Ellansé Lumps: What to Do About Early vs Delayed Nodules

When you have Ellansé injected, the result is often satisfying — fuller cheeks, a more defined contour. The puzzle comes when, a year or even two years later, you feel something hard at one of the original injection sites. It does not hurt, but it is firmer than skin should feel, and it stays fixed when you press it.

The first thought is usually: "Did it not absorb?" or "Will a bit of massage and heat make it go away?" — and that is exactly where delayed-onset nodules are most misunderstood. They are a different thing from the kind of firmness you feel right after the injection, and they call for a different approach.

This article is not about the decision of whether to get Ellansé in the first place. It focuses on what to do once a delayed lump has appeared: what it actually is, why it surfaces so late, why massage and blind hyaluronidase so often fail, and what we actually see — and do — in our revision practice.

1. First, tell the two apart: lumps right after injection vs. a lump a year later

Ellansé lumps come in two kinds: an early, transient lump that shows up within days to weeks, and a delayed-onset nodule that appears months to a year or two later. "Massage, heat, wait for it to absorb" only applies to the first kind.

Many articles describe every "Ellansé lump" as something that "absorbs on its own — just massage and apply heat." That is true for one kind and potentially misleading for the other. Clinically, the two must be separated first:

Key point: Advice like "it will absorb — just massage and apply heat" targets the early, transient lump. If yours appeared long after the injection, applying the same playbook often just means waiting in vain.

2. Why does Ellansé (PCL) surface "late"? The gap between gel and microspheres

Ellansé surfaces late because the carrier gel is absorbed within 6–8 weeks while the PCL microspheres keep stimulating collagen for 1–4 years; the nodule forms, long after the gel is gone, from overshooting collagen or a delayed foreign-body reaction.

To understand a delayed nodule, look at the two components of Ellansé and what happens to each.

Ellansé is a PCL (polycaprolactone) collagen stimulator. Its contents are roughly 30% PCL microspheres suspended in about 70% CMC (carboxymethyl cellulose) carrier gel:

• The CMC carrier gel provides the "immediate fill," but it is gradually absorbed by the body within 6–8 weeks.
• The PCL microspheres are the long-acting part. They degrade slowly by hydrolysis and, depending on the product version (S / M / L / E), can persist in the tissue for about 1 to 4 years, acting as a scaffold that keeps stimulating fibroblasts to produce new collagen (which is where the name "collagen stimulator" comes from).

The problem lies in that time gap. When collagen formation is "just right," you get natural fullness. But in a minority of cases collagen growth overshoots, or the immune system mounts a delayed foreign-body reaction to the PCL microspheres after some trigger (infection, biofilm, a change in the body's status) — and the lump then surfaces at a point when the carrier gel is long gone and you thought everything had settled.

This is not a coincidence. A systematic review pooling 40 studies and 117 patients (Wang H, Wu D, Lo C, et al. J Cosmet Dermatol. 2025;24(10):e70459. PMID: 41132036) reported a median time to complications of about 13 months for PCL (and 18.75 months for PLLA) — in other words, "a lump more than a year later" is a fairly typical timing for PCL, not a sign that you were simply unlucky.

Key point: A late nodule does not mean you are imagining it or that "it never absorbed." The carrier gel left within 6–8 weeks; what remains and triggers a reaction a year later are the PCL microspheres still stimulating collagen.

3. Why "massage, heat, and it will absorb" does little for a delayed nodule

Massage and heat do little for a delayed nodule because, a year out, there is no gel left to absorb; what you feel is dense self-collagen wrapped around PCL microspheres, and that capsule cannot be rubbed or warmed away.

This is the most common misunderstanding in clinic. The advice exists because the nodule is mistaken for "filler that hasn't finished absorbing" — but the reality is the opposite.

By a year out, the carrier gel has long been metabolized; there is nothing left to "absorb." The lump you feel is mostly dense self-collagen tightly wrapping the PCL microspheres — closer to a fibrotic nodule your own body has built. Massage or heat can slightly change the surface feel and boost local circulation, but they cannot "melt" an established collagen capsule.

So if your lump:

• appeared long after the injection,
• is fixed, firm, and barely moves when pressed,
• and has shown no sign of shrinking after a period of observation,

then it is unlikely to disappear on its own with massage and heat. Spending that time "waiting a bit longer" may instead let the capsule mature and become harder to treat.

