Can a Physician Safely Remove Hard Restylane Nodules - and How to Find That Specialized Doctor?

I had Perlane over three years ago, and it developed hard nodules around my mouth and in the naso folds. Three rounds of Vitrase have not removed the balls around my mouth. Is there a technique or physician who can help? One doctor said scar tissue had been formed, another said muscle. I tried more restylane in the upper face to balance it, but everything seems to swell in lower face after a few weeks (similar to Farah Fawcett - not as bad). What options are there?

Doctor Answers 9

Perlane and nodules

Dr. Shelton answers this as I would have. It's very unusual to have an allergic or immune reaction to the product but in this instance, it could be the case.  

Seattle Facial Plastic Surgeon
4.7 out of 5 stars 221 reviews

Fort Lauderdale Perlane

Prolonged nodules always make me suspicious of mixing hyaluronic acids with permanent fillers such as silicone or Artefill. Surgical excision, or kenalog injection every six weeks, are your two best options.

Will Richardson, MD
Fort Lauderdale Dermatologic Surgeon
4.3 out of 5 stars 10 reviews

Perlane duration

It would be highly unusual for Perlane to last three years. It is more likely that you have had a foreign body reaction to the injection. If this is the case, discuss with plastic surgeon, but hyaluronidase will not work.

Steven Hacker, MD
West Palm Beach Dermatologic Surgeon
5.0 out of 5 stars 4 reviews

Hard nodule after Perlane

Hard nodules after Perlane may indicate that this is a very rare granuloma, an immune reaction to the product that rarely ever happens, or it was not Perlane but a different product, or a biofilm has attached itself to the outside of the product and a collagen type of scar capsule has been created.  Antibiotics and a biopsy may be worthwhile prior to an excision of the material. I would not suggest much more filler in the adjacent areas until more is known.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 38 reviews

What to do about hard filler nodules present after 3 years?

It is excedingly rare to get hard nodules from a hyaluronic acid filler, especially those lasting for three years.  Hyaluronic acid fillers last approximately a year at most.

When there is a reaction to hyaluronic acid fillers, it is usually redness, swelling, bruising or pain. 

However, sometimes hyaluronic acid fillers like Restylane or Perlane are used in combination with more permanent fillers like hydroxyethylmethacrylate (HEMA) and ethylmethacrylate (EMA).

These fillers (HEMA and EMA) are known to cause problematic reactions in patients.

In addition, there are sometimes illegal out-of-country products used for injections. 

Two things that I would recommend doing:

1. Get a biopsy of one of the nodules done by a board-certified dermatologist to determine the nature of the nodules.  It can be an allergic reaction, like a foreign-body granuloma that was seen in the past with fillers like silicone or an infection, among other things.  I believe a biopsy is essential in this case.

2. If possible, get records of what you were injected with and let the dermatologist know.

Emily Altman, MD
Short Hills Dermatologic Surgeon
5.0 out of 5 stars 4 reviews

Can a Physician Safely Remove Hard Restylane Nodules - and How to Find That Specialized Doctor?

Does seem odd if it was an HA injected. But anything is possible. Excision might be your only choice! From MIAMI Dr. darryl J. Blinski

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 174 reviews

I do not believe this is Perlane

I would get your records and verify that the doctor reported this odd event to Medicis. Odds are, you were told it was Perlane, but it was a different product, and possible one not legal in the US. This happens more than you would think.

Mary P. Lupo, MD
New Orleans Dermatologist
5.0 out of 5 stars 18 reviews

Hyaluronic acid filler nodules

A good first step would be to get the records from your injections.  It makes a difference what was injected as to what the treatment is.

Many times patients are told or recall that they have had one filler, only to find out they had something different.

If hyaluronidase has not helped, patients can consider focal steroid injections, or have the lumps excised.

More problematic fillers are the semipermanent fillers and silicone, the worst im my opinion.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 178 reviews

Scar tissue afer filler

If the hyaluronidase did not help then it may be scar tissue and you may want to consider having it excised if it is bothering you.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

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.