PMMA filler lumps, and only offered surgery? Get assessed first

Blocked vessel, infection or allergy after PMMA: act at once

Urgent: a change in vision or eye pain after filler: call 995 now. Skin that turns pale, dusky or mottled, or pain that is getting worse, needs urgent assessment by the doctor who injected you, or at A&E, now. See the warning signs of a blocked blood vessel after filler.

Skin that is dying after a blocked blood vessel (necrosis) is an emergency. It needs urgent, more intensive care than a lump does, starting now.

Many people with PMMA had it injected years ago, and a firm lump that has been there for months is not an emergency on its own. The signs below are different. PMMA has been injected into the nose, the lips, the folds beside the nose and mouth and around the eyes, where blood vessels run close, and a blocked blood vessel is a risk with any filler injection there; in one series of 32 patients with complications after PMMA, 5 had tissue necrosis, death of tissue (Salles 2008). Hyaluronidase has no effect on PMMA, so if PMMA blocks a vessel, care is urgent and supportive, with referral where needed. Where hyaluronic acid sits in the same area, hyaluronidase can act on the hyaluronic acid part, and it is not delayed for a skin test. A blocked vessel is never treated with the Sculpting mode or any other laser.

What to look for

• Colour. Skin in or near the treated area that turns white or pale, then dusky, purple or net-like (mottled): urgent assessment by the doctor who injected you, or at A&E, now.
• Pain. Pain that is severe, or getting worse rather than settling: urgent assessment by the doctor who injected you, or at A&E, now.
• Eyes. Blurred or lost vision, double vision, or pain in or around the eye: call 995 now.
• Stroke signs. New weakness of the face, an arm or a leg, or slurred speech: call 995 now, and do not travel to a clinic first.

These signs usually appear during or soon after the injection, sometimes later: act whenever they appear, whoever injected the filler and whatever it was. Do not massage the area, put heat on it, or wait for a message reply, a booked review or the colour to settle. If your vision is affected, do not drive yourself.

Red, hot, swollen or draining

• A red, hot, painful, swollen or draining lump, or a fever: see a doctor the same day; if no doctor can see you today, go to A&E. It may be infected or inflamed, and it is treated medically first, before any dissolving, any device and any talk of surgery. Dr Sin Yong sees these lumps the same day.
• A lump that is growing quickly: see a doctor the same day (A&E if no doctor can see you today), not at a planned laser visit.
• Redness that is spreading, with a fever; feeling faint, confused or very unwell; or swelling around the eye with pain: call 995 or go to A&E now.
• Difficulty breathing, a tight throat, swelling of the tongue or throat, or swelling that spreads quickly across the face, after any injection, including hyaluronidase, can be a serious allergic reaction: call 995 now. Itch, hives or swelling that spreads beyond the treated area: contact the clinic that injected you the same day.

A collection of pus can need draining through a small opening alongside medical treatment; that is a much smaller procedure than an operation to cut PMMA out. More on this is in infection after filler.

PMMA lumps, and only offered surgery? Read this before you agree to it

Patients come to Dr Sin Yong after being told that PMMA, or another filler injected years ago that cannot be dissolved, has to be cut out, or that nothing can be done. It is true that PMMA cannot be dissolved. Before you agree to an operation, know what it means:

• A scar. Every cut through the skin of the face heals with a scar.
• A dent. Cutting out a lump takes tissue with it, and the area can heal hollow or uneven.
• Nerve injury. Nerves that give the face feeling and movement run close to where filler sits. An injured nerve can leave numbness, or weakness in a smile, a lip or a brow.
• Product left behind. Filler spread through tissue is hard to remove completely.
• No way back. Tissue that has been cut out cannot be put back.

With PMMA, product left behind is a particular concern. Granulomas grow finger-like into the surrounding tissue, which is why a treatment review of granulomas after all injectable fillers places surgical excision last (Lemperle and Gauthier-Hazan 2009). Another review, of granulomas after dermal fillers in general, notes that cutting them out is often incomplete because their borders are ill-defined, and that it may leave scars and deformities (Lee 2015).