4. Hyaluronidase, steroids, 5-FU: the limits of each

Hyaluronidase does nothing to an Ellansé lump because it only breaks down hyaluronic acid and PCL gives it nothing to act on; steroids and 5-FU can calm inflammation but cannot remove the microsphere core.

Many people first think, "Can't we just dissolve it with hyaluronidase?" — and this is the most critical, most overlooked point about PCL nodules.

• Hyaluronidase: dissolves only hyaluronic acid. PCL, PLLA, PDLLA, and CaHA are collagen stimulators — none of them is hyaluronic acid, so hyaluronidase has no target in them. Injecting it into an Ellansé lump is effort aimed at the wrong substance.
• Steroids and 5-FU: these mainly suppress surrounding inflammation and excess collagen, and can sometimes soften or flatten a nodule — but they cannot remove the microsphere core itself. Repeated steroid injection also carries a risk of local skin and soft-tissue atrophy, potentially costing you tissue quality before the lump is even resolved.
• Collagenase: some recent studies have explored it for PCL nodules, but this is investigational, its efficacy and safety still need more evidence, and it must be assessed in person by a physician — it is not something to try on your own.

What about oral antibiotics, saline flushing, laser or radiofrequency? All of them act on the inflammation and soft tissue around the nodule, not on the PCL microspheres themselves, so they may help an inflamed nodule and usually do nothing for one that is already encapsulated. One at a time:

• Oral antibiotics (such as doxycycline, a tetracycline): for the nodule that flares red and swollen long after injection, where biofilm (a bacterial film clinging to the filler surface) is suspected. King et al. 2016 (J Clin Aesthet Dermatol. 2016;9(11):E1-E5. PMID 28210391), reviewing the management of delayed-onset nodules, suggest a two-week antibiotic course first, with intralesional steroid added for non-hyaluronic-acid fillers. Antibiotics suppress bacteria and inflammation; the lump itself stays, and swelling often returns once the course ends.
• Saline flushing: for early, gel-phase clumping shortly after injection, where diluting and loosening can disperse material that has pooled. A nodule locked in collagen a year later will not flush.
• Laser or radiofrequency: the idea is to soften and speed the breakdown of the material with heat. For PCL nodules there is no adequate evidence, and for the related material PDLLA there is a single case report (see the AestheFill nodule treatment ladder). A cautious middle option in selected cases, not something to pin hopes on.
• Intralesional steroid: for the visibly inflamed stage when softening the nodule first is the goal, with the number of injections kept in check to avoid skin atrophy.

All four share the same ceiling: the inflammation can be brought down; the microspheres do not disappear because of it.

For balance: PCL nodules genuinely are uncommon in overall incidence — a retrospective review of 1,111 treatments (780 patients, 2015–2018) recorded no nodules or granulomas at all (Lin SL, Christen MO. J Cosmet Dermatol. 2020;19(8):1907-1914. PMID: 32485052). But that zero needs reading carefully: the paper states its shortest follow-up was one year, complications were captured by phone interview and patient self-report with no histological analysis, and the author writes that some late complications cannot completely be ruled out. Median onset for a PCL delayed nodule is around 13 months — later than that study's minimum follow-up. In other words it supports "good early safety," not "delayed nodules do not happen." The issue is that once a delayed nodule does form, the chemical approaches above are often not enough.

Key point: Hyaluronidase fails on Ellansé lumps not because the dose is too low, but because there is simply nothing for it to break down. Getting this straight can save you a lot of detours.

5. What we actually see in our revision practice

In our revision practice, PCL accounts for a sizeable share of the stubborn lumps that need physical extraction. That does not contradict the low incidence reported in the literature, because the two count different denominators.

This section is an observation from clinical practice; placed alongside the literature above, it gives the fuller picture.

In our revision practice — which focuses on filler complications and handles a substantial volume of lump extractions every day — PCL (Ellansé) is, among the severe lumps that actually require physical extraction, a notably common and notably hard, stubborn category. In terms of our case mix, it makes up a larger share of the "hardest, most extraction-requiring" group than incidence figures alone would predict. The remaining lumps are distributed across autologous fat, hyaluronic acid, PLLA (such as Sculptra), and others — generally not as hard as PCL.

