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The Truth About Filler Nodules

Posted: 6:00 a.m. Sunday, Oct. 15, 2017

By Anita Mandal, M.D.
Question: I want to get fillers in my deep smile lines and droopy mouth corners that are starting to look like puppet lines. My friend got a lump after filler treatment and it took a while for it to go away. I saw a plastic surgeon who gave me options ranging from a 6-month filler to one that lasts many years. With a long-lasting filler, if I get a nodule, will the lump stay longer compared to that from a temporary filler that doesn’t last as long?

Answer: Not necessarily. There are many factors that contribute to lumps and nodules. These include injection technique, tissue depth at which the filler is injected, choice of filler, the risk of nodules as well as area of injection.

Firstly, only FDA-approved injectable fillers with a high safety should ideally be used for facial rejuvenation. Your surgeon’s injector skill plays a significant role in reducing the risk of lumps, nodules and granulomas. However, no procedure is risk-free, no matter how safe, and, even in the presence of excellent technique, nodules can occur. Standard follow-ups to evaluate the treated tissues are important. If a nodule does develop, there are several simple, non-surgical ways to help dissolve it.

The depth of injection within the tissues and choice of filler are also important. All fillers are designed to be placed at certain depths. If a superficial filler such as Restylane Silk is placed deep for hollow cheeks, it will go away much quicker than expected. If a deeper tissue filler such as Radiesse is placed in a superficial plane for fine lip lines, not only can your mouth area look bumpy and unnatural, but you also increase your risk of nodules.

Area of injection is also a factor. For example, with lower eyelid hollows, I typically recommend either Restylane or Bellafill, the 5-year filler, as they seem to give the most natural results. Voluma or Juvederm in this area can cause too much puffiness.

Not all injectors are equally skilled. Not all fillers are the same. A Board Certified Facial Plastic Surgeon who understands the complex facial anatomy of aging as well as the intricacies of the various fillers and is an expert injector may be your most suitable choice. A comprehensive facial consultation is your first choice.


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