Treating Lumps From Collagen-Stimulating Filler: A New Approach

A 2024 case report described one woman whose non-inflamed lumps from calcium hydroxylapatite filler in the jawline were reduced using a combination of saline injection and focused mechanical vibration from a microneedling device. The result was encouraging for that patient, but because it is a single case, it should be seen as an idea worth testing rather than a proven treatment.

Why this was studied

Calcium hydroxylapatite is a collagen-stimulating filler. Tiny mineral particles in a gel provide some immediate volume, and over time the body builds collagen around them. It is sometimes diluted and spread thinly under the skin to improve firmness.

One known downside is that, unlike hyaluronic acid filler, it cannot be dissolved with hyaluronidase. If product collects into a small lump, options are more limited. Lumps that are not inflamed (no redness, heat or pain) are often due to product clumping in one spot rather than infection or an immune reaction. Clinicians have been looking for gentle ways to break up or spread out these collections.

What the researchers did

The report describes a woman who had diluted calcium hydroxylapatite placed along her jawline and midface. About two days later she noticed small, firm lumps in both jowl areas. They were visible and could be felt, but were not red, warm or painful.

At about six weeks, the clinicians warmed the area, injected a small amount of saline mixed with local anaesthetic directly into each lump to dilute the product, and then passed a microneedling device over and around the lumps for several minutes. The device was used mainly for its rapid vibration rather than for skin resurfacing. A second session followed a few weeks later.

What they found

The authors estimated that the lumps shrank by about 30% immediately after the first session and by about 70% a week later. After the second session they reported near-complete resolution, and the patient described them as resolved by about 10 weeks after her original filler treatment. No recurrence was reported.

The only side effect noted was mild redness lasting around two hours. The authors suggested the vibration may help loosen and spread the clumped particles once the saline has thinned the surrounding gel, but this explanation was not tested directly, and no tissue samples or imaging were used to confirm it.

How strong is this evidence?

This is the lowest level of clinical evidence: a single case report. It can suggest an idea, but it cannot show that a treatment works reliably, how often it works, or whether it is safe across many people.

Several points are worth keeping in mind:

• There was no comparison patient, so we do not know whether the lumps would have softened on their own or with massage alone. Some early lumps do improve over time.
• Lump size was estimated, not measured with imaging or a standard scale.
• The authors themselves noted they could not tell whether the improvement came from the saline dilution, the vibration, or both.
• The device settings were chosen by clinical judgment, and the reported timing between sessions was not fully consistent in the paper.
• The lead author was employed by the company that makes the filler used, and another author reported industry ties. This does not mean the result is wrong, but it is relevant context.

What it means for you

If you have had calcium hydroxylapatite and notice a lump, the first step is to have it assessed, not to try to break it up at home. The clinician will want to know when it appeared and whether it is tender, red, warm or growing. Those features help separate a simple product collection from inflammation, infection or a delayed reaction, which are managed differently. Our article on delayed filler reactions covers the inflammatory side of this.

For non-inflamed lumps, options that clinicians may consider include waiting and observing, massage, saline dilution, targeted steroid injection in some cases, or, rarely, removal. This report adds a possible technique to that list, but it is early research. It is not a standard treatment, it has not been studied in groups of patients, and approaches like this should only be done by a trained medical professional.

Prevention matters too. Choosing the right product for the area, appropriate dilution, careful depth and even spreading all reduce the chance of lumps. Areas with lots of movement, such as the lips, are generally not a place for collagen-stimulating fillers. Our article on biostimulators versus hyaluronic acid explains why reversibility is a factor worth weighing before treatment.

People with active skin infection, a history of keloid scarring, certain autoimmune conditions, pregnancy or a tendency to form granulomas may be advised to avoid collagen-stimulating products.

Questions to ask at your consultation

• Can this product be dissolved if I do not like the result?
• How common are lumps with this product in this area?
• What would you do if a lump formed?
• How soon after treatment should I contact you with concerns?

Frequently asked questions

Will a lump from collagen-stimulating filler go away on its own?

Some small, early lumps soften over weeks as swelling settles and the product integrates, but not all do. A clinician can tell you whether watching and waiting is reasonable for your situation.

Can I use a home microneedling or massage device on the lump?

No. The report used a medical-grade device in a sterile setting, combined with an injection. Home devices could irritate the skin, introduce infection or make inflammation worse.

Is a painful or red lump the same thing?

No. A lump that is red, warm, painful or growing needs prompt medical assessment, because it may reflect inflammation or infection rather than simple clumping.

If you are considering a collagen-stimulating treatment, or have a concern after one, HealthPark Medical Aesthetics can discuss the risks and options with you. Sometimes the right advice is simply to wait, and sometimes it is a referral.

Source

McCarthy AD, Berkowitz S, Chernoff WG. Successful treatment of noninflammatory CaHA nodules using focused mechanical vibration. Aesthetic Surgery Journal Open Forum, 2024. Read the study