Case Spotlight: Trying to Remove a Lump, Ending Up with a Deep Crater?

"Doctor, it was just a small bump at first. After the steroid injections, how did it turn into a deep pit?" At FILLER REVISION, we hear this story far too often. Patients arrive having already endured multiple rounds of blind steroid injections at other clinics, only to find the lumps remain while the surrounding tissue has collapsed. In our experience, steroid-induced atrophy after Ellansé complications represents one of the most challenging — and preventable — secondary injuries we treat. This is a classic example of "secondary damage from mishandled aesthetic complications."

Actual case showing tissue atrophy and indentation caused by blind steroid injection under the eye

In-Depth Analysis: Why Does It Keep Getting Worse?

This case reveals the critical differences in how aesthetic complications are managed. Why did the rescue mission become a disaster?

The Real Risk of Steroid Injection: Blind Injection and Layer Accuracy

We must clarify an important concept: steroid injection itself is not entirely unusable. When used correctly, it is indeed a tool for softening scars and tissue. However, the severe indentation in this case was caused by:

Root Cause | Explanation

------------ | -------------

Lack of Visualization (Blind Injection) | Without real-time guidance from high-frequency soft tissue ultrasound, the physician cannot see subcutaneous structures. It's like throwing darts blindfolded — nearly impossible to hit the tiny lump core precisely. Incorrect Injection Layer | If the steroid is not precisely injected into the lump core but instead penetrates the surrounding normal subcutaneous fat or dermal layer, it causes normal tissue atrophy. Uncontrolled Dosage | Excessive concentration or volume of steroids causes non-specific tissue destruction, leading to irreversible indentation.

💡 Key Insight: At FILLER REVISION, we see this pattern regularly — steroid injection performed without "visualization" is the primary cause of severe complications. It makes the drug unable to distinguish between "abnormal lumps" and "precious apple cheek tissue," ultimately leaving behind irreparable deep craters instead of resolving the lumps.

The Risk of Collagen Stimulators Under the Eyes

Ellansé's PCL microspheres stimulate collagen production, but in the extremely thin skin under the eyes, unpredictable excessive proliferation can easily form visible white nodules or lumps. These lumps are extremely difficult to treat (they cannot be dissolved with enzymes), and once formed, patients face the dilemma of "risking atrophy with steroids vs. having no way to dissolve them."

Doctor's Perspective: Two Safety Principles and Solutions

Based on these painful lessons, Dr. Liu Ta-Ju of Liusmed Clinic proposes two safety principles to prevent such tragedies at the source:

Principle 1: Choose Safe Materials for the Under-Eye Danger Zone

The periorbital tear trough area has complex structures and thin skin. We strongly recommend prioritizing safe, degradable hyaluronic acid (HA) products.

Advantage | Explanation

----------- | -------------

Reversibility | This is HA's greatest advantage. If dissatisfaction or lumps occur, hyaluronidase can safely dissolve it — a material with a "undo button." Stability | Quality hyaluronic acid rarely produces unpredictable granulomatous reactions.

Principle 2: Reject Puffiness! Choose the "Non-Puffy Smooth Tear Trough Injection Technique"

Many people are afraid of hyaluronic acid due to fear of failure or unnatural puffiness (commonly called the "caterpillar effect"). This is not the material's fault — it depends on the physician's technique and injection depth.

Our clinic's "Non-Puffy Smooth Tear Trough Injection Technique":

Technical Element | Explanation

------------------- | -------------

Deep Bone-Level Support | Mimics youthful bone and soft tissue support by placing hyaluronic acid deep to lift the sunken orbital area. Precise Dosage Control | Avoids excessive filler accumulation in superficial subcutaneous layers, preventing the Tyndall effect (blue discoloration) or edema. Long-lasting Improvement | Effectively smooths tear trough depressions while avoiding under-eye puffiness, restoring natural smoothness to the eye area.

When Blind Treatment Creates a Bigger Problem: The FILLER REVISION Approach

At FILLER REVISION, we frequently treat patients who arrived with a simple filler lump but left their previous clinic with both the original lump and steroid-induced tissue damage. The core problem is that blind steroid injection — without ultrasound guidance — cannot distinguish between the abnormal filler nodule and the normal surrounding tissue. Our approach is fundamentally different: every intervention begins with high-frequency ultrasound mapping to visualize the exact boundaries of the nodule, the surrounding tissue structures, and critical neurovascular landmarks. Only then do we proceed with targeted extraction or precisely guided treatment. This visualization-first protocol prevents the secondary atrophy that blind injections routinely cause, and it allows us to address the original lump definitively rather than trading one problem for another.

Frequently Asked Questions (FAQ)

Q1: What should I do if I developed lumps after Ellansé injection?

A1: Do not blindly get steroid injections. Seek a clinic equipped with high-frequency ultrasound. The doctor needs to first confirm the depth, size, and whether it's a granuloma. For simple nodules, ultrasound-guided micro-injection may be attempted; for stubborn lumps, minimally invasive pinhole extraction surgery may be necessary.

Q2: Will areas indented by steroid injections recover on their own?

A2: Full self-recovery is very difficult. Steroid-induced fat atrophy is usually permanent. Repair typically requires waiting until the tissue stabilizes (approximately 3-6 months), then performing precise filling with autologous fat transfer or hyaluronic acid.

Q3: Why don't you recommend collagen stimulators for under-eye injection?

A3: Because the risk is uncontrollable. The under-eye skin is the thinnest on the entire face — even the slightest excessive proliferation becomes a visible bump. Combined with the fact that these materials have no dissolving enzyme, once problems occur, the treatment cost is extremely high.

Q4: Will hyaluronic acid tear trough fillers really avoid the "caterpillar" effect?

A4: Technique is the key. As long as the injection layer is correct (primarily deep support) and an appropriately supportive HA formula is selected, superficial accumulation causing the "caterpillar" phenomenon can be avoided. Liusmed Clinic's "non-puffy technique" was designed precisely for this purpose.

Q5: What is ultrasound-guided injection?

A5: This is a form of visualized medicine. Through the ultrasound screen, the doctor can see subcutaneous blood vessels, nerves, lumps, and needle positions in real time. This ensures medication is precisely injected into the lump rather than leaking to surrounding areas and destroying normal tissue — the gold standard for managing complications.

Q6: Is repairing indentations or lumps painful?

A6: No. We use specialized local anesthesia and pain management techniques. Even when treating complex complications or performing minimally invasive repairs, pain levels are very low, and patients typically tolerate the procedure comfortably.

Book a Consultation

If you've already tried treatment for Ellansé under-eye lumps without success — or worse, developed tissue atrophy from steroid injections — FILLER REVISION specializes in exactly these cases. Our ultrasound-guided approach repairs both the original complication and the secondary damage.

Book a consultation →

About the Author

Dr. Liu Ta-Ju

Current Position: Director of Liusmed Clinic

Specialties: Aesthetic complication repair (lumps/indentation/puffiness), ultrasound-guided injection, non-puffy tear trough hyaluronic acid injection

Experience:

- Over 20 years of clinical minimally invasive and injection experience

- Committed to "visualized medicine," introducing high-frequency ultrasound to eliminate blind injection risks

- Advocates "safe aesthetics," refusing irreversible materials in high-risk areas

Philosophy: "Aesthetics should make you beautiful, not give you nightmares. We use ultrasound to see the truth and professional technique to repair regrets."