TOPIC: Pmma after HA

Is it true that you have to wait 6 weeks to see full size ? Like does it get smaller and then bigger or basically what you have after a couple days is what you get

Cgoody, I appreciate your comment but I would really like to keep this thread focused on results after Bellafill or PMMA having HA prior.

Dr_Sullivan wrote: To dissolve 1ml of Hyaluronic Acid, 100-150 units of hyaluronidase are required, with the higher end of this range typically needed for more robust formulations like Voluma. Consequently, dissolving 48 syringes of Voluma would require about 150 units per syringe, amounting to a significant cost. Specifically, the expense would be calculated as 48 syringes multiplied by 150 units per syringe, at a rate of approximately $2 per unit, totaling around $14,400. This estimation remains substantial even when considering that half of the Voluma may have degraded over time. Therefore, it's debatable whether a completely 'blank canvas' was achieved prior to subsequent treatments. If less hyaluronidase was used, it implies that a considerable amount of Voluma remained when Bellafill, another filler, was introduced. I don't know the specifics but something to ponder

Interesting! Never knew the actual costs involved. I know my practitioner told me has had to dissolve one patient who decided they wanted it gone, they went too large and their new partner couldn't work with it. All he said was it was a "very expensive waste".

I'm going to see how long my results last with the additional HA. At some point I might seriously ask him to investigate slowly adding Bellafill. If I find living with this size is what I want long term. Or if the Revanesse tends to last a long time I may just stick with it and do little touch ups...

The extra firmness of a stimulatory filler might be nice but this stuff seems pretty rigid. I appreciate your input Dr Sullivan! Thanks!

Still hoping to hear from someone who has actually had PMMA or Bellafill layered over HA. Anyone ???

jon11 wrote: Still hoping to hear from someone who has actually had PMMA or Bellafill layered over HA. Anyone ???

Email Rupeka and ask

Did that. Have not receive a reply.

I had Bellafill after HA from Shafer. It looked perfect for a while, but then it gets a little lumpy looking as the HA degrades. (Even then, you still cant even tell when Flaccid. Only when Erect, but its nothing crazy.) I'm going back for another round of Bellafill sometime in 2024. At that point the HA should all be gone, so I'm thinking the next Bellafill should stay smooth.

jrocket12 wrote: I had Bellafill after HA from Shafer. It looked perfect for a while, but then it gets a little lumpy looking as the HA degrades. (Even then, you still cant even tell when flaccid. Only when erect, but its nothing crazy.) I'm going back for another round of Bellafill sometime in 2024. At that point the HA should all be gone, so I'm thinking the next Bellafill should stay smooth.

This raises a good point. Obviously Hyaluronic Acid (HA) and Bellafill have their pros & cons, but should you choose to do a permanent filler over a temporary filler, you're likely going to see an eventual dissipation in size, and it would be hard to predict if that reduction is uniform or uneven.

For HA patients, it's anticipated that top-offs may be required annually but its safety profile (already naturally-occurring in your body, somewhat reversible, compatible with other fillers seemingly) justifies its temporary nature -on the flip side- Bellafill is permanent, and thus no top-offs are required once you've achieved your end goal, but can be more challenging to treat or remove in the event of a complication (albeit rare and typically resolvable). I'm an advocate of both fillers, just understand no elective cosmetic procedure is without risk.

That said, if you happen to have HA done before OR after PMMA, the eventual dissipation of HA over time will mean you'll likely see a few additional top-offs of PMMA than would normally be expected or projected under normal circumstances (like going straight PMMA only and no other fillers). @jrocket12 's comments make sense in this regard.

Would still like to hear from individuals who have had this specific procedure process done. On a side note I would say that I have tried contacting Dr Rupeka through direct message on the board and through email through the board and from his own website. So far no response. I have asked for pics, if he has any, of former patients who have done this. But even if the response is “ I don’t have any”. I would appreciate some communication. Comments?

jon11 wrote: Would still like to hear from individuals who have had this specific procedure process done. On a side note I would say that I have tried contacting Dr Rupeka through direct message on the board and through email through the board and from his own website. So far no response. I have asked for pics, if he has any, of former patients who have done this. But even if the response is “ I don’t have any”. I would appreciate some communication. Comments?

Board Private Messages are not effective for all Sponsors but their emails should be working -- how long ago did you email/contact Dr. Rupeka's Office through their site? I'll see if they are getting these messages to go through.

All of this has been within the last 2 days. I appreciate your help. Thank you

jon11 wrote: All of this has been within the last 2 days. I appreciate your help. Thank you

They are a high volume Clinic and I too have had to wait a day or two if I wanted to check on something more pressing than the return-time of an email, so I'd just wait a few more days and try again on Wednesday - if by then you haven't heard back, email me at This email address is being protected from spambots. You need JavaScript enabled to view it.

Dr. Rupeka’s office did finally contact me and they were very nice and helpful. They did not however have any picture records of anyone getting Bellafill after HA. Disappointed - but at least they were honest and up front. For my own reasons I have decided to stick with HA a little while longer. Thanks to everyone for your input

Did he give you any indication about whether or not he would want you to dissolve all the HA prior to the Bellaifil? I’m in exact same scenario and I don’t necessarily mind topping off HA but (a) concerned that chance of fibrosis increases with each procedure and (b) cost.

Yes, he would inject without removing the HA. I don’t know anything about fibrosis. Where did you get that info?