In short
- 🔑 “How much material is removed” and “how much the person improves” are two different measures. You can get good results on the second with a partial result on the first, and that explains almost all the confusion about this subject.
- In a series of 199 patients, gluteal removal was associated with statistically significant reductions in muscle pain, fatigue and anxiety, and with improvements in sleep and in how often they exercised.
- In the available systematic review, surgical excision achieved 48% complete responses and 50% partial ones for the granuloma.
- The emotional improvement is measured, not assumed. In a series of 160 facial patients, self-esteem and social interaction rose and anxiety and depressive symptoms fell.
- ⚠️ What it does not fix: it does not return the area to its state before the injection, it does not guarantee removing all the material and it does not cure an underlying autoimmune disease.
- 🔑 Nobody has yet measured how much material is really removed. The authors of the largest series acknowledge this and call for it as a line of research.
- The improvement is neither immediate nor linear. There is a recovery to get through, with seromas and dressings, before the result can be judged.
It is the question asked quietly, almost always at the end of the consultation, and the one that finds least of an answer on the internet: if I have surgery, am I going to feel better?
Not “how will I look?”, which is a different thing. But whether the fatigue, the muscle pain, the bad nights and that vague sense of being worse than someone your age ought to be have anything to do with this, and whether they are going to go.
This page gathers what the published series say. With two warnings first: they are series, not trials, and none of them promises anything.
If you are still deciding whether to have surgery, the page that deals with that is remove or monitor. The process is in the guide to biopolymer removal.
First: two things that are not the same
Almost all the confusion on this subject comes from mixing two different questions:
“Will they take it all out?” measures material. And there the answer is the one the main guide gives and it does not change: complete removal is rarely achieved, because these products infiltrate between the tissues instead of forming a pocket that can be emptied.
“Am I going to feel better?” measures the person. And that is answered with completely different figures: symptoms, quality of life, sleep, mood.
They are compatible. Part of the material can be removed and you can improve a great deal, because what causes the symptoms is not so much the presence of the product as the chronic inflammatory reaction around it and the mass of altered tissue. Removing the bulk of that changes the situation even if traces remain.
That is why this page does not talk about percentages removed. It talks about the other thing.
What improves, with the published evidence behind it
General symptoms
It is the most interesting finding in the recent literature, and it comes from the largest series: 199 patients operated on for removal of biopolymers from the buttocks and lumbar region in Medellín between 2022 and 2024.
The authors describe statistically significant reductions in three symptoms, expressed as an odds ratio — a measure in which the closer to zero, the greater the reduction:
| Symptom | Odds ratio after surgery |
|---|---|
| Muscle pain (myalgia) | 0.15 |
| Fatigue (asthenia) | 0.03 |
| Anxiety | 0.08 |
In addition, sleep quality and how often they exercised improved, which are two real-life indicators rather than questionnaire ones.
How to read this, so as not to read too much into it:
- It is a retrospective cohort from a single team, with its own technique and its own patient selection. It is not a clinical trial and there is no comparison group.
- The symptoms are reported by the patient, which is the correct way of measuring them and also the most sensitive to the effect of having had surgery.
- But the direction and the size are consistent, and they match what other, smaller series describe.
The shape of the area
That same series of 199 patients describes improvement in gluteal droop after surgery. It is not the result people expect — almost everyone assumes that having surgery means the shape gets worse — and it is worth saying, with its context: it is a series, using one particular flap technique.
In the series of 35 patients with mild to moderate involvement, the authors also conclude that the approach gives favourable aesthetic results.
And for the face, the series of 231 patients having permanent facial filler removed reports good levels of satisfaction and of perceived aesthetic improvement, measured with validated questionnaires and with follow-up ranging from 12 months to 6 years.
Mood
This is the outcome almost nobody measures and which probably weighs more than is acknowledged.
In a series of 160 patients operated on for complications from permanent facial filler, the psychological outcomes improved significantly: higher self-esteem and social interaction, less anxiety and fewer depressive symptoms.
