Are Granulomas Really a Problem?

A very well known dermatologist whose injections of Restylane provoqued bumps and one large nodule in and around the nasolabial fold (slowly disappearing after eight months), told me the following logic: Granulomas do not matter at all as long as you do not remark them, that he has many patients with bumps who continue with hyaloronic acid injections. The only point is that the material has to be injected very deep to people who react so sensitively to avoid negative cosmetic results.

Doctor Answers 6


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Granulomas are rare with hyaluronic acid fillers such as Restylane, injecting deeper would not prevent a granuloma if it was going to form, it would only make it more difficult to feel or see.

Las Vegas Plastic Surgeon
4.8 out of 5 stars 27 reviews

Granulomas.... NOT with Restylane...

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I completely agree with the other physicians!  This is completely wrong.  I have never heard nor experienced granulomas with Restylane injections. 

Hope this helps.  Good luck.


Dr. Grant Stevens

Grant Stevens, MD
Los Angeles Plastic Surgeon
4.7 out of 5 stars 152 reviews

Granulomas are highly unlikely with Restylane

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I have been injecting Restylane for many years (as long as it has been on the market in the US) and I have never either seen or heard of granuloma formation from this product. Restylane is a hyaluronic acid product and has no organ or species specificity. In theory there is no risk of an allergic reaction. In fact, in spite of its frequent use for cosmetic purposes, there are very few reports of hypersensitivity reactions. I suspect lumps like you are describing are all "technique dependent". I would also advise against deeper injections of Restylane. Other fillers such as Radiesse are much more effective when injected deeply to create volume. Please remember, your results depend upon the skill and experience of your physician injector.

Mitchell Schwartz, MD
South Burlington Dermatologic Surgeon
4.4 out of 5 stars 13 reviews

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This is a ridiculous statement.

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In fairness perhaps you misunderstood what your doctor was trying to say.  It is important to distinguish between lumps from too much material deposited in a given spot and an actual granuloma which is an inflammatory nodule.  Actual granulomas represent an inflammatory response and is associated with tenderness and focal swelling.  These are not welcome events and are uncomfortable.  The hyaluronic acid fillers are not dependent on inflammation for their filler effect.  Lumps general represent overfill.  I have a simple rule: if you can see fullness, it must be dealt with.  Occasionally one may have a situation where the fullness can be felt by gliding a finger over the skin but the contour otherwise looks smooth.  Generally I don't recommend fixing these.  The exception to this is if you can feel the bump inside the mouth.  The tongue has a way of always finding these so they are best dealt with.  

If you are a rare soul who does develop granulomas to hyaluronic acid filler, I would advise you that this is a type of allergy and I would strongly advise against having this filler in the future.



Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Restylane granuloma?

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I agree with Dr. Aldea. I have never had a case of granuloma after Restylane injection. Some of the thicker fillers, such as Radiesse, Perlane or Sculptra are more prone to this complication. I also would not recommend injecting anyone in the area of a "bump" as this will make its appearance more pronounced.

Granuomas and Wrinkle Filles

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A Granuomas is a chronic inflammatory reaction which may be seen with any long-lasting foreign body recognized as such by the body. This can include stitches and some fillers. I have used Restylane ever nice it was FDA approved years ago and have never entered a case of Granuoma with it. Such complications are a lot mor common with other filles such s Sculptra.  Personally speaking fillers associated with a high rate of Granuomas are problematic but potentially relying on the fullness and lumpiness of Granuomas for volumizing is a bigger problem. 

Peter A. Aldea, MD
Memphis Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.