Lumps After Filler: Granulomas vs Other Nodules

A 2020 study from Geneva examined biopsies from 26 people with lasting lumps after filler and found that not every lump is the same. Some were true granulomas, an active immune reaction, while others were simply collections of product with no inflammation. The key message for patients is that the type of lump, and the type of filler behind it, decides how it should be treated.

Why this was studied

Doctors and patients often use words like "nodule," "lump," "bump" and "granuloma" as if they mean the same thing. The authors argue that this causes confusion and sometimes the wrong treatment. A lump made of misplaced filler behaves very differently from a lump caused by the immune system walling off foreign material.

Many people also do not know exactly which product they received years earlier, especially if they had treatment in another clinic or another country. Without that information, choosing a treatment becomes guesswork.

What the researchers did

The team reviewed 26 consecutive patients, all women, with an average age of about 58. Each had a lump that had lasted more than three months after filler, and each had a tissue sample (biopsy) examined under the microscope. The lips were the most common site, followed by the folds beside the nose and mouth, the cheeks and the under-eye area.

Before the biopsy, most patients could not say for certain what filler they had received. The microscope helped identify the product by its shape and appearance in the tissue.

What they found

Most of the lumps examined were true granulomas. Many of these were linked to permanent or long-lasting materials, such as silicone-like products and acrylic microspheres, and one to poly-L-lactic acid (PLLA). Only a small number of samples contained hyaluronic acid.

The hyaluronic acid cases were the most telling for today's patients:

• Four were non-granulomatous: simple deposits of product without an inflammatory reaction. All four resolved fully with hyaluronidase, the enzyme that dissolves hyaluronic acid.
• Two were granulomatous. In these, hyaluronidase was not enough and the lumps were surgically removed.

Granulomas from permanent fillers cannot be dissolved by hyaluronidase. Some were surgically removed when they were noticeable, others were managed with anti-inflammatory steroid treatment or simply monitored. The authors propose a step-by-step approach that separates hyaluronic acid from other fillers from the start.

Two very different kinds of lump

In plain terms, the study draws a line between two problems:

• A non-granulomatous nodule is usually product sitting too superficially, in too large an amount, or in the wrong spot. It tends to appear early, often feels like a smooth bump, and with hyaluronic acid it often responds to hyaluronidase or gentle measures.
• A granuloma is the immune system building a firm cluster of cells around material it cannot clear. It usually appears months or years later, can be red or tender, and may need anti-inflammatory treatment, infection testing or surgery.

The authors are firm that a lump should not be labelled a granuloma unless tissue has actually been examined. They also note that if infection is possible, a culture should be taken before antibiotics are started, so that the right medicine can be chosen. For more on how hyaluronic acid filler can be dissolved, see our article on dissolving filler.

How strong is this evidence?

This is a small case series from a single specialist centre, combined with a review of published work. It is useful for describing patterns, but it has clear limits:

• It cannot tell us how often lumps occur, because it only included people who already had one.
• The patients were referred for a problem, so they are not typical of everyone who has filler.
• Most lumps involved older permanent products rather than the dissolvable hyaluronic acid fillers commonly used now.
• Some of the counts in the paper do not add up exactly, which the authors do not explain.

Even so, the central point, that different lumps need different treatment, is widely shared in the medical literature.

What it means for you

If you have had filler and notice a lump, the first step is an accurate diagnosis, not a quick fix. A physician will usually ask when the lump appeared, whether it is tender or red, whether you have been unwell or had dental work, and which product you received. Sometimes imaging or a biopsy is needed.

The study also highlights why keeping records matters. Knowing whether a product was hyaluronic acid or a permanent material can change the treatment plan entirely. Ask for written details of any product injected, and keep them with your health records. Our article on delayed swelling and lumps after filler covers what to watch for.

Contact your injector or family doctor promptly for a lump that is growing, red, warm, painful or draining. Seek urgent care for skin colour changes or severe pain soon after an injection, or any change in vision.

Questions to ask at your consultation

• Is the filler being offered dissolvable, and what happens if a lump forms?
• How would you tell an early product lump apart from a later reaction?
• Will I get written details of the product and amount used?

Frequently asked questions

Are lumps after filler common?

Small, temporary lumps in the first couple of weeks are fairly common and often settle on their own. Lumps that last for months, or that appear later, are uncommon. This study did not measure how often they occur.

Can every lump be dissolved?

No. Hyaluronidase only works on hyaluronic acid. It cannot dissolve permanent or non-hyaluronic acid products, and in this study it was not enough for the two hyaluronic acid granulomas.

Will I need a biopsy?

Not usually. Many early lumps are managed based on history and examination. A biopsy is more likely if a lump is long-lasting, unusual, or not responding to treatment.

If you have a lump after filler or want to understand your options before treatment, HealthPark Medical Aesthetics can review your history in a consultation and refer you to a specialist when that is the right next step.

Source

Modarressi A, Nizet C, Lombardi T. Granulomas and nongranulomatous nodules after filler injection: different complications require different treatments. Journal of Plastic, Reconstructive & Aesthetic Surgery, 2020. Read the study