This is not a minor or decorative finding. A good part of what brings someone to this consultation after years is not the lump: it is having stopped going out, being photographed or undressing in front of anyone.
What improves partly
The granuloma. The available systematic review, with 93 studies and 227 patients, found that surgical excision achieved 48% complete responses and 50% partial ones. That is: almost everyone improves; about half are fully resolved. That figure is set out, with the other side of the scales, in remove or monitor.
Autoimmune-type symptoms. In a series of 13 patients with a foreign body reaction who developed ASIA syndrome after gluteal injection of biopolymers, five had surgery and showed clinical improvement after removal. That is five patients: enough to say it happens, not enough to promise it.
The contour. It depends on how much tissue has to be removed and on the state of the skin. In a fair number of cases a second stage is needed to restore volume, and that is subsequent reconstruction, not a failure of the first operation.
What surgery does not fix
Written without hedging, because it is the part that makes everything above credible:
- It does not return the area to how it was before the injection. That starting point no longer exists.
- It does not guarantee removing all the material. And there is something worth knowing: nobody has measured it. The authors of the series of 199 patients say so expressly when they conclude that studies are needed to quantify the material removed and to compare techniques against each other.
- It does not cure an underlying autoimmune disease. If one coexists, it is still there afterwards, and its management is multidisciplinary.
- It does not remove the risk of complications from the surgery itself, which exist and are on the gluteal removal page and the face and lips page.
- It does not erase the scar. One problem is exchanged for a more manageable one, not for nothing.
When it shows
Two timescales, and it is worth not confusing them.
The result in the area is considered final at six months. Before that there is swelling, hardening that settles and a scar still maturing: what you see in the second month is not what you are going to have. That is also why appointments are spaced out and why there is no point making any decision about revision surgery before then.
The pain follows its own calendar, and it lags behind. When it improves, it usually does so between the first and the sixth month, gradually and not always continuously: there are better weeks and worse weeks, and that does not mean something is wrong.
🚨 There are patients whose pain does not improve after the operation. It is not the commonest outcome, but it happens, and it is the part of this conversation almost nobody puts in writing. If you have had pain for years and that is the only reason you are considering surgery, go into the consultation knowing that removal does not guarantee it will go. Removing the material and the reactive tissue eliminates the cause that can be eliminated; what sustained pain has established on its own account — sensitisation, nerve fibre damage, fibrosis in tissues that cannot be excised without cost — does not always go with it.
And beneath the two timescales, a shorter one that precedes them: the recovery comes before the result. In the series of 35 patients, a seroma — the most frequent complication — appeared at 31 days on average. Judging how the area has turned out before that is resolved makes no sense.
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Frequently asked questions
Will my fatigue go?
In the series of 199 patients there was a statistically significant reduction in asthenia after removal, and it was the most marked of the three symptoms measured. It is not an individual guarantee: it is what was observed in that cohort.
And the muscle pain?
That also fell significantly in the same series. It is worth remembering that these are patient-reported symptoms and that the study has no comparison group.
Will I look as I did before they injected me?
No. That is the point worth accepting before surgery. The aim is to resolve the problem and leave the area as good as possible, not to restore a previous state that no longer exists.
How much material will they take out?
A hundred per cent is rarely achieved, and we have to be honest about something more: there is as yet no reliable measure of how much each technique removes. The authors of the largest series note it as a gap in the literature.
If they do not take it all out, what is the point of surgery?
Because what produces the symptoms is above all the chronic inflammatory reaction and the altered tissue around the material, not just its presence. Removing the bulk can change the situation a great deal even if traces remain.
Does mood improve?
It has been measured in a series of 160 facial patients: self-esteem and social interaction rose, and anxiety and depressive symptoms fell. It is one of the best-documented outcomes and one of the least talked about.
When can I judge the result?
Not before the recovery is complete. As a reference, in one series a seroma appeared at 31 days on average. The specific timings are on the recovery and sick leave page.
I have an autoimmune disease. Will it be cured?