Dr Sin Yong maps each PMMA lump with ultrasound, treats any inflammation or infection medically first, and treats the lump with the Sculpting mode of Time Freeze Laser LCLR®, without an incision. In Dr Sin Yong's practice, almost every hard lump is treated without surgery. If yours is one of the few that needs surgery, you are told plainly, and why.

Silicone and other non-absorbable fillers in general are covered in silicone filler lumps, polyacrylamide gel in polyacrylamide filler lumps, and lumps from every kind of filler in hard lumps after filler or skin boosters.

“For hard lumps from mixed products, I use one tool, Time Freeze Laser LCLR®, to target the material without surgery.”

Dr Sin YongOn hard lumps from mixed fillers and skin boosters

What PMMA fillers are, and why they cannot be dissolved

PMMA, short for polymethylmethacrylate, is an acrylic. As a filler it is made of tiny beads, called microspheres, suspended in a carrier such as collagen. Artecoll, Artefill and Bellafill are PMMA beads in collagen. The carrier is gradually absorbed; the beads stay, and the body forms its own tissue around them. In a five-year study of PMMA in collagen injected into the smile lines, in which 871 of 1,008 participants completed the five years, satisfaction stayed high (Cohen 2015). The problems described below are the ones reported months to years after injection.

Many people with PMMA in the face had it injected years ago, often overseas, and some were never told the name of the product.

Three things set PMMA apart from the fillers most people have today:

• It cannot be dissolved. Hyaluronidase, the enzyme used to dissolve filler, acts on hyaluronic acid only. It has no effect on PMMA, and no injection dissolves it. That does not mean it has to be cut out: PMMA lumps can still be treated without an incision.
• It stays, and problems can start late. In one series, granulomas usually appeared 6 to 12 months after the procedure and chronic inflammatory reactions years later (Salles 2008).
• The body reacts to the beads. Around them, the body can form a granuloma: inflammatory cells gather and wall the material off, often with scar tissue. In 11 patients with PMMA problems around the eyes and midface, five of six tissue samples showed giant-cell inflammation (Limongi 2016).

Other acrylic fillers have been used as well. In 10 patients who developed inflammatory nodules after one made of acrylic particles in hyaluronic acid, electron microscopy found that after two years the filler showed signs of breaking down in every sample, no bacteria were found, and 40% of the particles were smaller than declared, which made them easier for the body's scavenger cells to take up (Wiest 2009). That filler is not PMMA, and those findings may not apply to PMMA.

PMMA, other acrylic fillers and other non-absorbable fillers compared

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PMMA filler complications: nodules, granulomas and inflammation, sometimes years later

PMMA can sit quietly for years and then become lumpy or inflamed. Because the beads stay, the body's reaction to them can begin, or flare again, long after the injection.

Granulomas, nodules and chronic inflammation

In 32 patients in Brazil with complications after PMMA injections, the problems were granulomas (10), chronic inflammatory reactions (10), chronic inflammatory reactions in the lips (6), tissue necrosis, or death of tissue (5), and infection (1). Granulomas usually appeared 6 to 12 months after the procedure and chronic inflammatory reactions years later, and the authors describe the complications as often persistent and difficult, or even impossible, to treat (Salles 2008). Treating the lump that troubles you is a different aim from taking out every bead, and the scan shows what can be done for yours.

Tissue necrosis cannot wait: skin that turns pale, dusky or mottled after any filler injection, or pain that is getting worse, needs urgent assessment by the doctor who injected you, or at A&E, now.

In 11 patients with problems after PMMA around the eyes and in the midface, symptoms began 2 to 24 months after injection, on average 7.2 months; all had swelling, redness and an uneven contour, and 64% had nodules (Limongi 2016). The eyelid problems and yellowish skin in that series are covered further down this page. In the five-year study of PMMA in collagen in the smile lines, a biopsy-confirmed granuloma developed in 1.7% of participants (Cohen 2015).

In an international ultrasound study of 240 granulomas after cosmetic fillers, 8.3% followed PMMA (Wortsman 2025). In a systematic review of 117 patients with granulomas after four collagen-stimulating fillers, PMMA accounted for 35% of reported cases, ahead of poly-L-lactic acid (31%), calcium hydroxylapatite (27%) and polycaprolactone (4%). Across all four products, granulomas appeared from 1 week to 15 years after injection, on average about 20 months, usually as nodules and most often around the mouth, with longer delays for fillers that do not break down (Wang 2025). The percentages describe the cases each study collected, not the risk with any one product. More on granulomas from every kind of filler is in filler granuloma.