This does not contradict the literature cited above (PCL having a "low overall incidence" and the lowest granuloma rate among collagen stimulators), because the two count different denominators:

• The literature measures the proportion of complications among all injection treatments.
• Our clinic sees the material mix among severe cases referred for physical extraction.

"Low incidence" and "a high share within severe extraction cases" can both be true. The reason is intuitive: PCL persists the longest (1–4 years) of all the collagen stimulators and works through a dual "immediate fill + long-acting collagen" mechanism — so when it goes wrong, what it leaves is an encapsulated mass of residual microspheres plus dense new collagen. Physically, that is harder and more stubborn than dissolvable hyaluronic acid or softer deposits, and more likely to fall into the "hard to treat without physical extraction" end of the spectrum.

Key point: This is a single-center clinical observation, and we are the referral endpoint for severe complications, so our sample is not representative of the general population — it does not mean Ellansé has a high incidence, and it is certainly not a reason to avoid it. Most small nodules resolve on their own; the ones that genuinely need active treatment are the late, persistent lumps that clearly affect feel or appearance.

6. Ultrasound-guided "see before you treat": single-pinhole physical extraction

The treatment direction for a delayed PCL nodule is to see the material, its position and the nearby vessels on ultrasound first, then physically remove the residual microspheres and capsule through a single pinhole.

If the root of a delayed PCL nodule is "residual microspheres + a capsule," and chemical dissolving cannot reach it, then the logical direction is minimally invasive removal of the source — but only after you can actually see it.

Ultrasound is the key tool here. Different materials have different ultrasound signatures: hyaluronic acid appears as low-echo cystic spaces; collagen stimulators like PCL often show as punctate high-echo spots; CaHA (such as Radiesse) shows strong echoes with posterior acoustic shadowing. With ultrasound we can:

• identify which material the lump is — and whether it is an encapsulated PCL nodule;
• localize the nodule relative to nearby vessels and nerves, so dangerous structures are avoided;
• still find the residual microspheres and the extent of the capsule even years after injection.

Once the picture is clear, we physically remove it through a single, minimally invasive pinhole, addressing the source of the lump rather than repeatedly trying chemical agents. This reflects a consistent principle: you have to see it to treat it safely — no blind aspiration or blind scraping.

And the real deciding factor in extraction is often not just whether it can be removed, but whether it comes out cleanly and evenly — as much as can be safely removed, not a 100% guarantee. When technique falls short, turning one lump into a stretch of uneven dents only creates a harder problem to fix. So before extraction we map the raised areas precisely across the whole face — much as one would plan precise full-face fat grafting — taking into account the tension of facial movement and how the filler itself changes over time; then, once swelling has settled, what should come out is removed precisely, no more and no less. Dr. Ta-Ju Liu's years of experience with underarm rotary-blade surgery, liposuction with fat grafting, and liposuction-failure revision have gradually made this evenness and precision an internalized skill — and it is the difference most valued by patients who were left uneven after extraction elsewhere and came back seeking repair.

For more on whether and when PCL nodules can be removed, see the complication differences between Ellansé S / M / L versions and whether an Ellansé problem can actually be extracted. If your lumps are multiple small granules from large-area, microdroplet "skin-booster" style injection, the closer read is collagen stimulators injected like skin boosters turning into lumps.

For a side-by-side view of what removal can actually achieve across both PCL and CaHA (Radiesse), see Radiesse vs Ellansé removal: what is actually possible.

7. What you can do after finding a delayed lump

If you are feeling a lump you suspect is a delayed Ellansé nodule, there is no need to panic — but you can start documenting it systematically, which is very useful at your consultation:

• Timeline: roughly when it was injected, which product (the version, if you know it), and roughly when the lump appeared.
• Location and change: which area, and whether it has grown, shrunk, or stayed the same over time, and whether it hurts.
• Photos: a few shots at different times under the same lighting and angle, to help judge change.

When to seek assessment early: the lump persists without resolving, is clearly hard, keeps growing, or comes with redness, warmth, or pain (the latter warrants attention for possible infection or biofilm), plus anything that affects your appearance and bothers you. Everyone's material, depth, timing, and tissue state differ, so the final approach should be decided after an in-person consultation and individualized ultrasound assessment.

For the broader context of this kind of collagen-stimulator lump, start with the causes and mechanisms of collagen stimulator lumps, the Ellansé (PCL) filler encyclopedia entry, and the collagen stimulator complications overview; for the wider topic of "lumps that appear years after injection," lumps surfacing years after filler injection covers it across materials. When you need further help, you are welcome to reach us through the filler revision clinic.

