Early Onset Nodule Formation
As we entered 2024, I also entered my fifth year in medical injectables. As the years have progressed, so too has my skill with these treatments. Fast forward to today, and I am humbled to have a full practice that includes an armamentarium of products that help my clients reach their goals. Hyaluronic acid (HA) dermal fillers are one of the tools I introduced early on in my practice. Over the years I have injected hundreds of syringes and while adverse events are always possible, they are very rare.
Last month, a client of mine experienced an early onset nodule from HA filler; this is the first time I have managed this rare complication. To fast forward, we managed the symptom and she 100% recovered. I asked my client recently how I could have supported her better. She said, I just wish I knew this could happen, because I felt scared when it did, not knowing what it was. To move this wish and empowering knowledge forward to all of my community, I asked for her permission to tell this story.
I offered my client the full-face rejuvenation approach with HA filler. The procedure went smoothly, and all was well until two evenings later when I received a photo from her expressing concern. She said that she felt swollen and mild pain when she smiled. While swelling, tenderness, and bruising is normal post-filler injection, it will typically move in the direction of improvement rather than get worse. It’s not normal, however, for one area of the face to become exacerbated with swelling and pain days later while the rest of the face has moved further along in its healing. I was so glad that my client tuned into her body, her intuition, and followed up with me.
That night we went through a check-in process to determine what the specific complication may have been. We ruled out other rare and serious adverse events like vascular occlusion. I began further research and considered the swelling to be either a hypersensitivity to the medicine, an infection, or nodule. With further investigation, it was likely not hypersensitivity since the reaction was localized rather than diffused through the entire treatment area. And likely not infection because the site wasn’t red, heated, there was no fever, and no other signs of infection. At this point, it was likely a nodule; an accurate diagnosis allows for streamlined treatment.
We initiated ice and antihistamine that evening, and planned to connect in the morning. There was no improvement in the morning so we added a steroid course, pepcid, baby aspirin, heat and massage. We saw immediate improvement. The swelling began to reduce, which led to visibility of a lump, and it became clear that her body had formed a nodule around the filler. Nodule reaction is not common, but it is a possible side-effect of filler. Once we determined that it was a nodule, we continued heat and massage, while continuing the course of other medicines. The client is currently at 100% healed.
We know that filler is a safe procedure, but statistically, an occasional complication will occur. In fact, this sort of complication can occur with just one syringe of filler alone. It feels vulnerable to share this adverse event, but I am dedicated to reflecting on my work in this writing practice in a way that honestly reflects both my experience and the complexities of the work itself. I have learned so much from this experience and feel confident in my management of these rare adverse events.