Why these lumps are different
Most people expect filler to be dissolvable. That is only true of hyaluronic acid. [8] Ellansé, Sculptra, Radiesse and Juvelook are collagen stimulators. They are made to stay and work for months, and a lump from one of them cannot be dissolved with an enzyme injection.
Lumps are not one thing. A lump can be a cluster of product, an over-response of collagen around it, or a reaction called a granuloma. Published reports describe lumps treated with medicines injected into the nodule, or removed by surgery, and they can be slow to clear. [9] [2]
Dr Sin Yong starts by finding out which kind of lump it is, because the answer changes what he does.
Which product, which problem
All four can leave a firm area months after the injection, and people often describe it as filler that went hard. The differences matter for what can be done.
| Product | Material | Usual complaint | Dissolved by hyaluronidase? |
|---|---|---|---|
| Ellansé | Polycaprolactone microspheres in a carrier gel | Firm nodules, or heaviness where it was placed | No |
| Sculptra | Poly-L-lactic acid particles | Lumps, drift to where it was not meant to be, or an area that kept building | No |
| Juvelook, Lenisna | Poly-D,L-lactic acid with hyaluronic acid | Nodules, especially under thin skin | Only the hyaluronic acid part |
| Radiesse | Calcium hydroxylapatite microspheres in a carrier gel | Firm nodules, often along the area treated | No |
Which kind of lump is it?
The first three are firm and quiet. The fourth is a medical problem and is treated as one.
Product placed too shallow or too densely can gather in one spot. It tends to be firm and stable, and it usually does not hurt.
The collagen response has gone further than intended in one area, so it builds into a firm patch or a heavy zone.
Product sits where it was not meant to be, such as the lower lid, the smile line or the jaw. It may show as a ridge or an uneven fullness.
It may be tender, red or warm, and it can appear months or years later. It needs a doctor the same day, or A&E if none can see you.
Why hyaluronidase is the wrong tool
Hyaluronidase breaks down hyaluronic acid. [10] Polycaprolactone and poly-L-lactic acid are not hyaluronic acid, so injecting the enzyme into one of these lumps does nothing useful.
The exception is a mixed history, where hyaluronic acid has been layered on top of an earlier collagen stimulator. The hyaluronic acid part can be dissolved, and the rest is reassessed. Ultrasound is how the two are told apart.
Why ultrasound comes first
Ultrasound helps to identify filler, and polycaprolactone has been described with its own appearance on a scan. [11] [12] A study of 27 referred patients with non-inflammatory nodules found them inside the fascia in every case, but its abstract does not name the filler types, so it may not apply to these products. [13] Depth matters, because a shallow lump under thin skin and a deep deposit near the bone are different problems.
Dr Sin Yong performs the scan himself, and he measures each deposit before any energy is delivered. Treatment is then directed at the excess.
What Dr Sin Yong does
What lowers the risk at the start
A review of poly-L-lactic acid links nodules mainly to how the product is reconstituted and placed. [4] For hyaluronic acid filler, published guidance links problems to the patient, the product and the procedure. [14] Not every lump comes from technique: one case collection felt that product properties mattered more. [2] If you are planning a collagen stimulator, ask which product will be used, whether it can be dissolved, and what happens if a lump forms.
What treatment cannot do
Response varies, and some firmness may remain.
No enzyme dissolves these materials. Treatment is directed at the excess.
A red, hot or tender lump is treated medically first.
Collagen that has formed is your own tissue.
Permanent filler, or a lump that stays after other steps, may need a surgeon.
Risks and side effects
Tenderness where the lump was targeted, and less often small crusts or temporary darkening. Rarely a burn, blister, lightening, scarring or more fat loss than intended. Eye injury is possible if eyes are unprotected. Treatment waits in pregnancy, on freshly tanned, sunburnt, infected or inflamed skin, and after a recent course of oral acne medication.
Steroid injections into a nodule can thin the skin or fat around it, and they are used with care.
Surgical removal leaves a scar and can cause dents or nerve injury.
A lump that grows, turns red, becomes hot or painful, or a fever. Same-day review, or A&E if no doctor can see you. Skin turning white, grey or mottled, or pain that is getting worse after filler, can mean a blocked blood vessel: go to the doctor who injected you or to A&E now. A change in vision or eye pain after filler: call 995.
What affects the fee
Fees are not published here. They depend on how many areas are involved, what the scan shows and how many stages the plan has. A written quote follows the assessment.