Triggers: dental work, more filler and other treatments

In 85 patients with late problems from non-absorbable fillers, the timing and type of problem varied with the material. In 28%, symptoms began after dental procedures, more filler injections or other invasive treatments to the face; 57% needed invasive treatment, and the authors advise great caution with non-absorbable fillers (Kadouch 2013).

What this means for you. Tell your dentist, and any doctor who plans to inject or operate on your face, that you have PMMA. More filler injections are among the reported triggers, so Dr Sin Yong does not inject new filler to hide a PMMA lump. A PMMA lump that becomes red, hot, painful, swollen or draining, or comes with a fever, needs a doctor the same day; if no doctor can see you today, go to A&E.

Ultrasound first: what the scan shows with PMMA

Ultrasound shows where the filler sits, how deep it is and how far it has spread, and what it is likely made of. With PMMA, it also shows the reaction around the beads, and whether there is fluid or an abscess.

On the scan, PMMA looks like one other filler, calcium hydroxylapatite. In 60 people with earlier fillers, PMMA and calcium hydroxylapatite both looked like coarse-grain ‘snowfall’, liquid silicone like fine-grain snowfall, and 12 people showed a mixed pattern, mainly from different treatments at different times (Urdiales-Gálvez 2021). In the international study of 240 granulomas after several kinds of filler, granulomas showed as dark nodules or as dark tissue around filler deposits, most often in the fat beneath the skin (37.1%) and in the lower eyelid, under-eye and inner cheek area (41.7%), and the authors conclude that ultrasound gives detailed anatomical information to support diagnosis and management (Wortsman 2025). An international consensus of 15 experts from seven specialties calls ultrasound mandatory for managing filler complications, and recommends identifying fillers already in place before any further injection (Velthuis 2025).

That overlap is why your history matters, and why the scan shows what a lump is likely made of; it does not prove it. Where a lump does not look like filler, further tests are arranged. Dr Sin Yong performs the scan himself, and the plan follows what it shows. More on scanning is in ultrasound-guided filler correction.

Is it PMMA or something else?

A lump in a face that once had PMMA can be:

• The PMMA itself, or the granuloma and scar tissue around it.
• Hyaluronic acid placed over or beside the PMMA, which can be dissolved, leaving the PMMA behind.
• Another non-absorbable filler, such as silicone or polyacrylamide gel; see silicone filler lumps and polyacrylamide filler lumps.
• A collagen stimulator from another treatment, such as Radiesse, which can look similar on the scan, Ellansé or Sculptra.
• An infection or abscess, which is usually red, hot, painful or draining and needs a doctor the same day; if no doctor can see you today, go to A&E.
• Something unrelated, such as a cyst, a lymph node or, rarely, a growth, which needs a different plan.

A granuloma is not always PMMA: in the international ultrasound study, half of the granulomas followed hyaluronic acid (Wortsman 2025). A lump that keeps growing, sits where nothing was injected, feels fixed to deeper tissue, changes the skin over it or comes with swollen glands elsewhere is assessed for other causes before anything is treated as filler. If the PMMA was injected overseas without records, see correction of filler done overseas.

PMMA granuloma treatment: what published work reports, both ways

The evidence on treating PMMA lumps comes from case series, one five-year study, case reports and reviews, mostly without comparison groups, and the areas, products and methods differ from study to study. This is what they report.

Medical treatment

In the five-year study of PMMA in collagen, almost all granulomas responded to the treatment the investigators chose, and 0.9% of participants still had one at the end of the study (Cohen 2015). In 11 patients with PMMA problems around the eyes and in the midface, medical treatment injected into the lumps gave minimal improvement in 6 (Limongi 2016). A treatment review of granulomas after all injectable fillers gives medical treatment injected into the granuloma, repeated in four-week cycles, as the preferred treatment; started early, it can shrink granulomas within weeks, and it can be combined with other medicines and pulsed lasers to limit thinning of the skin (Lemperle and Gauthier-Hazan 2009). In the systematic review of granulomas after collagen stimulators, medical treatment injected into the granuloma was the commonest treatment (Wang 2025).

