How to prepare for the procedure

First, an ASDS dermatologist will review the patient’s medical history and examine the condition to be treated. Areas to be treated should be kept clean. If there is a skin infection, then treatment needs to be postponed until it resolves. Patients who take blood thinners (such as aspirin, ibuprofen, and certain herbal medications) should stop them two weeks prior to injection with the approval of their prescribing doctor.

 Before and after - Bellafill injections for chicken pox scars.

Before (left) and after (right) - Bellafill injections for chicken pox scars.

Photo courtesy of C. Burgess

Injectable Polymethylmethacrylate + Bovine Collagen Filler

What is injectable polymethylmethacrylate + bovine collagen?

Injectable polymethylmethacrylate (PMMA) with bovine collagen is known as Bellafill. The FDA approved PMMA in 2006 to treat nasolabial folds, “smile lines”. This product recently received its FDA approval for improving the appearance of moderate to severe, atrophic, distensible facial acne scars on the cheeks. This makes it the only FDA approved injectable filler for acne scars.

As we age, the fat, muscles, bone, and skin in our face begins to thin. This loss of volume leads to either a sunken or sagging appearance of the face and increased facial wrinkles and folds. Some patient with inflammatory or nodular cystic acne may develop acne scars. Atrophic acne scars are depressed scars, which develop at sites of prior, severe acne inflammation. PMMA + bovine collagen has not been studied in ice-pick acne scars or sinus tracts. Prior to its approval, other treatments used for acne scarring included laser resurfacing procedures, chemical peeling, or dermabrasion.

The microspheres containing PMMA induce your skin to produce its own collagen, which can last up to 5 years. It also contains bovine, cow, collagen for immediate improvement. Given the bovine collagen component, a skin test must be performed at least 2-4 weeks before any injections with PMMA product. This test is performed in order to detect an allergy to the bovine collagen component.

Your doctor will evaluate the areas of your face needing improvement. Topical medication may be used for added comfort prior to your procedure. One or two treatment sessions with PMMA are needed to achieve optimal correction, which are often spaced at one month interval. The effects of PMMA can last up to 5 years.

When is it not appropriate?

  • Lips
  • Close to the eyes
  • Fine lines around the mouth

When is it appropriate?

PMMA +collagen can be used to treat

  • Wrinkles
  • Nasolabial folds
  • Atrophic acne scars on the cheeks


Who is not the right candidate?

PMMA + collagen is not recommended for patients who have:

  • A positive skin test to bovine collagen
  • Current oral or facial herpes
  • Active infection or acne in the treatment area 
  • Uncontrolled diabetes
  • Blood-clotting problems
  • Lupus or other connective tissue disorders
  • Allergy to any components of PMMA + bovine collagen
  • Severe allergies, such as anaphylaxis
  • Allergy to any bovine collagen containing products, such as injectable collagen, collagen implants, hemostatic collagen, and/or collagen-based sutures
  • Patients undergoing or planning to undergo desensitization to meat products that contain bovine collagen
  • Patients whom are pregnant or breast-feeding

What you should know

Topical numbing agents are sometimes applied to ease discomfort. Also, lidocaine is added to this product for improved patient comfort. Before and following treatment, ice may be given to ease discomfort and swelling.

PMMA filler may last up to five years, depending on the patient.

Possible Risks

Common side effects include:

  • Swelling
  • Bruising
  • Bleeding
  • Lumps and bumps
  • Itching
  • Redness
  • Discoloration

Uncommon side effects include:

  • Numbness
  • Allergic reactions – which may appear immediately, months, or years later
  • Infection
  • Blisters and cyst;
  • Inflammatory reactions – which may appear immediately, months, or years after injection
  • Migration of filler material to another site
  • Vascular occlusion
  • Scarring
  • Blindness