If you live in Tempe, Phoenix, or Scottsdale, you have probably seen ads for “5 year filler,” “one and done correction,” or “no more touch ups ever.” On the surface, permanent or long lasting fillers sound convenient and cost effective.

What you do not see in those ads is the part where your face keeps changing for the rest of your life… and the filler does not.

In our Tempe practice, NP Karla does not use Bellafill or Radiesse at all, and she uses Sculptra only in very specific, well educated candidates who truly understand the long term tradeoffs. The reason is simple: safety, reversibility, and respect for how your face will look ten or twenty years from now.

Let us break down why.

What Are “Permanent” Or Long Lasting Fillers

When people say “permanent filler,” they usually mean products that are not hyaluronic acid (HA) and cannot be dissolved with hyaluronidase. The most common include:

• PMMA (polymethyl methacrylate), the microspheres in Bellafill
  
• CaHA (calcium hydroxylapatite), the mineral beads in Radiesse
  
• PLLA (poly L lactic acid), the biostimulator in Sculptra
  

These products are designed to stay in the tissues for years and stimulate collagen around them. That is the appeal. It is also where the long term risk lives.

A recent integrative review of fillers explains that HA fillers are considered reversible and preferred for safety, while non HA fillers like PMMA, CaHA, and PLLA are irreversible and require extra caution due to the possibility of delayed inflammatory reactions and long term complications (Hong et al., 2025). 

The PMMA Problem: When “Forever” Fights Your Immune System

Bellafill and other PMMA based fillers use tiny plastic microspheres that your body cannot break down. They are meant to be permanent scaffolds.

The medical literature now clearly shows that PMMA fillers carry a real, measurable risk of foreign body granulomas:

• A 2023 review estimated granuloma formation at about 1.9 percent of treated patients, often appearing months or years after injection (Vengalil et al., 2023).
  
• Case reports describe giant PMMA granulomas forming as late as 7 years after treatment, requiring steroids, 5 fluorouracil, or surgical management (Sivam et al., 2023).
  
• The U.S. Food and Drug Administration’s safety profile for PMMA notes long term inflammatory responses including swelling, redness, lumpiness, and granulomas as documented risks for dermal filler use (U.S. Food and Drug Administration, 2021).
  

Granulomas are not just “a little lump.” They are a chronic immune reaction. They can itch, hurt, become red, grow over time, and emotionally devastate patients who thought they were buying a “low maintenance” solution.

Once PMMA is in, it cannot be dissolved. If your body decides to react badly years later, treatment may involve:

• Multiple sessions of steroids and other medications
  
• Ultrasound guided injections
  
• Sometimes surgery to remove as much material as possible
  

This is the main reason NP Karla refuses to inject PMMA fillers like Bellafill. The upside does not justify a permanent foreign body that you cannot easily reverse if something goes wrong.

Radiesse And CaHA: Long Lasting Does Not Mean Risk Free

Radiesse is made of calcium hydroxylapatite microspheres suspended in a gel. It is not truly permanent, but it can last 12 to 18 months or longer and stimulates collagen as the carrier gel fades. 

While many patients do well, the literature documents important complications:

• A 2012 oral pathology series described foreign body granulomas caused by Radiesse in the lips and oral vestibule, confirmed histologically as CaHA microspheres (Daley et al., 2012).
  
• A 2024 systematic review of CaHA and polycaprolactone fillers reported mostly transient side effects, but also noted more severe adverse events such as nodules, granulomas, cellulitis, vision loss, and tissue necrosis in some cases (Zago Sá Fortes et al., 2024).
  

Again, CaHA cannot be dissolved with hyaluronidase. If there is a problem, management is more complex and may involve months of treatment, and in some cases, surgical removal.

Because of these long term unknowns and the fact that safer, reversible options exist, NP Karla chooses not to use Radiesse at all in her Tempe practice.

Sculptra: Biostimulator, Not A Beginner Filler

Sculptra (PLLA) is not technically a permanent filler, but it behaves like a long term biostimulator. It works by triggering your fibroblasts to lay down new collagen over months. That new collagen can last years.

Complications can also arrive late:

• Case reports show PLLA induced granulomas and nodules that appear months to years after injection, sometimes resembling paraffinoma or xanthelasma clinically (Jeon et al., 2020).
  
• One report documented a granulomatous nodule developing more than 70 months (almost 6 years) after Sculptra treatment, far beyond the expected 2 year duration of the product, highlighting how long term the immune response can be (Storer et al., 2016).
  

Because Sculptra builds collagen that cannot be melted away with an enzyme, it is not easily reversible. If you love the result, that can be wonderful. If you do not, or if a nodule or asymmetry appears years later, it is a much bigger problem to fix.

