Lately people come into the clinic holding their phone: "The internet says an Ellansé lump can be dissolved with collagenase — is that true?"
It's a fair question, because there is a real study behind it. This isn't a rumour out of nowhere. But the gap between "there is a study" and "this is a reliable treatment" is still wide. Let me lay out what we actually know, and you can judge for yourself.
The bottom line first: new, worth watching, not yet on solid ground
If you only want one sentence: dissolving Ellansé with collagenase is a new attempt that appeared in 2025, backed by an early case report, but with a very small sample, a contested mechanism, and a peer challenge published almost immediately. It is not something you can safely demand as a "standard fix" yet.
I won't say it can't work, and I won't say it has no value. But framing it as "already validated, safe and effective" would be dishonest. Here's why.
Why would anyone try collagenase? Because Ellansé is hard to dissolve in the first place
The main component of Ellansé is PCL (polycaprolactone, the material in Ellansé). It's completely different from hyaluronic acid. HA can in theory be dissolved with hyaluronidase, but PCL is a polyester, and hyaluronidase does nothing to it. In the body it breaks down by hydrolysis, slowly, over 3 to 4 years.
That "hard to dissolve" property becomes especially difficult when something goes wrong. A study discussing vascular embolism from PCL fillers points out directly that part of what makes these complications so hard to manage is the inability to dissolve the filler quickly (Khan et al., 2025). Precisely because it is "easy to inject, hard to remove," people have gone looking for some other enzyme that might dissolve it. Collagenase was proposed in exactly this context.
For what it's worth, Ellansé is not a high-complication material. A retrospective covering 1111 treatments found that overall complications were uncommon (Lin & Christen, 2020). But "uncommon" is 100% for the person it happens to, and once a stubborn nodule forms, how to handle it becomes a real problem.
The latest evidence: what the iCare technique claims
In 2025, a study in the Journal of Cosmetic Dermatology proposed the "iCare technique," using collagenase to treat Ellansé M nodules (Wu, 2025). In brief:
- The clinical part involved 3 patients with 10 nodules that had persisted for over 2 years after injection.
- In the in-vitro part, the author claims a collagenase mixture turned Ellansé gel from a gel into a solution within 5 minutes, while anaesthetic, hyaluronidase and steroid did not.
- The method injects roughly 5 times the nodule's volume in collagenase mixture; small nodules (under 5 mm) responded better, larger ones (10 to 25 mm) needed multiple sessions.
- Those 3 patients had no allergy, infection or skin necrosis.
It sounds appealing. But note the limitations the author states plainly: only 3 patients, and recurrence risk, optimal dosing for larger lesions, and what happens with intravascular injection all still need more research.
But the evidence hasn't settled: mechanism and peer challenge
This is the part that needs a cool head, and the reason I'm asking you not to rush into belief.
First, there is an unresolved contradiction in the mechanism. Collagenase, as the name says, breaks down collagen — and PCL is a polyester, not collagen. By the usual understanding, collagenase would at most act on the layer of collagen the body grows around the PCL microspheres, not on the spheres themselves. The author's in-vitro work claims collagenase dissolves the PCL gel directly, which is a new claim that differs from existing understanding, and a new claim has to count as "unconfirmed" until other teams reproduce it.
Second, it was challenged by peers as soon as it appeared. The same journal published a commentary raising concerns about the technique (Vilar et al., 2025), and the original author wrote a reply (Wu, 2025). The reply clarified a few points — for example, that he used recombinant rather than bacterial-source collagenase, and that he relied on ultrasound guidance to avoid vessels. Back-and-forth is healthy, but it shows exactly this: the method is currently a subject of debate and challenge, not settled consensus.
Putting the two routes side by side makes the difference clearer.
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| Aspect | Collagenase dissolution (Ellansé) | Ultrasound-guided single-pinhole physical extraction |
|---|---|---|
| Level of evidence | Single author, 3-patient case series + in-vitro (2025; very new, peer-challenged, not independently reproduced) | Long-standing clinical practice; removal can be confirmed on imaging in real time |
| What it acts on | Claims to dissolve PCL gel directly (mechanism still contested: collagenase breaks collagen, PCL is polyester) | Physically removes the material itself, along with its fibrous capsule |
| Predictability | Unsettled: recurrence, dosing for large nodules, intravascular situations all unanswered | Confirmed on imaging, relatively predictable |
| Main risks | Intravascular injection, allergy (more so with bacterial sources); requires ultrasound guidance | Risks related to a minimally invasive procedure; requires skill and experience |
Key insight: The most dangerous thing isn't a "fake study" — it's a real study with an over-amplified conclusion. iCare is a real paper, but it's an early attempt in 3 people, still under peer challenge. Reading it as "collagenase can now safely dissolve Ellansé" makes the evidence sound stronger than it is.
On risk: don't treat it as a validated safe option
Collagenase is not without cost. Its relative — bacterial collagenase — is already known to cause bruising and swelling when used for other indications; on facial filler, the bigger worries are accidental intravascular injection and allergic reaction to bacterial-source preparations. The author himself stresses the whole procedure should be done under ultrasound guidance, confirming vessel position on imaging first.
In other words, even if this method is eventually shown to work, it is not a "any clinic can just inject it" thing. It demands a lot of the operator's imaging judgement and grasp of vascular anatomy.
A 2026 paper lists enzymes as a treatment. Does that overturn the above?
No. A 2026 case series on liquid-form PCL does list enzymes among its treatments, but what it treats is not "dissolving the PCL."
