The recent evolution of the philosophy of rejuvenation therapy toward addressing soft tissue loss with aging has prompted growing interest in fat transfer procedures as a means of volume replacement. However, fat transfer has several undesirable characteristics, including the need for a donor site and lack of predictability of fat uptake and volume retention. Injectable fillers are gaining popularity as an alternative to fat transfer because of their lack of donor site morbidity, instant effects, predictability, and vastly reduced recovery period. Because temporary fillers require inconvenient repeat visits, patients have been requesting permanent options. This article describes the author’s experience with a permanent adjustable large-volume filler based on polyalkylimide (Bio-Alcamid) and suggests that it could be a preferred and reliable alternative to fat transfer in appropriate patients. Permanent is defined as no decrease in volume of the product over time. However, because the area augmented may eventually decrease from further aging and fat atrophy, more product may need to be reinjected years later.