For this reason, NP Karla uses Sculptra only in highly selected, well informed patients, typically those with genuine volume loss, strong health, realistic expectations, and a long standing relationship with the practice. Every patient hears clearly that:

• It is not a quick glow up
  
• It is not easily undone
  
• It can affect how future surgery or other treatments feel and look
  

If that does not feel comfortable, Sculptra is not the right choice.

Why NP Karla Prefers Hyaluronic Acid Fillers

In contrast, hyaluronic acid (HA) fillers like Revanesse Versa+, RHA, and Restylane are:

• Temporary
  
• Well studied
  
• Dissolvable with hyaluronidase if something goes wrong
  

A 2024 review of hyaluronidase for dermal filler complications explains that HA fillers dominate the market in part because hyaluronidase allows practitioners to safely treat most HA related issues, from lumps and Tyndall effect to vascular compromise, often in a single office visit (Kroumpouzos et al., 2024). 

A recent 2025 systematic review on filler selection emphasizes the same point:
HA fillers are recommended when safety and reversibility are priorities, while non HA fillers like PMMA, CaHA, and PLLA are reserved for very experienced clinicians and carefully chosen patients because of their irreversibility and potential for long term complications (Hong et al., 2025). 

In real life, that means:

• If you get overfilled with HA, we can dissolve it.
  
• If you develop a visible lump months later, we can treat it.
  
• If your taste changes and you want a lighter look, we can undo it.
  

With permanent and long lasting non HA fillers, none of that is simple.

Your Face Will Keep Changing. Permanent Filler Will Not.

As you move through your 30s, 40s, 50s and beyond:

• Bone structure remodels
  
• Fat pads shift and descend
  
• Skin thins and loses elasticity
  

A filler that looked balanced at 38 can look strange at 52 if it is still sitting exactly where it was placed. This is especially true for permanent materials like PMMA or long lasting collagen from biostimulators.

Instead of aging gracefully, patients can end up with:

• Hard bumps where soft tissue has thinned
  
• Asymmetry as one side of the face ages differently
  
• “Stuck on” fullness that no longer matches the rest of the face
  

This is why NP Karla’s philosophy in Tempe is simple:

• Use reversible HA fillers as the default for contouring and volume.
  
• Avoid PMMA and CaHA entirely.
  
• Use Sculptra rarely and cautiously, with very clear, honest informed consent.
  

Questions To Ask Before You Say Yes To Any Filler

If you are shopping for injectables anywhere in Arizona, especially if someone suggests a “long lasting” or “permanent” filler, protect yourself by asking:

1. Is this filler hyaluronic acid or something else
   
2. If I hate it or have a complication, can you dissolve it
   
3. What are the documented long term risks for this exact product
   
4. Have you personally treated granulomas or nodules from this filler, and how
   
5. Where will this filler be when I am 10 to 15 years older and my face has changed
   

A provider who brushes those questions aside, gets defensive, or only talks about “how long it lasts” is not thinking far enough ahead for your safety.

You deserve an injector who cares more about your face at 65 than about a flashy before and after photo next week.

References

Daley, T., Damm, D. D., Haden, J. A., & Kolodychak, M. T. (2012). Oral lesions associated with injected hydroxyapatite cosmetic filler. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 114(1), 107–111. 

Hong, G. W., et al. (2025). Conditions to consider when choosing fillers. Journal of Cosmetic Dermatology. 

Jeon, Y. J., et al. (2020). Late onset foreign body reaction due to poly L lactic acid facial injections for cosmetic purpose. Archives of Plastic Surgery, 47(1), 87–92. 

Kroumpouzos, G., et al. (2024). Hyaluronidase for dermal filler complications: Review of applications and dosage recommendations. JMIR Dermatology, 7(1), e51400. 

Sivam, S., et al. (2023). Giant PMMA foreign body granulomas with imaging. Journal of Cutaneous and Aesthetic Surgery, 16(3), 260–263. 

Storer, M., et al. (2016). Late onset granuloma formation after poly L lactic acid injection. BMJ Case Reports. 

U.S. Food and Drug Administration. (2021). Polymethyl methacrylate (PMMA) safety profile. 

Vengalil, N., et al. (2023). Foreign body granulomas to polymethylmethacrylate soft tissue filler following COVID 19 infection. JAAD Case Reports, 33, 31–36. 

Zago Sá Fortes, R., Cassol Spanemberg, J., Cherubini, K., & Salum, F. G. (2024). Adverse events and satisfaction outcomes with calcium hydroxylapatite and polycaprolactone fillers in facial aesthetics: A systematic review. Cosmetics, 11(5), 165