After years of the filler-everything era, a different kind of consultation has become routine at Southwest Plastic Surgery. Patients are not arriving to add volume. They are arriving to have material taken out. Migrated filler, under-eye puffiness that never resolved, and permanent lip biopolymers causing asymmetry and firmness years later. Dr. Frank Agullo tells these patients that “I want it out” is often exactly the right instinct.
Here is how he approaches removal, and what he wants patients to understand before they decide.
Removing Permanent Lip Biopolymers
Biopolymers are permanent injectable materials, and over time the skin stretches around them and forms little bags. Dr. Agullo makes an incision right where the wet and dry parts of the lip meet, then removes the affected tissue and whatever he finds inside.
The incision goes all the way across, because removing it in spots leaves little dog ears, the puckered tissue at the edges. Placed where it is, it stays hidden. Healing takes about five days, and the scar keeps improving for roughly two months. Up close the line is visible; to everyone else it is not.
Dr. Agullo does not remove muscle. Some material sits deeper in the muscle, but cutting it would risk motion and expression, so he leaves the muscle intact. The body is already working to push the material toward the surface, which is part of why the bumps appear.
The Honest Part: Recurrence
| Question Patients Ask | What Dr. Agullo Tells Them |
|---|---|
| Can it be removed? | Yes, affected tissue and material both |
| Will the muscle be cut? | No, motion and expression are protected |
| Could it come back? | About 40% of the time, with a discount when it does |
| Is removal riskier than placement? | More involved and sometimes staged, but often the right call |
Dr. Agullo states the recurrence rate plainly. Once he removes what has surfaced, the body may keep pushing more up, and about six months later a patient sometimes notices it again and returns to have more removed. The practice applies a discount when that happens, because an honest number matters more than a perfect-sounding promise.
Migrated Filler in the Face
Old filler often does not fully dissolve. It migrates, drifting away from where it was placed. When a patient is already having a facelift, Dr. Agullo can place medication during the procedure to dissolve some of it, leaving the natural tissues intact instead of over-inflating an area like the high cheekbones. He is deliberately cautious about stacking more filler on top of filler.
Under-Eye Filler That Stays Puffy
One of the most common concerns the practice sees is under-eye filler that has held water and stayed swollen for years. Dissolving it is usually the first step, and it can take more than one treatment, especially if it has been in place a long time or earlier attempts did not work. Once the tissue returns to baseline, fat grafting is a safer way to address true hollowing. Recovery is supported through the practice’s ElixirMD and Med Spa services.
Why Removal Is More Involved Than Placement
It is natural to assume that material that went in easily will come out easily. At Southwest Plastic Surgery, Dr. Agullo explains that the opposite is usually true. Placing filler takes minutes through a needle. Removing it, especially permanent biopolymers, is more delicate and is sometimes staged across more than one visit.
The reason is that injected material does not stay in a tidy pocket. It spreads, scars into surrounding tissue, and with permanent products bonds to structures worth protecting, like nerves and muscle. Removal is its own operation, planned carefully, and the team is candid about what can be fully reversed and what cannot.
The Approach Behind the Practice’s Removal Work
Dr. Agullo built this part of the practice around honesty rather than promises. That means stating the recurrence rate for biopolymers, applying a discount when a patient needs a second removal, and resisting the temptation to layer new filler over old. For patients who have spent years adding volume, the message is consistent: the right move is often subtraction, patience, and letting their own tissue return to baseline before deciding on anything new.
What Recovery From Removal Looks Like
Recovery depends on what is removed. After lip biopolymer removal, the incision heals in about five days and the scar keeps improving for roughly two months. Patients are swollen at first, which is expected, and the team explains clearly what is normal versus what would be a reason to call.
Dissolving hyaluronic acid filler involves essentially no downtime beyond minor swelling or bruising at the injection points. Fat grafting later, once the tissue has returned to baseline, is gentle, with swelling that settles over a few weeks. None of it is dramatic, but Southwest Plastic Surgery makes sure each patient knows what to plan around before booking.
Common Reasons Patients Come In for Removal
The most frequent requests the practice sees fall into a few patterns: permanent lip biopolymers causing firmness or asymmetry, filler that has migrated away from where it was originally placed, and under-eye filler that has held water and stayed puffy for years. In each case, Dr. Agullo evaluates whether dissolving, surgical removal, or a staged approach is the right path, and he is candid about what can be fully reversed and what cannot.
About Dr. Frank Agullo
Dr. Frank Agullo is the founder of Southwest Plastic Surgery in El Paso, Texas. He is double board-certified by the American Board of Plastic Surgery and the American Board of Surgery, a Fellow of the American College of Surgeons, and completed his plastic surgery fellowship at the Mayo Clinic. He is a Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center Paul L. Foster School of Medicine and has been named a Castle Connolly Top Doctor for thirteen consecutive years.
Ready to Talk?
If you are tired of chasing one filler with another, or you want a biopolymer out, the team at Southwest Plastic Surgery can help. For the surgeon’s editorial take, see Dr. Agullo’s essay on drworldwide.com. For the patient-facing walkthrough, see the companion post on agulloplasticsurgery.com.
Call (915) 590-7900, text 1-866-814-0038, or book online at swplasticsurgery.com. #StayBeautiful.
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