DELAYED ONSET NODULES. How to diagnose & treat lesions after dermal filler [Aesthetics Mastery Show]
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- Опубліковано 27 січ 2021
- Delayed onset nodules following dermal filler treatment - also known as lesions, or simply just lumps - can strike fear into the hearts of aesthetic clinicians because they are far from easy to diagnose and manage.
Firstly, you have to diagnose whether the lesions are just post-procedural, then whether they are inflammatory or non-inflammatory, then whether they're bacterial or not.
Should you watch and wait, and/or treat with antibiotics, steroids, and/or reverse the filler altogether with hyaluronidase.
In this episode of the Aesthetics Mastery Show, Dr Tim answers these questions and so much more about the diagnosis and treatment of delayed onset nodules.
Here's Dr Tim's article about delayed onset nodules that you can download for free: drtimpearce.com/resources/del....
Here are Tim's other social media channels:
Facebook: / drtimpearce
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Website: drtimpearce.com/
Podcast: open.spotify.com/show/20kUIxU...
Sign up to Dr Tim's free webinar about how to free yourself from complications anxiety: www.aestheticcomplications.co...
#dermalfiller #medicalaesthetics #aesthetics - Навчання та стиль
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Awesome discussion as always 🙌🏽👍🏽🙏🏽 !!!. Look forward to the next!
So pleased it help, thanks for letting us know, appreciate that 🙏🏽
Much appreciated
Good information thank you
Dr Tim you are doing God's work!
This is such an amazing Theme, because all those not glamourous things actually do happen. I habe now a patient with a massive delayed onset nodules in the cheeks where I injected VOLUX 4 months ago. She had a dental work 2 weeks ago and has an urinary tract infection too. Now on antibiotics and prednisolon..lets see how it goes.
Yes- it's easy for patients to forget when they only see the result on instagram!
Hi! Can I ask how is she doing now? I am currently going through the same
Informed consent on all possible outcomes and procedures not just the sale of the day.
Dr Pearse,
Do you see any correlation of women who have BII symptoms and injection reaction. I had allergic reaction and systemic inflammation one month after radiesse, not sure if it could also be related to breast implants
Dr Tim, I really need help!
I have a few nodules in the top right hand side from lumifill kiss filler, one being right on/above the vermillion. I distinctly know the nodule was there from the very moment it was injected. Months later and after using hylase 3 times it is still there along with others. There was no delayed onset. What would you suggest? I don't want to over hylase my lips
Thank you 🙏
After one successful hyper-diluted radiesse treatment on the neck , a second treatment was performed , 2 months later, several nodules were noted on all the treated areas . The same technique was used in both procedures. Can that be a body reaction to the filler?
Doc
I had cheek filler about a year ago then all of a sudden it looks as though I have line/ lumps running from my lower inner corner eyes to the middle of my cheek areas. No pain. This only occurred after my doc, who is an ocular plastic surgeon, had to dissolve some filler in that area. I went back on several visits complaining about this is making me look older than 60 and she is telling me those lines are just my anatomy.
Fast forward to 13 days ago when I had co2 laser treatment done the line/lumps are even more pronounced. 🤦♀️ so frustrating (anatomy shouldn’t move). I go back this week for a follow up. I’m feeling like it is old filler that has migrated. Any thoughts? I know it is hard to say what it might be without pics but any thoughts?
Hi doctor i got lip fillers for the first time 3 months ago, two weeks later i noticed my veins throbbing on the right side of my face. I went back to my injector and she has dissolved 4 times already and my veins are still throbbing and i can still feel some balls around my lips and alot right under my nose. The throbbing of my veins goes as far as my right temple. What can it be? 😢
I had filler on my chin 3 weeks ago voluma and something else now my body itches and stomach cramps. I had filler in past and never happened. One side is more sensitive tiny bit harder
Hello Tim, do you do dermal filler procedures? And where are you located? I would pay premium for you to fill in the depressed acne scars on my nose. Thank you.
Thanks for this vid! I had lip filler done about a month ago. The minute she did this one section I felt my lip get hard. I asked her about it and she said it was probably just swelling. The bump is still there but not visible. Just something I can feel with my tongue. Going back to speak with the injector on Saturday.
Could be a haematoma. These can take a couple of weeks to about a month to settle if it was. But absolutely go back to your practitioner if you ever feel you need more support.
Kind regards Mary. Clinical advisor for Dr Tim
@@DrTimPearce I appreciate yall, thanks so much!
@@Earth_Schooled is it ok now
Same thing happened to me. I am sitting here with nodules. I never took a vaccine or got sick. But did do Hyaluronidase on the other side then 2 days later got these nodules. Should i do Hyaluronidase on these nodules?
