The problem

A contour irregularity is seen after filler or fat injections. These may appear as lumps, rolls, or “waves” under the skin.

What causes these bumps?

Early lumps or fullness after filler injections or fat transfer can be related to post-procedural swelling. Needle entry points can cause small lumps as can movement of a needle or cannula (injection tube) under the skin. Fluid or edema can ensue after treatment that is a physiologic response to injury. Certain fillers (including hyaluruonic acid) are hydrophillic, meaning that they attract water molecules. This can also cause early fullness or irregularities.

Bruising or bleeding during or after treatment with fillers or fat can cause irregularities in the early stages after treatment. Bruises represent a collection of blood seen under the skin and these areas can be firm and nodular.

Lumps after filler or fat transfer can be related to the technique and placement of the injected material. In the eyelids and surrounding area, the skin is exceedingly thin, and injected material may be seen through the skin. In many cases, gradually injecting in small amounts in deep planes avoids visibility of injected substances. Filler or fat injected in larger collections very close to the skin can potentially be visible.

Foreign body granulomas are inflammatory reactions to foreign materials. These have been reported in association with some injectable fillers (including Sculptra, Radiesse, and permanent fillers) but are rare with hyaluronic fillers. They can be associated with skin redness.

Lipogranulomas have been reported after facial fat transfer. These are similar to foreign body granulomas and may present as a lump caused by an inflammatory reaction. Oil cysts can also occur after fat transfer which are non-inflammatory collections of isolated oil. These may also appear as lumps.

What you see in the mirror

Lumps, bumps, irregularities, waves, or rolls under the skin. These may be seen and/or felt.

Dr. brett kotlus cosmetic oculoplastic filler

Hard roll 2 years after Aquamid filler injection