8. Extracted elsewhere, but still uneven: can it be fixed?

An uneven face after extraction elsewhere can usually still be corrected, but ultrasound first has to sort the unevenness into residual material, a hollow where too much was taken, or scar adhesion; each of the three is handled differently.

This is one of the most frequent reasons people come to us — and it is usually harder to deal with than a lump that has never been touched.

"It was extracted" is not the same as "it came out clean," and neither of those is the same as "it came out even." The core of an Ellansé lump is PCL microspheres plus the fibrous tissue they provoked, so its border is rarely as crisp as a hyaluronic acid bolus. Aspirate blindly, by feel alone and without imaging, and it tends to fail in one of two directions: too little comes out — the nodule is still there, only broken up, with a border that is now even harder to read — or too much comes out, taking the normal fat and supporting tissue next to the lump along with it, so the surface caves in. The bump was never solved, and now there is a hollow as well.

Revision follows a different logic from a first extraction, and it begins with reading the terrain again: which part is residual material that was never fully removed, which part is a hollow where tissue was over-harvested, and which part is scar adhesion tethering the skin downwards. Under ultrasound these are three different things, and they call for three different answers — residual material has to come out, a hollow is assessed for reconstruction once the tissue is stable, adhesion has to be released. Put all three through the same maneuver and the area is simply damaged a second time.

That is why whole-face mapping before the procedure is the deciding step: outline the true extent of what is raised, factor in how facial movement pulls on it, and then — once the swelling has settled — remove exactly what should go, no more and no less. It is, in effect, precise fat grafting run in reverse. Dr. Ta-Ju Liu's years of moving between liposuction, fat grafting, and liposuction-failure revision feed the same logic straight into this work.

Key point: What decides the outcome was never whether something was taken out, but whether the face is even once it is. That is exactly why so many people who "already had it extracted" still have one more journey ahead of them.

9. Uneven right after injection, never extracted: telling the three causes apart

Unevenness that appears after the injection itself, with no extraction involved, has only three sources: uneven volume or depth, swelling that has not settled, and collagen overgrowth in one spot. The first two mostly even out or settle during the 6–8 weeks in which the carrier gel is absorbed; only the third needs treatment.

How to tell them apart: timing and feel. Bumps in the first days that are soft to press and come with bruising are swelling. As the gel is absorbed the volume shrinks unevenly, and differences that were hidden can become visible, a point also made in Radiesse vs Ellansé removal: what is actually possible. A raised area that only starts hardening two or three months in, holds a fixed outline and does not give when pressed is local collagen overgrowth, and by then it is on the delayed-nodule path described in section 1.

The handling follows the same split. Swelling only needs time; do not massage hard or add more filler. Mild gel-phase unevenness caught early can sometimes be shaped under a physician's guidance, provided it has not yet been fixed in place by a capsule. An overgrowth bump does not respond to massage or heat and goes to ultrasound identification and, if needed, extraction. If your unevenness appeared only after extraction elsewhere, that is a different problem, and section 8 covers it.

Key point: With unevenness, ask first when it started. What appears within weeks of injection usually flattens on its own; what hardens and rises months later usually does not, however long you wait.

10. The four ways Ellansé "goes wrong", and the path for each

Clinically, a failed Ellansé result takes one of four forms: nodules, migration, overfilling, or asymmetry. Only nodules and excess residual material call for extraction to be considered; migration and asymmetry are mostly handled first with time and local adjustment.

• Nodules: palpable, fixed, firm granules or masses that harden with time. This is what the earlier sections describe; once formed, the path is ultrasound identification and single-pinhole extraction.
• Migration: material found where it was never injected, for example slipped down to the side of the cheek or piled up under the eye. Once PCL is wrapped in collagen it rarely moves again, so what looks like migration is usually material placed in the wrong layer or area from the start. After the collagen response has stabilized, ultrasound confirms where the material actually sits, and a local reduction is planned from there.
• Overfilling (the so-called pillow face): a whole area bulging, expressions blunted, a smile that looks propped up. PCL has no dissolving injection to fall back on, so the options are to wait for it to degrade (1–4 years depending on the version) or to reduce it under ultrasound guidance, removing the excess and leaving the well-placed part alone.
• Asymmetry: the two sides respond at different rates, or the volumes differed from the start. Collagen growth is still changing for months after injection, and topping up too early often produces a bigger gap; most cases are left to stabilize, then the fuller side is reduced. Adding to the smaller side tends to widen the gap.