I have them now
Hello dear Dr
My sister developed preorbital swelling after 4 yes from filler under left eye
The right side has no problem
Here in my country no one can treat her she complain from it about one yr
The Dr inject HC locally but not effective
But the strange point is that it started every month at menstrual cycle time
👏🏻👏🏻👏🏻👏🏻👏🏻 AMAZINGGGG
Thank you Luisa 🙏🏽🙏🏽
How effective are steroids on these hard lumps? I have these lumps for years and was recently treated with hylase and got no response at all.
Thank you so much! Is there a possibility to treat nodules with antibiotics after hyaluronidase injection, as the nodules are still visible and have spread over other parts of the face (I was not on antibiotics when I was treaded with hyaluronidase)? Thank you!
It could be that all the filler wasn’t dissolved at time of injection therefore some is still reacting. Antibiotics are only required in cases where infection is considered. Maybe a course of steriods maybe the better treatment and redissolving again.
Hope you find resolution
Kind regards Mary. Clinical advisor for Dr Tim
Hi, thank you so much for this. I was starting to really freak out because anything on your face is such an important problem, but after this I am calmer. So first I had a sudden fever for a couple of days that came and went, and then the next day I woke up and on my left side it's like my filler had shifted or grew, I didn't know. It is soft but it has tenderness to it. So I am leaning on inflammation, but you said either leave it or treat it, I was wondering what the treatment for that soft inflammation post cold or vaccine or something would be. Please
Good evening Vanessa. If you are run down and your body goes into autoimmune response, filler certainly can become inflamed. For the most, it resolves all on its own as you feel better. For a small number of patients steroids maybe required to settle down inflammation.
Kind regards Mary. Clinical advisor for Dr Tim
Wow, the same thing happened to me. After my filler the following morning I was swollen on one side. I quickly used Hyaluronidase on that side. I looked leveled and fine. 2 days later I woke up very swollen on the opposite side. It's hard, and big. 2 nots or maybe nodules. Exactly what you said delayed. WHAT SHOULD I DO? MORE hyaluronidase on that side didn't work. 😢😢😢
I got some redness and bumps like a rash just got it this Thursday. Not happy, now I have to wait till Monday to get checked by doctor. Will this be an infection?
I’d could be a simple irritation to the cleansing solution used to sterilise your skin prior to your injections. However if you are in pain you must push for a review much sooner.
Kind regards Mary. Clinical advisor for Dr Tim.
I have an ongoing infection 3 weeks after juvederm, voluma. I developed an abscess 2 weeks after filler and its been drained 4 times a long with antibiotics that didn't seem to work. A new nodule has appeared in a different spot than abscess and is a sore lump that is starting to turn reddish. Doctors' are testing my bacteria to know which antibiotic they should use now. II also have a dent in my face (due some past dissolving) and scar tissue around where the abscess is healing. This is truly a nightmare!!! My injector has basically told me that they can;t treat me anymore and if I experience more pain or fever I should go to emergency, that is what I did and fortunately I am being treated at a hospital with a reputable dermatologist! what I wonder is, how long does biofilm take to go away, or does it ever go away?
Biofilms are the hardest to resolve as they are little balls of bacteria hiding in a very hard impenetrable casing. This is why antibiotics don’t always work on their own and correct it needs to be the right one.
Sounds like your in the right track to healing. Sorry you’ve gone through this difficulty though.
Kind regards Mary. Clinical advisor for Dr Tim
Hi please help ! I had cheek filler and laughter lines filled about 5 weeks ago. I noticed right away that there was lumps under my skin around the injection sites. I was told it would calm down after 4 weeks however they're still there its week 5.5. Now have white lines under my eyes that are risen up and quite noticeable. I have been taking anti histamines with no effect as the clinic told me to so . I am worried the lines will never go and i feel worse now then i did pre treatment. should i ask for a refund and can anything be done I am loathed to have them stick any more needles i my face tbh. They are worse when i am warm and slightly get itchy
Sounds potentially like superficial filler. But you must return so that they can take a look rather than just advice over the phone.
Potentially may require reversal or if lucky some firm massage. But often reversal is the way forwards.
Kind regards Mary. Clinical advisor for Dr Tim
I’m 6 mos post cheek filler. Everything was fine then out of nowhere both cheek bones have hard nodules on them. At first they were painful in certain places now they aren’t. I do believe there is swelling with it bc my under eyes are puffy. No one has a clue what it is! I look like I’ve been majorly overfilled (but I wasn’t).
Delayed onset nodules can be to do with your immune system playing havoc. If you have been unwell or have had a vaccine recently this can trigger an immune response. Sometime can resolve spontaneously and sometimes require steriods.