It is a retrospective series of seven cases, about bruising that persisted for several months after liquid-form PCL injection (Byeon et al., 2026). It sets four categories side by side: pigment fragmentation with lasers, thermal loosening, mechanical dispersion, and enzymatic degradation (hyaluronidase, lipase). One thing has to be said before citing it: three of the thirteen authors are members of the medical research team at Dexlevo, the manufacturer of the product used, and the paper discloses that conflict of interest itself. That does not make the content untrustworthy, but you should read it with that in view.
Break it into three layers and it is clear that it does not contradict the conclusion above.
First, hyaluronidase cleaves the glycosidic bonds of hyaluronic acid; it does not break down polyester. That has not changed because of this paper. The fastest resolution in the series was Case 7, on the upper arm: a single dose of hyaluronidase plus gentle massage, resolved in 6 days. Another case was under the eye (Case 5), where Restylane hyaluronic acid had been injected in the same session. The reasonable reading is dispersion of the surrounding matrix, or treatment of hyaluronic acid that was present at the same time, rather than dissolution of the PCL.
Second, lipase is an esterase, a different enzyme from hyaluronidase. The lipase data the paper cites comes from an in-vitro experiment: PCL degraded completely within 120 hours in the presence of lipase. That is a result in the laboratory, not a clinical protocol, and no such injectable use exists in Taiwan.
Third, liquid-form PCL and microsphere PCL are not the same material. All seven cases used GOURI, the liquid-form product, while the Ellansé discussed in this article is the microsphere type. How to tell the two apart, and why a lump from each takes a different route, is set out in "liquid PCL" means two products.
So the paper is worth knowing about. It records how long-term bruising from one particular material was managed. But the statement that hyaluronidase does nothing to Ellansé's PCL still holds.
So what should you do now? Back to the predictable route
If you're stuck with a stubborn Ellansé nodule, my advice is direct: treat collagenase as an option worth watching but still under study, not the one to chase right now.
For collagen-stimulator complications, we still rely on ultrasound-guided single-pinhole physical extraction. Not because we reject new methods, but because it is currently the most predictable: imaging first to see the nodule's position, depth, and relationship to vessels and nerves, then taking the material out along the border of its fibrous capsule, confirming in real time how much has been removed. It's the same logic as whether Ellansé can actually be removed and the mechanism and risks of collagen stimulators: you have to see it to handle it well.
If collagenase one day accumulates more independent, larger-scale evidence, it could become a useful supplementary tool in some situations, and I'd welcome that. Until then, making an unsettled method your first choice means the risk is yours, not the paper's.
Frequently Asked Questions
The internet says collagenase dissolves Ellansé — will one injection fix me?
There isn't enough evidence to support that "one shot and it's gone" expectation. The supporting study has only 3 patients, is a very early attempt, and was publicly challenged by peers. It is not a validated standard treatment, nor something any clinic can safely perform. Treating it as "a research direction worth following" is reasonable; treating it as "a ready solution" is premature.
Does collagenase dissolve the Ellansé itself, or the scar around it?
That is exactly the core of the current debate. Collagenase breaks down collagen, while Ellansé's PCL is a polyester, so by the usual understanding it would at most act on the collagen capsule the body grows around the PCL. The original author's in-vitro work claims it dissolves the PCL gel directly, but that has not been independently reproduced, so "what it actually dissolves" is not settled.
If HA can be dissolved with hyaluronidase, why not Ellansé?
Because the materials are completely different. HA is a sugar, and the enzyme can cleave it; Ellansé's PCL is a polyester, which hyaluronidase doesn't touch — it breaks down by hydrolysis over 3 to 4 years. That's also why Ellansé is more troublesome than HA when something goes wrong: you can't just rely on an off-the-shelf enzyme to clear it quickly.
A study says enzymes fix it, so can Ellansé be dissolved or not?
PCL cannot be dissolved. The 2026 liquid-form PCL case series does list enzymes among its treatments, but what it treats is bruising that lasted months after injection, not the PCL itself. Hyaluronidase cleaves the glycosidic bonds of hyaluronic acid and does nothing to polyester: the fastest case in the series was on the upper arm, a single dose of hyaluronidase with massage, and another was under the eye, where hyaluronic acid had gone in during the same session. All seven cases also used liquid-form PCL, a different material from Ellansé's microsphere type, and a lump from each takes a different route.
So how should an Ellansé lump be handled?
First, use ultrasound to see the lump's position, depth, and relationship to vessels and nerves, then decide. We rely mainly on ultrasound-guided single-pinhole physical extraction, removing the material along with its fibrous capsule and confirming in real time. The actual approach has to be individualised after in-person consultation and imaging — it isn't one formula applied to everyone.
Can I just wait until the collagenase technique matures?
It depends on your situation. If the nodule is stable, painless, with no inflammation or displacement, watchful waiting is a reasonable option. But if it's growing, reddening, painful, or affecting your appearance enough to bother you, waiting for an immature method may not pay off. That trade-off is best judged together with a doctor experienced in repair, after looking at imaging.
If you're struggling with an Ellansé or other collagen-stimulator lump and don't know which "new method" claim to believe, you're welcome to book an assessment with Dr. Ta-Ju Liu. I'll lay out your situation, your imaging, and the options that are genuinely viable right now, and then decide what to do.
This article is educational information, not individual medical advice. The use of collagenase for fillers described here is at the research stage and not a standard treatment; any enzyme injection or filler procedure must be decided after in-person consultation and imaging assessment.
