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Mary Byron By Mary Byron • February 22, 2018

Lumps After Filler Treatment

There are currently around 22 types of fillers flooding the market and while most of them are biosynthetic materials or bio-organic products, all can possibly cause lump formation. With fillers currently indicated in many aesthetic situations such as filling  deep or superficial wrinkles, correction of congenital or acquired depressions (e.g scarring), correction of asymmetries, volume replacement, contouring, and rejuvenation, lumps or granuloma formation has become a common complaint.

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The first time you feel or see one is a scary, confusing experience.  Don't worry if you find them shortly after having facial fillers or lip augmentation. The most common cause of lumps a few days after the procedure are swelling, bruising, or hematoma arising from the injection itself. Provided infection and vascular blocks have been ruled-out, there is no need to worry as these resolve on its own within one to two weeks. You can minimize the swelling by icing or applying a cold compress. Please follow your Provider's post-op instructions to a T. Some fillers like Sculptra have a "timed" massage while others are best left alone. 

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When the cause is congealed hyaluronic acid (e.g. fillers from the Juvederm and Restylane families), these are easily corrected by injecting hyaluronidase right into the lump. Hyaluronidase, like hyaluronic acid, naturally occurs in the body. It is an enzyme specific for hyaluronic acid but cannot really distinguish between your own and the filler. This is where the skill of the Provider matters. For best results, it it best to use it full strength. However, the process should not be too agressive - meaning the lump should be dissolved in a span of 2-4 treatments, depending on the size and consistency.

Give your tissues some time to heal after dissolving the fillers with hyaluronidase before being injected with fresh filler. Hyaluronidase itself will produce some swelling which might affect the Injector's accuracy.

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When the normal swelling is gone but the lumps are noticeable or palbable, do visit your Provider for a check-up. The lumps will be assessed on their consistency (soft, hard,or rubbery) or whether there is associated tenderness when touched. Soft lumps are the easiest to manage as these are more likely just undissolved or clumped filler which your Injector can smoothe out with a firm massage.

Pain and hard consistency may mean that your body sees the filler as a foreign substance and is attacking the fillers. This is the start of granuloma formation and requires a different approach. This allergic reaction is treated with steroids (oral and/or injectible).  Some patients report significant improvement with Arnica and Bromelain. For best results, observe proper Pre-op and Post-op instructions and report to your doctor if there is immediate blanching, violacious discoloration or unbearable pain.

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