Can Permanent Fillers Be Removed?

The short answer: yes, but only surgically. Permanent fillers — biopolymer, liquid silicone, PMMA — cannot be dissolved the way hyaluronic acid can. There is no injection that reverses them. They have to be physically removed by surgical excision, often in stages, with the honest goal of taking out as much as is safe. Dr. Paulo Michels, a Brazilian board-certified plastic surgeon who received the ISAPS Gold Medal for Best Body Contouring at the World Plastic Surgery Olympiads 2025, assesses and operates on these cases at Elyzee Hospital in Abu Dhabi.

Why can’t permanent fillers just be dissolved?

Because dissolving only works on one type of filler. Hyaluronic acid fillers can be broken down with an enzyme, which is why they feel “reversible.” Permanent fillers are a completely different material — biopolymer, injectable liquid silicone, PMMA (Metacrill) and older semi-permanent products — and no enzyme or injection can dissolve them. That single fact changes everything about how they must be treated.

Worse, these materials do not stay where they were placed. Biopolymer and liquid silicone spread along the tissue planes, migrate, and trigger chronic inflammation, forming hard granulomas (inflammatory nodules). PMMA and older products become fixed and encapsulated in the tissue. None of them can be washed or melted away. The only real removal is to physically excise the affected tissue.

How are permanent fillers actually removed?

Through surgical removal. The encapsulated filler and the granulomas it has formed are carefully cut out under general anaesthesia. This is reconstructive surgery — not a cosmetic injection reversed — and it requires an experienced plastic surgeon, careful planning, and complete honesty about what each case allows.

Most commonly the material sits in the buttocks, where biopolymer and silicone injections are frequent, but it also affects the face and other areas. The problems that bring patients in — migration, hardening, lumps, chronic inflammation, pain and distortion of the shape — are exactly what removal is designed to relieve.

Can all of the filler be removed?

Honestly, not always completely. When biopolymer or liquid silicone has spread widely through the tissue, removing every last trace is not possible without damaging healthy structures around it. Anyone who promises 100% removal in every case is not being truthful.

What surgery can reliably do is remove as much of the material as is safe, take out the worst granulomas, and relieve the pain, inflammation and deformity. For most patients that is a profound improvement, even when a small amount of infiltrated material has to be left behind. Dr. Paulo Michels will tell you honestly, after examining you, how much can realistically be achieved in your case — before anything is decided.

What are the goals of surgery — and is it done in stages?

Removal is usually planned as two stages, because the priorities are different at each step:

• Stage one — removal and relief. The encapsulated filler and granulomas are excised. The first aim is to take out as much material as is safe and settle the chronic inflammation and pain. Drains and a compression garment are often used, depending on how much is removed.
• Stage two — contour restoration. Once the tissue has fully recovered, the shape is restored where volume has been lost — for example with fat grafting or a lift — as a planned second step.

So the honest goals, in order, are: maximum safe removal, relief of symptoms, and restoration of a more natural contour. Recovery depends on how much material is removed and from where, but is typically in the range of two to four weeks.

What if I had filler abroad and don’t know what it was?

That is common, and it does not stop you being assessed. Part of the evaluation is examining the area — sometimes with imaging — to understand what is there and how it behaves, then planning removal accordingly. You do not need to know the exact product to be helped. The important step is an early, honest assessment: permanent fillers are far easier to receive than to remove, and the sensible path once you have them is careful surgical planning, not another injection. Dr. Paulo Michels assesses and operates at Elyzee Hospital in Abu Dhabi, for patients from both Abu Dhabi and Dubai — patients from Dubai travel about an hour. Where a safe restoration is planned after removal, options such as a Brazilian Butt Lift with your own fat are discussed as the second stage.