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This review focuses on the evolution and development of the <jats:styled-content style=\"fixed-case\">PMMA<\/jats:styled-content>\u2010collagen gel, Bellafill, and the 10\u00a0years of postmarketing experience of Bellafill since it received premarket approval (<jats:styled-content style=\"fixed-case\">PMA<\/jats:styled-content>) from the <jats:styled-content style=\"fixed-case\">FDA<\/jats:styled-content> as Artefill in 2006. Artefill was rebranded to Bellafill in 2015.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The authors conducted a literature search on PubMed for key articles describing the steps in which Arteplast, a <jats:styled-content style=\"fixed-case\">PMMA<\/jats:styled-content> filler developed in 1989, led to the development of Bellafill, the only <jats:styled-content style=\"fixed-case\">PMMA<\/jats:styled-content> filler approved by the <jats:styled-content style=\"fixed-case\">US FDA<\/jats:styled-content> for the treatment of nasolabial folds and acne scar correction. The factors governing efficacy and safety were also evaluated for the major <jats:styled-content style=\"fixed-case\">PMMA<\/jats:styled-content> fillers available in the world.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The process of manufacturing and purifying <jats:styled-content style=\"fixed-case\">PMMA<\/jats:styled-content> has played a major role in minimizing adverse events for Bellafill. Postmarketing surveillance data for the 2007\u20102016 period show that for more than 530\u00a0000 Bellafill syringes distributed worldwide, 11 confirmed granulomas (excluding clinical trial data) (0.002% of syringes sold) have been reported. Data on other <jats:styled-content style=\"fixed-case\">PMMA<\/jats:styled-content> fillers are limited and inconsistent. The authors suggest that adverse events are often attributable to lack of proficiency in treatment technique and other factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Bellafill has demonstrated an excellent safety and effectiveness profile in multiple clinical studies, customer feedback, and 10\u00a0years of postmarketing surveillance experience. Adverse events occur with all fillers for a variety of reasons. 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