No. Removal takes away the material and the reaction it provokes, but it does not cure a pre-existing autoimmune disease. The coexistence of autoimmunity is described as worsening the inflammatory response to the material, and in those cases management is multidisciplinary.
Might I need more than one operation?
It is possible, and it does not mean anything has gone wrong. A second stage may be planned to restore volume or to complete an area, and it is discussed before starting.
Sources
- Osorio E, Ramírez B, Herrera O, Suarez C, Ciro C, Varela A. Three-flap Technique: Comprehensive Approach for Biopolymer Removal in the Gluteal and Lumbar Regions. Plast Reconstr Surg Glob Open. 2026;14:e7870. A retrospective cohort of 199 patients in Medellín (January 2022 – September 2024); improvement in gluteal ptosis, in quality-of-life markers and in symptoms, with statistically significant reductions in myalgia (OR 0.15), asthenia (OR 0.03) and anxiety (OR 0.08), and improvements in sleep quality and exercise frequency; the authors conclude that further studies are needed to quantify the material removed and to compare with other techniques. https://pubmed.ncbi.nlm.nih.gov/42495057/
- Mustin DE, Barrett DL, Gangal A, White MS, Yeung H. Management of silicone granuloma: A systematic review. JAAD Int. 2023;11. Ninety-three studies with 227 participants; surgical excision accounted for 66.2% of treatments, with 48% complete and 50% partial responses; overall, 41.8% complete and 51.6% partial; the evidence is limited to case series and a single cohort study. https://pubmed.ncbi.nlm.nih.gov/36865613/
- Ghoraba S, Loucas M, Loucas R. Management of Permanent Filler Complications Using Deep-Plane Facelift and Temporoparietal Fascial Flap Reconstruction: A Retrospective Study. Aesthet Surg J Open Forum. 2025;7:ojaf106. A retrospective study of 160 patients operated on between 2014 and 2022, with a mean follow-up of 16 months; significant improvement in self-esteem and social interaction and a reduction in anxiety and depression levels; overall complication rate of 22%. https://pubmed.ncbi.nlm.nih.gov/41376670/
- Montealegre G, Uribe R, Martínez-Ceballos MA, Rojas-Villarraga A. ASIA syndrome symptoms induced by gluteal biopolymer injections: Case-series and narrative review. Toxicol Rep. 2021;8:303-314. A series of thirteen patients with a foreign body reaction who developed ASIA syndrome after gluteal injection of biopolymers, followed between May 2016 and May 2018; five underwent surgery and showed clinical improvement after removal of the material. https://pubmed.ncbi.nlm.nih.gov/33552929/
- Eusse Llanos JC, Posada López S. Paramedian open approach for gluteal biopolymers removal: a case series of 35 patients. JPRAS Open. 2025;45. A series of 35 patients with mild to moderate involvement; the most frequent complication was seroma (40%), with a mean time to formation of 31 days; 42.85% had no complication at all; the authors conclude that it is a safe alternative with favourable aesthetic results. https://pubmed.ncbi.nlm.nih.gov/40837208/
- Pascali M, Chirico F, Rugge L, Rauso R. Aesthetic Surgical Pathway in Permanent Facial Filler Removal. Facial Plast Surg. 2024;40:19-30. A series of 231 patients operated on for removal of permanent facial filler with aesthetic restoration; follow-up from 12 months to 6 years; functional and aesthetic correction was overall rated as improved on the GAIS scale, with high levels of satisfaction on both subjective and objective assessment. https://pubmed.ncbi.nlm.nih.gov/36696919/
Book your consultation
If what is holding you back is not fear of surgery but the suspicion that it will not achieve anything, what settles that doubt is a specific assessment: what symptoms you have, how much material there is and what state the tissue is in.
With that we can talk about what it is reasonable to expect in your case, including what is not going to change.
Clinical confirmation by the surgeon
Registration no. 46/4624077
Registration no. 46/4624503
Last reviewed: 6 September 2026. This content is for information only and does not replace an individual assessment by a healthcare professional.
