Autologous Fat Nodules and Residual Hyaluronic Acid
海膽貓 · · Last reply 🌐 繁中
Dear Dr. Liu, I have already booked my consultation for July. I would like to ask if my condition is suitable for treatment. Thank you.
Many years ago, I had an unsuccessful Autologous Fat grafting procedure under my eyes, which resulted in noticeable Lumps/Nodules on both sides. I have previously received several steroid injections. Last year, I underwent a transconjunctival revision to remove some of the fat. While there has been some improvement, I still have residual lumpiness, uneven texture, and irregular shadows in the tear trough area at the junction of my lower eyelid and mid-face.
Additionally, I have previously had Autologous Fat and Hyaluronic Acid fillers in my nasolabial folds and apple cheeks. I currently feel that there is filler migration or residue, which has caused unevenness in my nasolabial folds, "cat lines" (mid-cheek grooves), and mid-face contours. There is also a lump in my right nasolabial area that is suspected to be migrated filler, though I am unsure whether it is fat or Hyaluronic Acid.
I would like to ask: for a case like mine, involving a mixture of fat and Hyaluronic Acid and previous revision attempts that still left behind Lumps/Nodules and unevenness, is it possible to use Ultrasound-guided examination to identify the materials, and then evaluate options such as Pinhole Extraction, dissolution, or other Filler Revision methods to improve the condition?
1 Replies
Dr. Ta-Ju Liu · Board-certified dermatologist🌐 繁中 Doctor
Hello, your situation is described very clearly.
Direct Answer: Having a history of mixed autologous fat and Hyaluronic Acid (HA), undergoing previous revisions, and still experiencing lumps and unevenness can definitely be managed. We can use ultrasound examination to assess the situation, followed by evaluating pinhole extraction, dissolution, or other revision methods. The most crucial first step is not immediately deciding to dissolve or extract, but to clearly see "what is actually inside."
Several Possibilities to Differentiate
Judging from the photos, there is a noticeable bulky sensation, unevenness, and irregular shadowing at the junction between the lower eyelid and the midface. Because you have previously undergone autologous fat grafting and Hyaluronic Acid (HA) injections, along with steroid treatments and transconjunctival revision surgery, the contents underneath could be:
1. Fat lumps
2. Fibrotic tissue
3. Residual Hyaluronic Acid (HA)
4. Liquefied areas or scar adhesions
5. Tissue atrophy caused by past steroid use
These usually present with distinct appearances on high-resolution ultrasound imaging. You mentioned that it's uncertain whether the lump in the right nasolabial area is fat or Hyaluronic Acid (HA); relying solely on appearance often makes it difficult to differentiate. Ultrasound can determine the anatomical layer, extent, depth of the filler, as well as whether there is displacement or encapsulation.
General Treatment Direction
- If the examination shows that the lump is localizable and manageable, the ideal approach is to remove or reduce the tissue causing the bulge or lump via minimally invasive pinhole techniques.
- Residual Hyaluronic Acid (HA) can be evaluated for suitability with hyaluronidase (dissolving enzyme); for fat lumps or fibrotic masses, simply injecting hyaluronidase usually has limited effectiveness. We need to evaluate whether minimally invasive extraction is appropriate based on the location, depth, and tissue morphology.
- Let's establish reasonable expectations first: Cases with multiple previous fillers, revisions, and steroid treatments usually cannot be fully restored to smooth condition in a single session. Instead, the approach is to first identify the main structures causing the irregularity and improve them in stages. The goal is to "reduce the bulky sensation, smooth out the lines, and make the lighting and shadows look more natural," rather than instantly reverting back to the original state in one go.
When to Seek Immediate Medical Attention
If the lump suddenly increases in size, becomes red, swollen, warm, and painful, or if the skin shows discoloration, please seek medical attention promptly.
This online response serves as general health education and does not constitute a diagnosis, nor can it replace an in-person consultation and ultrasound examination.