Lumps 4 months after Subcision! Can kenalog injections fix this or more rounds of hylenex? (Photo)

Question

I got subcision with vollabela filler in March 2024 for my acne scarring. I initially had flat/minor scarring. However now I'm left with small lumps that make my scars look worse& raised. I got the bumps dissolved with 0.1ml hylenex 4 times (thinking it was filler) & saw little improvement. However there're STILL visible bumps left. The bumps don't feel hard to touch, but look raised. Could these small lumps be fixed with Kenalog injections or could it still be filler that needs to be dissolved?

Eric M. Joseph, MD · Answer

If you were concerned about raised areas where you had injectable filler, if the dissolving enzyme was not helpful, steroid injections maybe useful for decreasing the amount of scar tissue that could be present and causing these raised areas. If that is not helpful, sometimes a shave biopsy or light electrocautery may be considered for achieving a flatter cheek appearance

Nelson Lee Novick, MD · Answer

I have been performing Field Subcisions and individual subcisions for elevating and smoothing acne scars since 1995. Individual subcisions works well for treating wider-based, boxcar and rolling scars. It is generally not appropriate for treating ice pick scars and dilated pores, and I see many of these kinds of scars in the photos provided. Lumps of excess fibrous tissue can appear when such ice pick scars are treated inappropriately in this fashion or sometimes also if an appropriate scar is subcised too aggressively. (In general, TCA CROSS would be more appropriate for ice pick scars.)  Fortunately, fibrous lumps can usually be easily flattened with intralesional Kenalog. You would be wise to make certain to consult with a board certified cosmetic dermatologist scar treatment specialist. , Hope this helps.

Hung William Song, MD · Answer

I have seen this happen a few times with Vobella. If it is not responding to the Hylenex, it is probably not the HA that is causing the lumps. More likely, it is excessive collagen production around the filler. Kenalog could help but there is a risk of causing atrophy which would make the acne scars worse. If Kenalog is used it must be hyperdiluted and only minuscule amounts should be injected over multiple treatments at least three months apart to prevent over shooting. It seems like an easy remedy but if done incorrectly, it could be disasterous. This should only be performed by a doctor with experience doing this. You can also just leave it alone and it should resolve on its own after about 2 years.

Lumps 4 months after Subcision! Can kenalog injections fix this or more rounds of hylenex? (Photo)

Answers (3)

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Lumps 4 months after Subcision! Can kenalog injections fix this or more rounds of hylenex? (Photo)

Answers (3)

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Recommended reading

Everything you need to know about Hyaluronidase

Our mission is to create a world where every investment in modern beauty is Worth It.