What is the best protocol for granuloma treatment post Volbella filler?

Granulomas are inflammatory nodules that can develop as a reaction to dermal filler injections, including Volbella. Treating granulomas typically involves a multi-step approach aimed at reducing inflammation, resolving the granuloma, and improving the appearance of the affected area. Here's a general protocol for granuloma treatment post-Volbella filler:1. Consultation with a Dermatologist or Plastic Surgeon: If you suspect you have a granuloma or are experiencing any adverse reactions after Volbella filler injections, it's essential to seek medical attention promptly. A healthcare provider experienced in treating complications associated with dermal fillers can evaluate your condition and recommend an appropriate treatment plan.2. Evaluation and Diagnosis: The healthcare provider will examine the affected area and may perform additional tests, such as imaging studies or a biopsy, to confirm the diagnosis of granuloma and rule out other potential causes.3. Topical Treatments: In some cases, topical treatments such as corticosteroid creams or gels may be prescribed to help reduce inflammation and promote healing of the granuloma. These medications are typically applied directly to the affected area and may be used alone or in combination with other treatments.4. Intralesional Steroid Injections: For larger or more persistent granulomas, intralesional steroid injections may be recommended. This involves injecting corticosteroid medications directly into the granuloma to help shrink it and reduce inflammation. Multiple injections over several weeks may be necessary to achieve the desired results.5. Oral Medications: In some cases, oral corticosteroids or other systemic medications may be prescribed to help control inflammation and promote resolution of the granuloma. These medications are typically reserved for more severe or widespread cases and may be used in combination with other treatments.6. Surgical Removal: In rare cases where other treatments are ineffective, surgical removal of the granuloma may be necessary. This involves excising the affected tissue under local or general anesthesia. Surgical removal is typically considered a last resort and is reserved for granulomas that are causing significant symptoms or aesthetic concerns.7. Follow-Up: It's essential to follow up with your healthcare provider regularly to monitor the progress of treatment and make any necessary adjustments. Your provider can assess the response to treatment, monitor for any complications, and recommend additional interventions as needed.It's important to note that the treatment approach for granulomas post-Volbella filler may vary depending on the individual patient's condition and the severity of the granuloma. Your healthcare provider will develop a treatment plan tailored to your specific needs and goals.

I recommend following up with a cosmetic dermatologist.  Granulomas need either kenalog and/or 5 FU. I do 5f/steroids for all my patients with filler complications. Best, Dr. Emer

Nodules after Voluma, Volbella and Vollure have been reported. These reactions have been reported months after injection and sometimes have been associated with recent dental work. Some people have felt that they are related to the development of a biofilm in the area of injection. They generally are best treated with a course of antibiotics such as doxycycline. They generally take 6-8 weeks to resolve. Dissolving this type of hyaluronic acid can be challenging. I would suggest following up with your provider and considering a course of doxycycline 150 to 200 mg a day for 6-8 weeks.