Whichever form it is, ultrasound comes before any intervention. The four look different on ultrasound and follow different sequences, and one wrong guess sends the whole plan off course.

11. How Ellansé, Sculptra, AestheFill, Radiesse and collagen filler lumps differ

They are all loosely called "collagen injections", but the lumps behave very differently: true collagen filler (in Taiwan, the "panda needle" is mostly porcine collagen) is metabolized within months; PLLA and PDLLA nodules tend to be diffuse and softer, and some shrink as the material degrades; PCL nodules are dense and long-lasting; CaHA tends to form calcium-rich clumps. None of the five has a matching enzyme, so the direction for all of them is to identify the material first, then choose between observation, medication and physical extraction.

The table describes nodule character and handling only; it does not rank the products. The median onset figures for PCL and PLLA come from the Wang 2025 systematic review cited above; the persistence and nodule descriptions follow our own pages on the safety comparison of three collagen stimulators, Radiesse calcium deposits, panda-needle collagen lumps and the ultrasound material comparison chart. If you are not even sure which product was used, the ultrasound signatures (punctate high echoes with a mini comet-tail for PCL, strong echoes with posterior shadowing for CaHA, a diffuse faint signal for PLLA) usually let us identify the material first.

Key point: "Failed collagen injection" hides five different materials. Identify the material first, and you know whether this lump will shrink on its own, keep hardening, or keep flaring.

12. After extraction: recovery time, the pinhole scar, and whether the site will dent

The pinhole is small, but this is an extraction, so swelling and bruising are expected: they usually settle in about 2–3 weeks, the roughly 2 mm pinhole heals in about 2 weeks, and the final result takes about 3 months, varying from person to person. Whether the site dents depends on whether the extent was mapped precisely beforehand and whether only what should go was removed.

The general swelling and healing course is in our single-pinhole extraction explainer; individual recovery varies with the extent, the site and the tissue, and we go through your own situation at consultation. After extraction there is a period in which the swelling settles and firmness gradually softens, and the contour you see in the first weeks is not the final one.

Two things decide whether it dents. First, a PCL nodule is surrounded by collagen it stimulated; extraction removes the microspheres and the capsule and leaves the collagen that should stay, so volume loss is usually smaller than after a hyaluronic acid extraction, a point covered more fully in will the face dent after extraction. Second, the whole-face mapping and "no more, no less" approach from section 6: outline the raised area accurately, account for facial movement, and extract once swelling has settled, and the chance of a dent stays low. Blind aspiration by feel, without imaging, is the usual starting point for a bump that turns into a hollow.

Key point: I won't tell you the recovery is short; what I care about more is whether the face is even at around three months. The extra time spent mapping before extraction is what buys that result.

There is a real example behind that sentence: a patient with two-year-old Ellansé lumps in the forehead, every comparison photo taken only at three months after repair — the forehead Ellansé case. How long to wait before judging each kind of treatment is covered in when you can tell whether a lump treatment worked.

Frequently Asked Questions

Ellansé lump — what should I actually do first?

Classify it before anyone touches it. Ultrasound tells you whether you are dealing with an early accumulation of material, a delayed fibrous nodule, or an inflamed lesion — get the type wrong and every step after it goes wrong too. Early, mild, non-inflamed lumps can be observed; anything that keeps growing or flares up with redness needs an in-person assessment before a decision is made; a stable, stubborn, well-demarcated fibrous nodule is where ultrasound-guided single-pinhole extraction earns its place. Massage, heat, and hyaluronidase do nothing to an established PCL nodule — that is not where your time should go.

What are the side effects of Ellansé?

The ones that actually bring people back to clinic are: nodules and firm lumps (the most common — PCL microspheres keep stimulating collagen, with a reported median onset around 13 months post-injection), migration (material settling in a layer or place it should not be), asymmetry, delayed inflammation (redness and swelling recurring long after the injection, sometimes linked to biofilm), and an uneven surface left behind by mishandled extraction — the last one is not the material's fault but a consequence of how it was treated, and it is the hardest of all to put right. Short-term swelling and bruising that settles within about two weeks is not a lasting side effect; what counts is change that persists, hardens, or keeps flaring. How each of these is handled is what the rest of this article covers; if what you are after is the material itself — what PCL is made of and how long it lasts — see the Ellansé (PCL) filler encyclopedia entry.

