Questions answered by Dr. Lee
Questions answered directly by Medical Director Dr. Jung Su Lee in the Doctor's Columns.
Is every firm filler lump a granuloma?
No. Overfilling, uneven filler distribution, migration, fibrosis, infection, and delayed inflammatory nodules can all feel firm. A granuloma cannot be definitively diagnosed by touch alone.
Answered by Medical Director Dr. Jung Su Lee · What is a filler granuloma? How it differs from filler clumping, its symptoms, and treatment
Can hyaluronic acid fillers also cause granulomas?
Yes. Although hyaluronic acid fillers are biodegradable, delayed inflammatory reactions and foreign-body granulomas have rarely been reported. However, not every delayed nodule after hyaluronic acid filler injection is a histologically confirmed granuloma.
Answered by Medical Director Dr. Jung Su Lee · What is a filler granuloma? How it differs from filler clumping, its symptoms, and treatment
Can dissolving injections eliminate a filler granuloma?
Hyaluronidase may help when hyaluronic acid filler remains. However, it is ineffective for non-hyaluronic acid fillers, and additional treatment may be needed when fibrosis or granulomatous inflammation has already developed.
Answered by Medical Director Dr. Jung Su Lee · What is a filler granuloma? How it differs from filler clumping, its symptoms, and treatment
Can fillers injected long ago still cause problems?
Yes. Filler granulomas or delayed inflammatory reactions can appear months or years after injection. Problems may be discovered long afterward, particularly with materials of unknown composition or nonabsorbable substances.
Answered by Medical Director Dr. Jung Su Lee · What is a filler granuloma? How it differs from filler clumping, its symptoms, and treatment
Does a filler granuloma always require surgery?
Not always. Nonsurgical treatment may be considered first depending on the filler composition, presence of infection, lesion size and extent, and skin condition.
However, surgical removal may be considered for recurrent inflammation, skin damage, or a mass that does not respond to treatment.
Answered by Medical Director Dr. Jung Su Lee · What is a filler granuloma? How it differs from filler clumping, its symptoms, and treatment
Can surgery remove all the filler?
Whether removal is possible and how much can be removed depend on the type and location of material and the degree of adhesion to surrounding tissue.
Even a relatively localized lesion may be difficult to remove completely if it is closely attached to normal tissue or important structures such as nerves and blood vessels.
Rather than attempting to remove all filler indiscriminately, it is important to assess how much of the symptomatic lesion can be safely removed while minimizing normal tissue injury.
Answered by Medical Director Dr. Jung Su Lee · What is a filler granuloma? How it differs from filler clumping, its symptoms, and treatment
Can an area suddenly feel hard years after fat grafting?
It is possible. Small nodules or areas of fibrosis or calcification that were not previously noticeable at an old fat-grafting site may become palpable over time.
However, new firmness at a grafted site does not necessarily mean that the previously grafted fat is the cause.
If a lesion has only recently become palpable, other possible causes should also be checked.
Answered by Medical Director Dr. Jung Su Lee · Why does a fat-grafted area become hard?
Will massaging the hard area make it disappear?
Vigorous massage cannot be recommended before the cause is identified.
Unlike temporary symptoms during recovery, an established hard calcified mass is unlikely to resolve with massage alone.
In particular, avoid repeatedly pressing hard on painful or inflamed areas.
Answered by Medical Director Dr. Jung Su Lee · Why does a fat-grafted area become hard?
Can all grafted fat be removed in one procedure?
This depends on the lesion's form and extent.
If fat is spread widely across several layers beneath the skin or has become fibrotic and adherent to surrounding normal tissue, selective removal of the necessary areas may be required to preserve normal tissue.
For safe removal, ultrasound or CT may be needed to identify the remaining fat, calcification, and their relationship to surrounding tissue.
Firmness in a fat-grafted area does not necessarily mean that a complication has occurred.
Temporary firmness can occur during early postoperative recovery.
However, if a distinct lump remains for several months or becomes firmer over time,
if the grafted area is visibly apparent through the skin, develops uneven contours, or becomes painful, identifying the cause may be necessary.
After considering when, where, and how many times fat was grafted, together with the current tissue condition,
whether treatment or removal is actually needed should be determined individually.
If a hard lump in a fat-grafted area concerns you, we recommend assessing the fat and surrounding tissue through a consultation at 02-545-3700 or via KakaoTalk at “UVOM Plastic Surgery.”
Answered by Medical Director Dr. Jung Su Lee · Why does a fat-grafted area become hard?
Is fat grafting always needed after forehead implant removal?
No. If the original forehead contour and soft-tissue volume remain adequate after removal, fat grafting may not be necessary.
Implant removal and fat grafting therefore do not always need to be performed together. The need for fat grafting should be assessed separately based on the expected contour and actual tissue condition after removal.
Answered by Medical Director Dr. Jung Su Lee · Can fat grafting be combined with forehead implant removal?
Is the space left by the implant simply filled with fat?
No. An implant is a solid object of a defined shape and volume, whereas autologous fat is distributed within tissue and must survive after grafting. They create volume differently.
Rather than filling the implant's former space with an equal amount of fat, grafting is planned according to where volume is needed and the overall forehead contour after removal.
Answered by Medical Director Dr. Jung Su Lee · Can fat grafting be combined with forehead implant removal?
Is recovery faster if implant removal and fat grafting are performed together?
Not necessarily. There may be a practical advantage to performing both treatments in one operation, but recovery varies with the extent of removal, adhesion, fat harvest site, and extent of grafting. Currently available evidence does not support a general claim that simultaneous treatment produces faster recovery than staged treatment.
Answered by Medical Director Dr. Jung Su Lee · Can fat grafting be combined with forehead implant removal?
When can fat grafting be performed after forehead implant removal?
