Lumps – Diagnosis, Prevention and Treatment
This article is intended for aesthetic clinicians who want to find out more about non-inflammatory lumps and bumps caused by dermal filler. If you are a patient looking for more information about this topic check out this link.
How to diagnose lumps caused by dermal filler?
Non-inflammatory lumps are very common, especially lumps in lips. They are perhaps the most common follow up from dermal fillers. Thankfully they are the easiest side-effect to treat. The skin lesion is identifiable through the presence of a soft spongy bump inside the skin. It is important to assess if the lesion is absent of any inflammatory signs and symptoms. These include itching pain, tenderness or erythema around the injected area.
On the other hand, there is a sub-type of inflammatory lesions which can be confused with simple dermal filler lumps; chronic inflammatory nodules. These nodules are usually not inflamed enough to be red or tender. However, these lumps are very different than the ones created by dermal filler. They usually form over a long period of time. They feel like a hard lump on palpation, more like a smooth but slightly rubbery pebble.
What are filler bumps?
Non-inflammatory lesions consist of isolated pockets of sterile filler or fluid which cause and aesthetic problem. More often than not, they do not cause a great deal of physical discomfort to the patient. However, they create a lot of anxiety for both the clinician and the patient.
Lumps in the face are usually caused by three main variables: the product, the patient or the procedure. Low quality product can attract a lot of moisture. Product which looks perfect initially can attract water over long periods of time.
The next factor is the patient. Client selection is extremely important in avoiding side effects, such as lumps. Find out from your patients if they are prone to fluid retention. This tends to show up particularly during the morning, where they may have puffiness around their eyes and cheeks which can last for a few hours during the day.
Similarly, the quality product placed in the wrong compartment or depth of the face can create soft bulges inside the tissue. These can especially happen around ligaments in the wrong depth near delicate structures around the modiolus, the tear trough or oral commissionaires.
How to manage and treat lumps and bumps in the skin?
The first thing a clinician can do in order to get rid of the lump is to attempt its integration with the skin. Massage is the usually the easiest solution. Often, new practitioners are too scared to apply the right amount of pressure. The patient shouldn’t feel hurt. In order to find the right amount of pressure, I suggest massaging your own skin in order to accustom yourself with the pain threshold.
Injecting normal saline can reduce the size of a lump in many patients if it’s followed by a massage. This technique is likely making hyaluronic acid dermal filler break down and redistribute itself. The advantage of using this method is the low risk of allergic reactions.
In some cases, a mechanical extrusion could prove effective in removing the filler lump. Insert a green needle into the tissue and then squeeze the area until the filler extrudes. Here’s a case I treated using this technique.
The last resort is injecting the area with hyaluronisade in order to break down the filler and return the patient to the untreated state.
Each region and patient is unique. Clinicians should consider all the options available to deal with lumps and bumps caused by dermal filler. Aesthetic practitioners should communicate their options and decisions to the patient in order to follow the most preferable course of action. In case none of the mentioned procedures reduce the non-inflammatory lesions, inflammatory nodules should be considered as a possible diagnosis.