Swelling & Nodules with Filler: What You Need To Know

This blog is created to help anyone experiencing delayed swelling after filler. I do a very high volume of filler and every once in a while I will get a call from a patient telling me that they woke up and their filler is a little swollen. I am not talking about the immediate swelling you experience the first two weeks after you get filler. I am talking about swelling that can occur months or even years down the road. It could be mild and isolated to one side of the face, one eye, just lips, or in severe cases all of the areas where filler was injected.

It is usually one of two things:

  1. Temporary inflammation of the filler (most common)
  2. Delayed onset post inflammatory nodules (less common).

Temporary Inflammation:

What you are experiencing is actually quite common with Hyaluronic Acid fillers. These fillers are very hydrophilic and they attract water naturally but even more-so during certain times when the body is inflamed. 

Here are some of the most common causes:

  • any sickness especially colds and sinus infections
  • any time allergies are flared up
  • after sunburns or excessive sun exposure
  • any time your body is holding a little extra fluid (ie: Salty mexican food & margs!)

In regards to Covid-19 we do see some patients who experience swelling in their fillers both while actively sick with the virus and after receiving the vaccine. It’s when your body is the slightest bit broken down and immunocompromised that we see this reaction the most. We have been seeing this for years with sinusitis, the flu, etc. so it is definitely not specific to anything covid related, but again it can happen and we do see it.

What I recommend:

I call it “watchful waiting.” We give it two weeks and it should fully resolve on its own. If for some reason it should not, we can dissolve the filler. You do not have to worry about any permanent issues. While you wait: 

  • Take an antihistamine like Zyrtec every AM & Benadryl every PM until resolved
  • Hydrate with lots of water
  • Try flonase nasal spray for a couple of days to decrease any swelling in the nasal cavity
  • Give the swelling time to self resolve

Should the swelling get much worse let me know and we could do an oral steroid but typically this is not warranted. I typically see this resolve on its own in 2 weeks or less. 

Delayed Onset Nodules

These typically pop up “out of nowhere” weeks to months after filler injections. They can be challenging to treat as they can present very differently. Some are hot or cold, soft or firm, tender or non tender.  Like the inflamed filler they are often triggered by illness, injury, or any stress to the patient’s immune system.

Here are some of the most common causes:

  • any sickness 
  • autoimmune disease
  • any time allergies are flared up
  • after sunburns or excessive sun exposure
  • during times of increased stress

We know that germs can play a role and can manifest later with these nodules. Think of fillers like an implant. Our bodies may think that the fillers are a foreign body and may try to “fight” off the filler. The nodules are often encapsulated balls of filler that the cells of the body are trying to fight. The good news is that our bodies eventually figure it out and we will see the nodules resolve on their own eventually. Many times, if the nodules are causing discomfort or visibly displeasing we will treat them in hopes of quicker resolution.

How I treat nodules:

  • Antibiotics
  • Antihistamines
  • Dissolve filler
  • Steroids if warranted for facial swelling

Dissolving Filler

If you are my patient, you should know that I only work with HA fillers. Hyaluronic acid is a naturally occurring carbohydrate in the body- making it very safe and is also completely reversible. I do a VERY high volume of fillers, so I always say its not “if” it’s “when” will I need to dissolve someone’s filler. I want to have the ability to correct filler when it needs to be corrected or reverse a complication should one arise. This is why I only work with HA fillers that are reversible.

Filler that is acting up may never dissolve on its own and will likely need to be dissolved. I see filler last much longer (years longer) than it’s expected to, so if you have filler in unwanted areas I would recommend dissolving and starting over.

What is the Dissolving Protocol?

I use hyaluronidiase, which is an enzyme that targets the hyaluronic acid filler. Once this is injected into the filler it can take up to one week to fully dissolve. Sometimes more than one dissolving session is needed. Then, we wait at least 2 weeks to allow time for the tissue to heal before deciding if we need or want to re-inject with filler again. It is important to wait this 2-4 week period before re-injecting with filler. This allows any inflammation to subside and for the tissue to completely heal so that the new filler will look its very best. I know it’s hard, but wait it out!

Again, I explain all of this to you not to scare you, only to educate you. I always want to be 100% transparent with all of my patients and make sure everyone is aware that complications, although rare, can and do occur. The important thing is that I am very experienced in recognizing and treating them when they do happen. I will always be here for my patients and I will always make sure my patients are 100% happy in the end.

Getting a hold of me or the original person that did your filler is always the first step, then we will see where you need to go from there!

XO 

Racquel

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Racquel Frisella

Board Certified Nurse Practitioner & Aesthetic Specialist based in Saint Louis, Missouri

I work as a cosmetic injector and skincare specialist with 12 years of experience in the Aesthetic Industry. I see patients both in-office at Nayak Plastic Surgery & Avani Derm Spa for treatments as well as online for customized, complimentary skincare plans. I focus heavily on preventative and corrective injections, treatments, and skincare.  My career is my passion and I love to help people feel like the very best version of themselves. I am a wife and a mother of 3 beautiful children under the age of 3. I love all things beauty, fashion, and fitness. I am creating this site as a place to share my expertise on beauty, anti-aging, and skin while also giving a glimpse into my lifestyle as a mom, wife and lover of fitness!  

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