A case report describes the successful treatment of foreign-body granulomas caused by PMMA beads with a medical treatment that the authors call an innovative therapy (de Barros Silveira 2012). In the series of 10 patients with inflammatory nodules after a different acrylic filler, not PMMA, the nodules responded well to a combination of medical treatments, including medicines injected into the nodules (Wiest 2009).

Surgical debulking and removal

In the same 11 patients with PMMA around the eyes and midface, surgical debulking, cutting away part of the PMMA and the reaction around it, was done in 9 and was effective for the swelling, redness and nodules (Limongi 2016). In 9 patients with PMMA nodules and deformities of the face, shock-wave therapy applied from outside the skin was combined with surgical removal of the PMMA and graft injections to correct the deformities. The wave therapy itself caused no complications, the deformities improved in all 9, and 5 had minor complications after the removal and correction surgery; the authors state that the wave therapy made removal easier and reduced the scar tissue around the PMMA (Goisis 2025). In the systematic review of granulomas after collagen stimulators, surgical removal often resolved symptoms (Wang 2025).

A laser placed inside the lump: a different technique

Published work also describes a different technique: in 27 patients with PMMA granulomas on the nose, a laser was placed inside the lump, through the nostril or through a cut in the skin, to heat and break up the PMMA, which was then taken out. Partial removal was effective in all cases, one patient had a small blister on the bridge of the nose, and follow-up ran from 6 to 47 months (Goldman 2021). That study did not use the Sculpting mode, and its figures do not apply to it; nor did any other study on this page.

PMMA filler removal surgery: what it involves and the problems reported

Surgical removal means an incision, through the skin, inside the nose or inside the mouth, and cutting out the PMMA together with the scar tissue and granuloma around it. Debulking means cutting away part of it. The published numbers run both ways.

• Material left behind. A review of granulomas after dermal fillers in general notes that their borders are ill-defined, so cutting them out is often incomplete and may leave scars and deformities (Lee 2015).
• Complications after removal. Of the 9 patients who had PMMA removed surgically with shock-wave therapy, 5 had minor complications after the removal and correction surgery (Goisis 2025). In 50 women with problems from non-absorbable fillers in general, the filler was drained and a facelift with fat grafting done; the authors report the surgery as successful in all, and 4 had a facial nerve branch stop working for a time and 5 had thick, raised scars (Gadallah 2023).
• Scars, dents and nerves. Every incision leaves a scar, removing tissue can leave a dent or an uneven contour, and an injured nerve can leave numbness, or weakness in a smile, a lip or a brow.
• No way back. Tissue that has been cut out cannot be put back.

Surgery has a place. In the series of 11, debulking in 9 was effective for the swelling, redness and nodules (Limongi 2016); in the series of 9, the deformities improved in all (Goisis 2025); and in the systematic review of granulomas after collagen stimulators, surgical removal often resolved symptoms (Wang 2025). The treatment review keeps surgery or drainage for lumps and cystic granulomas with little ingrowth into the surrounding tissue (Lemperle and Gauthier-Hazan 2009). The point is the order: scan first, decide after.

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Dr Sin Yong explains the risks and limits of each option at the assessment, including waiting where that is reasonable and surgery where it is needed. Get assessed before you agree to surgery. A scan does not delay that decision: an operation can still be done later if it is ever needed, but it cannot be undone. More on operations to take filler out is in filler removal surgery.

PMMA around the eyes, in the nose and in the lips

Around the eyes

In the 11 patients with PMMA placed around the eyes and in the midface, 36% had yellowish skin that looked like a xanthoma, a fatty deposit in the skin, and 18% had an eyelid pulled out of its normal position (Limongi 2016). Ultrasound shows how close the PMMA sits to the eyelid. Dr Sin Yong treats PMMA lumps near the eyes with the Sculpting mode of Time Freeze Laser LCLR®, without an incision; near the eyelids, settings are kept conservative and the eyes are protected. For under-eye filler problems of every kind, see under-eye filler gone wrong.

