The Ugly Truth About Permanent Fillers

The use of fillers to restore or add volume to different parts of the face and body is on the increase. Doctors prefer to use temporary fillers for this. However, it is human nature to look for a treatment that needs to be done only once and which can give long lasting or permanent results. Unfortunately this desire drives people to seek out a practitioner who can offer this type of filler to them. This desire also gave the market an opportunity for several companies to promote ‘permanent fillers’. About 20 years back several products were introduced in the market, doctors were trained in their use and somehow unqualified persons also got their hands on such products. The companies did aggressive sales campaigns and many doctors thought that permanent filler is a good thing. Then started an epidemic of such products being injected into people’s faces and bodies and everyone was initially in happy land. Not much was known about the long-term effects of such products nor how the human body deals with them in the long run.

Fast forward 3 years or more, and problems started appearing. Inflammations, swellings, nodules, irregularities, pain, hardness, migration of the product, thinning of the skin, infections etc started troubling the people who received such products. Now it appeared that it was very difficult or impossible to remove them. So something which was hoped to be a permanent beauty fix became a permanent disaster.

Some persons continued to be benefitted and did not experience any problems, this is also true.

Body Reaction To Fillers

So let us understand the issues related to permanent fillers in a Q &A format.

1. How does human body deal with anything ‘foreign’ to it?

Body has several ‘policeman’ and ‘detective’ type of cells which will recognize the foreign substance. Once recognized, the cells try to attack the filler or send ‘soldier cells’ to the job. The soldier cells with ‘chemical bullets’ try to dissolve these foreign particles. There are also other cells which try to swallow these filler particles, sometimes they join up to form giant cells that can swallow big particles. However, many of these fillers cannot be swallowed, cannot be digested or dissolved. So the cells are ‘frustrated’ and a lot of local damage is done by the chemicals released, this is like a war zone.

The body then tries to cover them up into small ‘graves’; this is what leads to formation of thick scar tissues. These reactions are more when the particles are smaller, irregular in shape or chemically reactive. This is why initially things seem okay as body reaction is mild but as time passes, the particles break up and cause strong reactions.

2. Are the permanent fillers lying separate from body tissues?

Unfortunately no. The tissue reaction binds the filler strongly to body tissues. We cannot remove them without also cutting out body tissues in many cases.

3. Are the permanent fillers lying separate from body tissues?

Is it possible to remove them by syringe or by squeezing out? Only a few of them can be squeezed out. Most cannot be removed by syringe, although they were injected by syringe.

4. Is it possible to remove fillers completely?

No it is not possible. But we can reduce the quantity and also reverse the damages caused by fillers. Some filler lying deep inside can be left intact but we try to remove superficial fillers which cause more damage to skin

5. Can they harm the body?

Are they poisonous? No they are not like poison but they cause a lot of problems locally. If infection occurs then it can be dangerous to the body or life.

6. Which chemicals are used in permanent fillers?

There are more than 25 types and in most cases the patient does not know what has been injected into her. Knowing the name can help in treatment.

7. What about silicone injection?

Also called Bioplastique, it has been used as filler. It can migrate and can result in a lot of problems like scar tissue, distortion, thinning of skin, pain and deformity. Please note this silicone oil is different from silicone implants used in breast or buttocks.

8. What about unlicensed [illegal] persons doing injections?

Unfortunately there are a lot of women without medical licenses who set up shop and inject unknown substances into gullible women in the privacy of their homes. This is a very prevalent problem in the middle east. Quite often they are injecting polyacrylamide gels which are cheap or worse still industrial silicone oil. They do not follow sterility and often inject huge amounts which can definitely harm the body in long run.

The Treatments

What can be done if I already have permanent filler in my body?

There is no need to panic. You should see a plastic surgeon experienced in dealing with this difficult problem. After examination and tests like MRI scan, the doctor may suggest any one of the following:

1. Do nothing and just check up periodically. This is when the filler is properly injected deep, is not causing a problem and there is no need to disturb it.
2. Remove the permanent fillers by small incision and squeeze out
3. Remove the filler by small opening and using liposuction or open removal
4. Remove the permanent fillers by specialized liposuction (Vaser assisted)
5. Cut out the filler and affected tissues surgically and do fat grafting or other plastic surgeries later on
6. More complex procedures

Stem cells: Recently we have realized that stem cells prepared from the patient’s own fat can help in this repair work by reducing scar tissue, helping fat grafts to survive and repairing damaged tissues provided fillers are also reduced by removal.

Message To The Public

• Do not patronize the illegal persons offering to do permanent fillers at your home
• Report such persons to the authorities
• If you have had such permanent fillers, do not panic and see a specialist
• Do not insist on your doctor to remove fillers by cutting inside the mouth. This can introduce infections and cause nerve damage.
• Take your time to decide, do not rush into removal surgery in panic. It should be a calm decision
• Do not get temporary fillers injected on top of the permanent, this can give bad reactions
• Inform your doctor and dentist if you have permanent fillers in face or body. Must take antibiotics 1 hour before a dental procedure to prevent infection/reaction happening in the filler area
• Permanent fillers area can get activated after vaccination [especially covid vaccine]. But this usually settles with time and medicine, do not panic.
• Always prefer temporary fillers, which are licensed for use on face and body. No filler is licensed for breast at the moment
• Fat grafting using one’s own body fat is the safest permanent fillers. For best results it must be performed by an expert in this field

Dr. Mohan Rangaswamy, Consultant Plastic Surgeon at the American Academy of Cosmetic Surgery hospital (AACSH) in Dubai is experienced in removal of permanent fillers. Being well qualified in cosmetic and reconstructive aspects of plastic surgery, he combines the two fields of science to remove the fillers and to also repair the associated complications as best as possible. AACSH is well equipped for this purpose, including the use of stem cells from one’s own fat.