Two Years of Ellansé Forehead Lumps That Hyaluronidase and a Flush Could Not Fix — Mapped by Ultrasound, Removed Through Pinholes, Judged at Three Months

Her forehead had been injected with Ellansé, a polycaprolactone (PCL) collagen stimulator. It had turned into hard lumps two years earlier: stone-like to the touch, with a badly uneven surface. In those two years she had tried two things, hyaluronidase and a saline flush. Neither made the lumps go away. Hyaluronidase could not work, for a simple reason: it only acts on hyaluronic acid. Ellansé is made of PCL microspheres, a collagen stimulator with no matching enzyme. That is knowable before anything is injected; there is no need to test it on a forehead. The flush is easier to misread. Photograph the forehead right after a flush and it looks flat; two or three days later it often still looks flat. Part of that flatness is water — the fluid flushed in, and the swelling that follows, temporarily fill in the irregularities. With lumps that have been encased in collagen for two years, the unevenness usually returns within a week of the fluid being absorbed. Many people then assume the lumps have grown back. They never left. Flushing can be worth discussing early on, while the material is still a gel and has not yet been fixed by tissue; two-year-old lumps are past that stage. So the real fork in this case was knowing when to stop and look inside first. Forehead skin is thin and sits directly on bone, which leaves very little margin for unevenness, and blind dissection shows up on the surface. Ultrasound confirmed each lump's extent and depth and turned it into a map before any decision about where to remove; the removal itself is documented in full on MinimalCutSurgery. The result is only judged at three months. Every comparison photo here was taken three months after repair, once the swelling had settled and the fluid had been absorbed. To be honest about the limits: not every lump can be removed completely. The goal is to smooth the irregularities and bring the forehead back to a more natural line. Her repair is not finished. The forehead came first; her apple cheeks and nasolabial folds are planned as later, separate stages. (Photos used with the patient's consent; the same patient before treatment and three months after repair. An individual case that does not represent results for everyone.)