In the nose

PMMA has been injected into the nose, and one published series describes granulomas there treated with a laser placed inside the lump before the PMMA was taken out, a different technique from the Sculpting mode (Goldman 2021). The nose is one of the areas where a blocked blood vessel is a real risk with any filler injection: skin on the nose that turns pale, dusky or mottled, or pain that is getting worse, needs urgent assessment by the doctor who injected you, or at A&E, now, and a change in vision or eye pain means calling 995 now. For nose filler problems of every kind, see nose filler gone wrong.

In the lips and around the mouth

In the series of 32 patients with complications after PMMA, 6 had a chronic inflammatory reaction in the lips (Salles 2008), and in the review of granulomas after four collagen-stimulating fillers, the area around the mouth was where they were found most often across all four products (Wang 2025). Cutting into the lip leaves a scar that can be felt and can change the shape of the lip. Dr Sin Yong maps PMMA in the lips with ultrasound and treats the lumps with the Sculpting mode of Time Freeze Laser LCLR®, without an incision; hyaluronic acid lip filler placed over old PMMA is dissolved first, after a skin test. For other lip problems, see lip filler gone wrong, and for the folds beside the mouth, smile line filler gone wrong.

Tried other treatments and almost given up?

Many patients who come to see Dr Sin Yong about PMMA filler lumps tell him they have tried almost everything else and had given up hope. Having tried other treatments does not mean nothing more can be done: what is done next depends on what the scan shows.

That history is useful. Knowing what was injected, when, and what has already been tried often explains why a problem has stayed: hyaluronidase acts only on hyaluronic acid and only where it reaches, some fillers are not hyaluronic acid at all, and swelling or fluid can look like filler. Ultrasound shows which of these applies, and the plan starts from there. For material that cannot be dissolved, Dr Sin Yong uses the Sculpting mode of Time Freeze Laser LCLR® for nodules large and small, without an incision. How each person responds varies.

If you have been told nothing more can be done, it is still worth having the area scanned: ultrasound shows what is there, and the plan is made from that. Bring any records of past treatments, product names and dates if you have them. More on this is in when filler dissolving has not worked.

How Dr Sin Yong treats PMMA lumps without surgery

1. History. What was injected, where and when, if known; any dental work, infection or new filler before the lump appeared; what has been tried and what you were offered. Having no records is fine.
2. Ultrasound mapping. Dr Sin Yong scans each lump himself: the likely material, its depth, how far it reaches and the vessels nearby.
3. Inflammation or infection first. A red, hot, painful, swollen or draining lump, or a fever, needs a doctor the same day (A&E if no doctor can see you today): Dr Sin Yong sees it the same day and treats it medically before anything else.
4. Hyaluronic acid over the PMMA. Where hyaluronic acid filler sits over or beside the PMMA, he dissolves it, once any inflammation or infection is under control. Your allergy history is checked. Before planned dissolving, Dr Sin Yong always does a skin test: a small amount of hyaluronidase is injected just under the skin to check for a reaction. A small first dose goes into the mapped filler, with a review at about 48 hours, because dissolving more than the excess can leave a hollow. In an emergency such as a blocked blood vessel, dissolving is not delayed for a skin test; a blocked vessel is never treated with the Sculpting mode or any other laser.
5. The PMMA itself. He treats PMMA lumps with the Sculpting mode of Time Freeze Laser LCLR®, his own protocol on a long-pulsed 755 nm and 1064 nm laser platform, directed at the mapped lump, without an incision. Like any laser, it can cause blistering or a change in skin colour, so settings are chosen for your skin.
6. Review. Each lump is reassessed, and any further visit is planned from what is seen.

He does not inject new filler to hide a PMMA lump. Where the face has lost shape because of lumps, that is considered only after they have been addressed. Dr Sin Yong developed the Time Freeze Laser LCLR® protocol himself and performs every scan and treatment himself on Orchard Road. He has been invited to share his clinical expertise in Seoul, Dubai, Bangkok and São Paulo, including as a Global Key Opinion Leader. More on the laser is in the Sculpting mode of Time Freeze Laser LCLR®.