I really appreciate you writing and my heart goes out to you. There are several different types of nodules associated with fillers. And they need different types of treatment. So, in my opinion, if any nodule is quite visible and causing psychological strain, it’s good to get an accurate diagnosis; especially if it’s not likely to go away on it’s own over the next three months.
Please keep in mind that hyaluronic acid based filler nodules can usually be removed or improved with the enzyme hyaluronic acid injections. Although it sometimes does take repeated visits. Please, please don’t use Bellafil which are tiny, plastic beads that are permanent. If something goes wrong, it can’t be removed without surgery and a scar.
The Three Main Types of Nodules
- Filler Material Clumps. These are basically just what they sound like. The filler particles didn’t get evenly dispersed and are now causing a lump. The collagen stimulators like Radiesse and Sculptra can be great when used well. But if they clump as they are injected, they stay clumped, and then start to stimulate collagen (like they are supposed to); it’s easy to see why a nodule develops.
- Inflammatory Clumps. These are rarer than most people think. You’re own body has an immune response to the material injected and then a usually red, tender, firm lump develops. Most common in those with active, autoimmune diseases like rheumatoid arthritis. This one is sometimes over diagnosed when it’s really # 1 or # 3 that’s the problem.
- “Biofilm” and Bacterial/Fungal Nodules. These can often be quite subtle. More common with HA fillers, but can happen with others. This includes when fillers are layered one of the top of each other even at different times. If there is a contamination of the filler, often on injection, then bacteria get trapped in there. There is a whole protocol for treating these that I won’t go into here. Please never let someone inject through the mouth!
Some Thoughts About How to Get an Accurate Diagnosis
- Many providers, including MDs, loath to biopsy the face. But a tiny 3mm punch submitted to a good pathologist can typically distinguish between the 3 types above. The stains for bacteria and fungi (PAS) need to be done. If the choice is a small biopsy, or repeated aggressive steroid injections into the face, a small biospy may be way better than guessing. The steroid injections will do almost nothing if the problem is clumping of the material. Aggressive steroids can cause temporary and sometimes permanent “dents” in the skin.
- Antibiotics are often a good idea, but it’s even better if your doctors can figure out which bacteria you have and treat it more effectively.
- If it turns out it’s a clump of material, it’s too long a discussion of options of how to treat it here. It depends somewhat on what was done. Was the Radiesse or Sculptra diluted or mixed with anything at injection? Sometimes providers are mixing these and HA fillers. How much exactly was injected and what technique was used? You’ll need an expert cosmetic dermatologist to help you be a detective to come to a good diagnosis and treatment.
I hope this helps you, and stay tuned in a few weeks for a blog post on Sculptra and the next “mixing” method and nodules.
Hope this helps,
Dr. Brandith Irwin, MD
Founder of SkinTour & MadisonMD Skincare
Follow my skin tips and travels on Instagram!
The post Nodules From Fillers – This Time It’s Radiesse appeared first on Skintour.
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