Permanent fillers

Permanent fillers are injectable filling materials that are not fully broken down by the body. Depending on the material, they may remain in the treated area for many years or potentially indefinitely.

This is different from temporary dermal fillers, which are gradually broken down over time. The long-lasting presence of permanent material can also make problems more difficult to assess or correct if they develop.

If you had permanent filler treatment in the past, this does not automatically mean that you will develop complications or that the material needs to be removed. It is useful, however, to establish what product was used before considering another filler treatment in or around the same area.

For a broader introduction to injectable filler treatments, see our guide to fillers.

What are permanent fillers?

A permanent filler is an injectable material that is not fully broken down by the body. This means that some or all of the material can remain in the tissue for a very long time.

A permanent filler is not the same as a filler that simply lasts longer than average. A product can produce an effect for months or years without being considered permanent.

Materials that have historically been used as permanent or non-resorbable fillers include:

• PMMA, or polymethylmethacrylate;

• polyacrylamide gel, often shortened to PAAG;

• silicone oil;

• Bio-Alcamid.

With older treatments, it is not always immediately clear which substance was injected. Remembering a brand name or approximately when the treatment took place may not be enough to identify the material reliably.

If you want to understand the main alternative category, read about temporary fillers.

Are permanent fillers banned in the UK?

The UK does not have the same blanket rule described on the Dutch version of this page. Current UK regulation of dermal filler products depends partly on factors such as the product's composition, intended purpose and regulatory classification.

Rules also differ according to the procedure and part of the UK. In England, for example, it is illegal to administer an injected filler for cosmetic purposes to someone under the age of 18, except within the limited medical circumstances set out in legislation.

The government has also been developing broader regulation and licensing requirements for non-surgical cosmetic procedures in England.

Because product status and regulation can change, the fact that a filler is described as permanent should not by itself be used to decide whether a particular product can legally or appropriately be used.

Why can permanent fillers create long-term concerns?

Permanent filler material remains present while the surrounding tissues continue to change over time. This can make some problems less predictable and more difficult to manage than with a material that is gradually broken down.

Problems described with permanent filler materials can include:

• persistent or recurrent swelling;

• pain or tenderness;

• firm areas beneath the skin;

• inflammatory nodules;

• inflammatory reactions around the material;

• movement of filler material;

• changes in contour or asymmetry.

Not everyone with a permanent filler develops these problems. The presence of permanent material alone does not mean that a complication will occur.

Can permanent fillers cause problems years later?

Yes. Problems associated with permanent filler material can sometimes become noticeable long after the original treatment.

A delayed problem might include recurrent swelling, redness, discomfort or a new area of firmness in a previously treated area.

One possible cause of a firm inflammatory lump is a granuloma, which is a local inflammatory response around foreign material. However, not every lump that develops after filler treatment is a granuloma.

Filler material may also sometimes be identified away from its original position. This is generally described as filler migration.

For more information about that specific problem, see filler migration.

What happens to permanent fillers after 10 years?

Permanent filler material may still be present 10 years after treatment. There is no single outcome that describes how every permanent filler will look or feel after that length of time.

The result can depend on factors including:

• the material used;

• where it was injected;

• the amount present;

• how the surrounding tissue has responded;

• changes in the face or treated area over time.

The surrounding tissues also continue to change with age while permanent material may remain. A treatment that caused no obvious problem shortly after injection therefore cannot be assumed to remain unchanged indefinitely.

At the same time, some people may have permanent filler material for many years without developing obvious symptoms.

Permanent fillers vs temporary fillers

Permanent and temporary fillers mainly differ in how long the material remains in the body and what options may be available if a problem develops.

Temporary fillers

Temporary fillers are designed to be gradually broken down over time. How long they remain depends on the material, treatment area, amount used and individual factors.

Some temporary fillers contain hyaluronic acid. In certain circumstances, hyaluronic acid filler can be broken down using hyaluronidase.

Temporary does not mean risk-free. Temporary filler treatments can still cause side effects and complications.

Permanent fillers

Permanent fillers are not fully broken down by the body and may therefore remain for many years or indefinitely.

If a problem develops, the material cannot generally be managed in the same way as a standard hyaluronic acid filler. Assessment may be more complex, particularly when the exact product, location or amount of material is unknown.

Permanent does not automatically mean better, and temporary does not automatically mean appropriate. Product choice should be considered alongside the treatment objective, anatomy, possible risks and the practitioner's assessment.

For a broader overview of problems that can occur with filler treatments, see filler complications.

Can permanent fillers be dissolved?

Permanent fillers generally cannot be dissolved in the same way as hyaluronic acid fillers.

Hyaluronidase is an enzyme that breaks down hyaluronic acid. It is therefore relevant to hyaluronic acid filler and is not a universal dissolving agent for permanent materials such as PMMA, silicone oil or polyacrylamide gel.

If you do not know which material was previously injected, this should be assessed before any attempt is made to dissolve or otherwise treat an old filler.

Read more about hyaluronidase.

Can permanent fillers be removed?

In some circumstances, treatment or partial removal may be possible. Complete removal of permanent filler is not always achievable.

What may be possible depends on factors such as:

• the material used;

• its exact location;

• the amount present;

• the symptoms or concern;

• how the material is distributed;

• the response of the surrounding tissue.

Permanent material may be spread through tissue or become closely associated with surrounding structures. Attempting to remove it can therefore affect the surrounding area as well.

For this reason, the first question is not automatically how to remove all of the filler. It is more important to establish what material is likely to be present, whether there is actually a problem and what management options may be appropriate.

What are the alternatives to permanent fillers?

Many modern aesthetic filler treatments use materials that are not intended to remain permanently in the body.

Hyaluronic acid fillers are one important category of temporary dermal filler. Other filler types work differently and should not automatically be treated as interchangeable.

A temporary filler is not automatically appropriate for every person, treatment area or cosmetic goal. Temporary fillers can also cause side effects and complications.

A practitioner can assess the treatment area, your previous treatments, the proposed product and the intended result before discussing whether another filler treatment should be considered. Choosing not to have another treatment is also a valid option.

For more information about this category, read what hyaluronic acid fillers are.

What if you already have permanent fillers?

Having permanent filler material does not automatically mean that something is wrong.

If you have no symptoms but are considering another cosmetic treatment in the same area, tell the practitioner about your previous filler treatment before anything new is injected.

Where possible, try to find:

• the name of the product;

• the original clinic or practitioner;

• treatment records;

• invoices;

• product labels or stickers;

• the approximate treatment date;

• the areas that were injected.

If you develop a new lump, persistent swelling, redness, pain or another change around an area previously treated with filler, arrange an appropriate clinical assessment.

If the exact material is unknown, further assessment may sometimes be needed before another treatment or corrective procedure is considered.

Can you have temporary filler if permanent filler is already present?

There is no general answer that applies to everyone.

Before adding another filler, the practitioner needs to understand what material is already present, where it was placed and whether there have been any previous problems.

Injecting a new product without understanding the existing material may make later assessment more difficult. Previous filler treatment should therefore form part of the consultation and treatment planning.

If you are considering another filler treatment, you can also read our general guide to how fillers work.

Are permanent fillers the same as biostimulating fillers?

No. The terms describe different characteristics.

Permanent describes whether injected material remains in the body rather than being fully broken down.

Biostimulating describes a treatment approach or product intended to stimulate a biological response such as collagen production. A product should not be assumed to be permanent simply because it is described as biostimulating.

For a dedicated explanation, see biostimulating fillers.

Frequently asked questions about permanent fillers