There is no single interval appropriate for everyone, but we generally recommend waiting at least 6 months. Timing should be determined after assessing inflammation or infection around the implant, the extent of removal, swelling and tissue recovery, and the actual remaining contour.
Answered by Medical Director Dr. Jung Su Lee · Can fat grafting be combined with forehead implant removal?
Can fat grafting reproduce the same forehead shape as an implant?
Autologous fat can improve insufficient forehead volume and curvature, but implants and fat grafts have different characteristics.
An implant has a fixed shape and volume, whereas grafted fat undergoes survival and resorption. The same projection and shape as the implant therefore cannot be guaranteed.
Answered by Medical Director Dr. Jung Su Lee · Can fat grafting be combined with forehead implant removal?
Can hyaluronic acid filler remain for at least 5 years?
Persistence varies with the product, injection site and amount, cross-linking properties, and individual tissue condition. Disappearance of visible volume does not necessarily mean that all filler-related residue or surrounding tissue reactions have resolved. However, a lump discovered at least 5 years after injection is not necessarily residual hyaluronic acid filler. Examination and appropriate tests may be used to distinguish residual filler, fibrosis, inflammatory nodules, and other masses.
Answered by Medical Director Dr. Jung Su Lee · Can granulomas appear years after filler injections?
Could a granuloma be related to filler injected 10 years ago?
The possibility cannot be completely excluded. Case studies of oral and facial foreign-body granulomas have reported filler injections approximately 3–10 years before the lesions were identified.
However, those studies also included non-hyaluronic acid fillers and mixed treatments. This does not mean every new lump appearing 10 years after injection is a filler granuloma. Other soft-tissue masses must be distinguished.
Answered by Medical Director Dr. Jung Su Lee · Can granulomas appear years after filler injections?
Do granulomas feel hard?
They can feel firm, but touch alone cannot confirm a granuloma. Residual filler, fibrosis, infectious nodules, and other masses may also feel firm.
Answered by Medical Director Dr. Jung Su Lee · Can granulomas appear years after filler injections?
Can a filler granuloma be painless?
Yes. Active inflammation may cause pain, redness, and swelling, but some present only as a palpable lump without pain. Painless palpable nodules were also commonly reported in case studies of oral and facial foreign-body granulomas.
Answered by Medical Director Dr. Jung Su Lee · Can granulomas appear years after filler injections?
Does dissolving the filler make a granuloma disappear immediately?
Hyaluronidase may help if the causative material is hyaluronic acid and residual filler is a major contributing factor.
However, hyaluronidase is an enzyme that breaks down hyaluronic acid; it does not directly remove infection, fibrosis, or all established granulomatous inflammatory tissue. Repeated or other treatments may be needed depending on the lesion.
Answered by Medical Director Dr. Jung Su Lee · Can granulomas appear years after filler injections?
Can the problem be diagnosed if I do not know which filler was used?
Even without the product name, the cause can be narrowed down using the timing, sites, and number of treatments, changes in symptoms, an in-person examination, and imaging.
Repeated treatment with different fillers can complicate diagnosis and treatment. A biopsy may be considered when the cause is unclear or another condition must be distinguished.
Past filler treatment history matters even years later
Delayed inflammatory nodules and foreign-body granulomas related to fillers are uncommon complications, but may appear months to years after treatment. A firm lump, recurrent swelling, redness, or pain at a previously injected site warrants assessment of a possible connection, even if treatment was long ago.
However, not every late-developing lump is a foreign-body granuloma. Residual filler, migration, noninflammatory nodules, infection and abscesses, fibrosis, and unrelated soft-tissue masses can look similar.
Treatment should therefore be chosen after identifying the cause through procedure history, an in-person examination, and, when needed, imaging, culture, or biopsy, rather than dissolving filler or administering anti-inflammatory injections based on symptoms alone.
If facial foreign material or a filler granuloma concerns you, please call 02-545-3700 or contact “UVOM Plastic Surgery” on KakaoTalk.
For more columns on facial foreign material removal, click a title below ▼
How can an old facial injection be assessed when its ingredients are unknown?
I have been told that old filler remains. Can it all be removed?
Why tissue around facial foreign material becomes hard
Answered by Medical Director Dr. Jung Su Lee · Can granulomas appear years after filler injections?
Can fat that has survived in the face be removed again?
Depending on the condition, some can be reduced or removed. However, grafted fat may survive across several layers among normal tissue, so complete removal of only the grafted fat cannot be assured.
Answered by Medical Director Dr. Jung Su Lee · Does your face look larger after facial fat grafting? Can the grafted fat be removed?
Can facial fat grafts be removed with liposuction alone?
Limited liposuction may be considered when fat is relatively soft and evenly distributed. However, liposuction alone may be insufficient if the fat has formed hard lumps or is accompanied by fibrosis, adhesions, or fat necrosis.
Answered by Medical Director Dr. Jung Su Lee · Does your face look larger after facial fat grafting? Can the grafted fat be removed?
If my face looks larger immediately after surgery, should the fat be removed right away?
Early enlargement may be due to swelling, so excessive graft retention cannot be determined immediately. The timing of surgery and recovery should be reviewed, and swelling distinguished from surviving grafted fat before deciding on correction.
Answered by Medical Director Dr. Jung Su Lee · Does your face look larger after facial fat grafting? Can the grafted fat be removed?
Can fat-dissolving injections dissolve grafted fat?
They cannot be regarded as an established general standard treatment for overcorrection after facial fat grafting. Even small volume differences in the face can cause depressions and asymmetry, so the medication's approved indications, supporting evidence, and the condition of the fat must be assessed carefully.
Answered by Medical Director Dr. Jung Su Lee · Does your face look larger after facial fat grafting? Can the grafted fat be removed?
