GRANULOMAS

he nodules are accumulations of gel in the area of tissue affected by the injection of the filler. They can affect the right anatomical plane of injection or they can be located in another plane. They are one of the most common complications associated with filler injections. They can be classified according to two characteristics:

TYPE (non-inflammatory, inflammatory)
ONSET (early or late)

Non-Inflammatory Nodules, Early Onset (nIN)

Usually these nodules (commonly called “lumps”, “balls”, “spots”) appear immediately after treatment. We can distinguish them into two categories: small and large

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SMALL nINs

They are usually not visible and are not painful (or at least very painful). They are slight thickening of gel (due to a slight movement during muscle contraction) and resolve spontaneously within a month of treatment.

Treatment

They do not cause any aesthetic damage and do not require any corrective intervention. If they persist: hyaluronidase.

Big nINs

They are usually visible (regardless if they create a negative aesthetic effect) and are annoying (they rub against the teeth). They are located internally in the lip mucosa or inside the lip muscle (deep location). They are coarse accumulations of gel, the result of an incorrect positioning of the too superficial gel, an excessive quantity, an incorrect technique or a mix of these causes.

Treatment

They will not be absorbed or integrated by the tissue, cause aesthetic damage and therefore need to be dissolved by hyaluronidase.
Other types of treatments other than hyaluronidase (surgical excisions, incision and drainage, use of fiber lasers) are absolutely to be avoided.

Non-Inflammatory Nodules, Late Onset (nIN)

Usually these nodules, also called GRANULOMA or COLD NODULES, are caused by an immune response to some filler ingredients.

A post-filler granuloma forms when our body’s immune system responds to a foreign body that cannot be eliminated physiologically. The incidence is very rare (0.01 to 1.0%) and usually occurs after a latency period, which may last several months or years after the injection.

Treatment

Granulomatous reactions to hyaluronic acid fillers can be treated with hyaluronidase.
Always excluding active infection10 , granulomas respond well to oral or intralesional steroids
If the various treatments above fail, surgical excision remains the primary choice for foreign body granuloma.

Inflammatory Nodules, Early Onset (IN)

Usually these nodules are abscesses, related to a local infection after treatment.

Treatment

Check the treatment of infections section

Download our guide on granulomas and always keep it with you.

The information contained in this page is for general information purposes only. This page and all information contained therein do not constitute: 1) the advice of
medical 2) an evaluation or 3) a consultation 4) as a substitute for a formal medical evaluation and/or a doctor’s consultation. Furthermore, the information and correspondence contained in any email, text message or chat on social portals, including all responses, is not and will not create a formal doctor-patient relationship. Prospective patients who would like a formal consultation are welcome to call for an appointment. The contents present cannot be copied, reproduced, published or redistributed because they belong to the author himself. Copying and reproduction of the contents in any way or form is prohibited. The diffusion, distribution and/or copying of the document or part of it, transmitted by any subject other than the recipient, is prohibited, both pursuant to article 616 of the CP, and pursuant to Legislative Decree No. 196/2003. The publication and redistribution of contents not expressly authorized by the author is prohibited.

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GRANULOMAS

Non-Inflammatory Nodules, Early Onset (nIN)

Non-Inflammatory Nodules, Late Onset (nIN)

Inflammatory Nodules, Early Onset (IN)

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