If no resolution and still causing you problems then reversal maybe required.
Kind regards Mary. Clinical advisor for Dr Tim
Hello, the same thing happened to me. I haven’t had filler recently but all of a sudden areas were I have had fillers have become swollen. Not all areas but my check bone is swollen and so is my under eye.
I've had same issue where chin filler lumps came out of no where during a bad flu and pretty visible as well
I had cheek filler (JV) which shifted and then went bright red. Put same filler in lips which swelled up so bad. Months down the track and lips are still swelling. They keep just injecting dissolver and squeezing it out. Will I ever be able to have filler again?!
I know you can’t tell me that. I wish I could find someone here with your knowledge
Did your skin got bad after dissolver
I have a gut infection overgrowth of bad bacteria. Caused my hplyori. I just got lip filler 3 weeks ago my lips are a little bumpy but not hard. I feel like it can be an infection.
If lumps are soft it is often more compatible to being filler itself that’s just settled in the lip. Return back to your practitioner for a good firm massage. If there is any sign of inflammation you should also return for a review and potentially treatment with medication could be required.
Kind regards Mary - clinical advisor for Dr Tim
I have horrible bumps on my cheeks bones (lateral) from radiesse that protrude like a large ridge. I look like handsome squidward. It has been one month. I am living with depression. I have never been so sad in my life. I used to look 18 now I look 40 with razor sharp cheek bones and hollow temples/ under eyes. I’m only 29 and plan to get married next year, now I am considering rescheduling it, which in turn will effect my timeline of having a family. I am desperate. Do you have any luck with kenalog injection into the ridge/lump? Thank you Dr. I was injected with radiesse without knowing after getting only HA Juvaderm from the practitioner for 3 years. She never told me she was using radiesse 😢
hey, do you have updates, what happened. i just had kenalog
Dr. Pearce- I started getting restylane in my eye troughs six years ago because my hashimotos disease was causing such terrible circles under my eyes. One my right side most of the restylane has turned into several nodules that extend from my eye socket (very scary) down to my cheek. They have been there now for two years- but started growing about four years ago. Last month a doctor injected steroids into the largest one. It appeared to pop and dissolve a little- but now is harder than ever and back with a vengeance. I look a little disfigured, can't go anywhere without glasses to hide it, and am not sure what the next steps should be. Will they always be there? Are they treatment resistant at this point? Any help would be extremely appreciated.
Unfortunately due to your autoimmune disease and dermal filler it can become unpredictable and can struggle with more side effects such as nodules.
Steroids and potentially reversal maybe your option Liza.
Kind regards Mary. Clinical advisor for Dr Tim
@@DrTimPearce Thank you so much for your kind response Mary. I'll keep going with the steriods and possibly reversal.
@@lizah.3800 I hope you find resolution soon
You would have a million subscribers if this wasn't so intelligent. Normal people dont want to hear this much technical gem information and other doctors seem to arrogant to spend the time learning. Your quality is so high.
Hi there. Thanks for the compliment about the quality. As a lay person myself, I agree that Tim's UA-cam content is pretty detailed, and therefore not ideal for a patient audience, but that's OK because the main people we're trying to serve are clinicians in medical aesthetics, who seem to be very happy with the level of detail. Hanging around with lots of doctors and nurses etc as I do, I find they're super knowledge hungry, but I'm sure there are some, as you say, who are less so. All the best, Miranda
@@mirandapearcemindset Its good that you find people in the field are hungry for it. All things should be this way. I love the depth and wish you guys the best.
@@skinprison thanks so much, appreciate that 🙏
I think some patients also value this level or detail especially in an area which is not so commonly understood but incredibly sensitive at the same time. This gave me a lot of comfort that the advice we were receiving was correct
It’s not made for normal people.. healthcare professionals greatly benefits from this videos!
I have injected ellanse M 18mounths ago.I developed 3 subcutaneous nodules in my right nasolabial fold.it didn't have any pain or discoloration on my face.
Just palpable during touch.
How do i get rid of them?
Ellansé cannot be dissolved and you will have to wait until it resorbs in a few years. Some say it can last as long as 4 years. Depending on the nature of the nodules will be the possible treatment. Steroids can help if Inflammation is an issue but sounds like if it’s not causing any pain it maybe that you have to wait until nature takes it course.
Sorry we can’t be much more help. Kind regards Mary. Clinical advisor for Dr Tim.
@@DrTimPearce thankyou so much
First. Thank you for taking the mystery out of aesthetics.
This is a massive compliment for Tim, he will be very happy. Thank you
Thank you, I was very grateful for this compliment!
