bellafill be removed?
Bellafill contains microspheres which are not absorbed by the body and can only be removed surgically. For this reason, many doctors recommend that people try temporary dermal fillers such as Sculptra Aesthetic or Juvederm injections first, because the results cannot be easily reversed.
Risks and side effects
Although non-surgical treatments such as Bellafill are considered low risk, there are some possible side effects and complications that patients should know about before making the decision to undergo treatment.
Some commons side effects include:
- Bruising, redness & swelling at the injection site
- Asymmetry or lumps
- Under or over-correction
Most of these side effects usually subside within one to two weeks.
In addition, there is the risk of allergic reaction to the bovine collagen, so every person considering treatment with Bellafill should undergo a specific allergy test prior to treatment. Other adverse reactions are possible, and this list is not exhaustive. Your injection professional should review all potential side effects with you prior to the procedure.
Most importantly, when considering Bellafill patients should understand that it cannot be dissolved or reversed. If you are not satisfied with the results, the only course of action would be to have the filler surgically removed, which is difficult, or just live with the results
Tips for choosing a provider
Choosing a qualified Bellafill provider should be an important part of your research to ensure natural-looking results. To help you find a qualified provider:
- Choose a board-certified plastic surgeon, facial plastic surgeon or dermatologist.
- Look at before and after photos of their Bellafill patients.
- Check out their online patient reviews.
- Food and Drug Administration (FDA). (n.d.). Bellafill. Retrieved from https://www.accessdata.fda.gov/cdrh_docs/pdf2/P020012S009c.pdf
- Lemperle, G., Sadick, N., Knapp, T., & Lemperle, S. (2010). ArteFill permanent injectable for soft tissue augmentation: II. Indications and applications. Aesthetic Plastic Surgery, 34(3), 273–286. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2872008/
- Wollina, U., & Goldman, A. (2015).Fillers for the improvement in acne scars. Clinical, Cosmetic and Investigational Dermatology, 8, 493–499. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4598204/
- Lemperle, G., Knapp, T., Sadick, N., & Lemperle, S. (2010a). ArteFill permanent injectable for soft tissue augmentation: I. Mechanism of action and injection techniques. Aesthetic Plastic Surgery, 34(3), 264–272. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2872009/
- Gold, M., & Sadick, N. (2018). Optimizing outcomes with polymethylmethacrylate fillers. Journal of Cosmetic Dermatology, 17, 298-304.https://doi.org/10.1111/jocd.12539
- Medeiros, C., Cherubinbi, K., Salum, F., & de Figueiredo, M. (2013). Complications after polymethylmethacrylate (PMMA) injections in the face: a literature review. Gerodontology, 31, 245-250. doi: 10.1111/ger.12044
- American Society of Plastic Surgeons (2019). How much do dermal fillers cost?Retrieved from https://www.plasticsurgery.org/cosmetic-procedures/dermal-fillers/cost