I had Ellansé extracted elsewhere but my face is uneven — can it be fixed?

Usually yes, but the source of the unevenness has to be told apart first: residual material that was never fully removed, a hollow from taking out too much, or scar adhesion. Under ultrasound these look different and are treated differently, and running all three through the same approach only damages the area again. These cases generally call for a more conservative, staged strategy — let the tissue stabilize first, then decide what should come out and what should be left alone.

Is it normal for an Ellansé lump to appear more than a year later?

"Normal" here means "not rare, and with an explainable mechanism." The PCL carrier gel is absorbed within 6–8 weeks, but the microspheres keep stimulating collagen for 1–4 years; the median onset for a delayed nodule is around 13 months post-injection, so a lump appearing more than a year later is a fairly typical timing for PCL. That said, "not rare" does not mean "ignore it" — late, persistent, firm nodules deserve an in-person assessment.

Will an Ellansé lump go away on its own?

It depends which kind. An early, transient lump in the first days-to-weeks may settle as swelling subsides or improve with massage; but a delayed-onset nodule that appears months to a year or two later is mostly dense collagen wrapping the microspheres, usually does not disappear with massage and heat, and may have a capsule that matures the longer it is left.

Can hyaluronidase dissolve an Ellansé lump?

No. Hyaluronidase only breaks down hyaluronic acid, and Ellansé is made of PCL, not hyaluronic acid, so hyaluronidase has no target in it. This is exactly why PCL nodules often need a physical approach rather than chemical dissolving.

It has been many years since the injection — can Ellansé still be removed?

In most cases, yes. Even years after injection, ultrasound can still identify and localize the residual PCL microspheres and the capsule, which can then be physically removed through a single minimally invasive pinhole. The actual feasibility and extent are confirmed after an in-person and ultrasound assessment.

My Ellansé result is uneven. How is it corrected?

Start with when it appeared. Bumps within the first weeks are mostly swelling or uneven gel-phase volume, and most flatten within 6–8 weeks; do not add filler or massage hard during that time. A raised area that only hardens and stops giving months later is local collagen overgrowth: massage and heat will not help, and ultrasound is used to define the extent before deciding on extraction. If the unevenness appeared only after extraction elsewhere, the correction follows a different logic, covered in sections 8 and 12.

Can the same area be injected again after extraction? Will a nodule form again?

Yes, but not right away. The final result takes about 3 months after extraction, and the appearance is still changing during that time, so an early top-up often lands where it is not needed. Before any re-injection, ultrasound should confirm that no residual microspheres or capsule remain, because a further injection is itself one of the possible triggers of a delayed reaction, and new material layered on residue amounts to stimulating it again. The choice of material is best discussed at consultation, since dissolvable hyaluronic acid and autologous fat each have trade-offs; the main rule is to stay clear of the layer where residue was found. As for whether a nodule forms again, nobody can promise it will not; clearing the residue, waiting for the tissue to stabilize and avoiding the residual layer are the three things we do to lower the odds.

Which areas are more prone to delayed Ellansé nodules?

Areas where the skin is thin, sits on bone, or moves a lot. On the forehead, temples and under the eyes the skin is thin with bone right beneath it, so any irregularity is seen and felt early and lumps are noticed sooner; around the chin and nasolabial folds, constant talking and chewing pulls on the material and stimulates it unevenly, so nodules there often take irregular shapes. The eye area is also explicitly listed for avoidance in the Ellansé labeling; the approved site in Taiwan is the nasolabial fold, yet in clinic we regularly see it placed in the cheeks, temples and under the eyes. The margin for error differs by area too: the forehead and under-eye demand a high standard of evenness, so extraction there relies even more on careful mapping and control of extent. For the forehead and temples see the forehead and temple filler lump guide; for the chin see the chin and jawline filler lump guide.

Editorial Review: This article was written by Dr. Ta-Ju Liu based on current medical literature and clinical experience in filler revision, for educational purposes only; it does not constitute individual medical advice. The causes, severity, and management of Ellansé delayed-onset nodules vary from person to person — actual diagnosis and treatment should be based on an in-person and ultrasound assessment.