I got this reaction on all injected arras on my face after 9 months from last injections. It occurred also in areas injected a year before. I am swelled all the time one or two places at the sime time irregular bumps. Lastly steroid helped but it came back. I am taking steroids again but it might be a bit resistant. 😥
How is your skin noe
How r u now
Are they dangerous? Do they need to be removed? I have a small hard bump inside bottom lip I think it’s a nodule because dissolving agents have not got rid of it . I did it 7 times
For most lumps and bumps have a negative impact of patients wellbeing. Depending on the type of the lump will depend on the impact it has on health and well-being.
If hyalase hasn’t improved the lump a potential visit to your doctor may be required for an injection or oral course of steroids to help.
Hope this help. Kind regards Mary. Clinical advisor for Dr Tim
Hi. This video has given me some clarity I think with what's going on with me. Thankyou. I had jaw and cheek filler around 3 months ago...all was fine up untill around a month ago. It goes through flare ups...sometimes one side of my face...sometimes both. Its def not a hard lump just very inflamed and angry to the touch. Would you suggest anti biotics?
Steroids might the first port of call
@@DrTimPearce thanks so much for replying. I wanted to share my experience in case it helps somebody else....
I went to see my practitioner 3 days ago, she didn't really ask me too many questions. Blamed it on the fact I didn't drink enough water...well i do alot of sports so I'm aware of staying hydrated. She wanted to dissolve straight away, with my face already being so swollen, painful and inflamed I said I would like to come back in a few days as I wasn't mentally prepared for the procedure
In the days that followed I started taking NAC on the advice of a friend...on day 2 the inflammation had gone down by 80%...at one point it was so swollen I couldn't shut my eye properly...it was affecting my sleep as I couldn't sleep on either side. I was suprised I had inflammation as I'm generally very healthy and eat clean. Also NAC has many many benefits.
Hope this helps soneone
@@sambarnes7824 what is nac
@@sambarnes7824 Did it end up going away permanently? Are you using NAC for maintenance still?
@@sambarnes7824what is NAC please
I had radiesse done in a hand rejuvenation. 2 wks. After my hand swelled twice the size. I’ve been on steroids and antibiotics for a week. For the most part the swelling has gone down but I’m left with a golf ball sized bump on the back of my hand. I am going back to the dr. This week but I researched radiesse and I know it can’t be dissolved. 😳 I find myself going down the rabbit hole.😳😔
How did you heal ?
I have a hard lump on my lips from filler. It's been there for two years and I finally decided to dissolve my lips. This lump has been dissolved 4 times and it hasn't changed. It almost feels calcified. Is it safe to inject steroid into the nodule? or surgical removal? This really sucks. It was from vollure and I'm reading some have delayed onset nodules from vollure.
I’m sorry you have been struggling. Sometimes filler nodules unless treated early enough don’t respond well to hyalase. Nodules can become resistant.
I’d advise to be seen by a medical clinician to potentially look at manually extruding the old dermal filler with a needle.
I have the sameeee issue. HA Filler put in 4 years ago and have a nodule that feels hard. I have an appointment to get it dissolved but I’m not sure it’ll even work. Have you found any solution ? Thanks !
@@babymlo so I learned that this actually happens when filler is injected too deep in the cutaneous. When it’s deep for whatever reason it gets compacted and doesn’t dissolve. Mine finally dissolved but it took 6 session!!! It was terrible but I’m happy it’s out. For a sec I thought I had silicone and was freaking out
@@TheLastGen 6!? Ughh. Well thank you so much for the info. Glad it’s finally gone 🙂
@@babymlo yeah! And with less dilution. It was crazy. I’m happy too! But it was awful.
she should keep quiet about letting it sit, not everyone has it as easy as she did, it's been 3 years for me and my lip filler migrated all around my lips 6 months after getting them and caused lumps and bumps and weird ridges all around above and below my lips (nodules and suspected biofilms), I felt pretty ugly, it's still there but most doctors don't seem to have education in dealing with this. I was never given steroids or antibiotics, Ive had hyaluronadaise in conservative amounts, it improved some of the nodules but still the nodules persist. Can you suggest the types of steroid and antibiotic you would use for people that need it?
She hasn’t experienced multiple hard nodules that never go away. They are physically uncomfortable, scary and deforming.
She’s the doc’s wife what did you expect.
R u here in the u.s??
Hi, we are based in Manchester in the UK.
Why not just except responsibility for the diagnosis no matter who wrote down what or what the patient said you are the doctor stop pushing the blame.
Hello doctor please I need Ur help I got ellance filler a week ago but now I feel a hard lump under eye what should I do will it go away 😭😭😭😭
Look at a previous response above he said that will take 3 years to re absorb