Autologous Fat Nodules and Residual Hyaluronic Acid
海膽貓 · 5/24/2026🌐 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
劉達儒醫師🌐 繁中 Doctor
Hello, your situation is described very clearly. I have reviewed your photos, and I can indeed see a noticeable lumpiness, unevenness, and irregular light reflection at the junction between the under-eye area and the mid-face. Since you have previously undergone **Autologous Fat** grafting, **Hyaluronic Acid (HA)** injections, and have also received steroid treatments and transconjunctival revision surgery, the most important first step is not to immediately decide on dissolution or extraction, but to clearly identify "what exactly is inside." For cases involving residual mixed fillers, we typically use high-resolution ultrasound to assess the situation: **Autologous Fat** clumps, fibrotic tissue, residual **Hyaluronic Acid (HA)**, liquefied areas, scar adhesions, and even tissue atrophy caused by past steroid use usually present with distinct appearances on ultrasound imaging. If the examination reveals localized, treatable lumps, the ideal approach is to use **Pinhole Extraction** to remove or reduce the tissue causing the protrusion or **Lump/Nodule**. If there is residual **Hyaluronic Acid (HA)**, we can evaluate whether it is suitable for treatment with hyaluronidase. If the issue involves fat nodules or fibrotic lumps, hyaluronidase alone is usually limited in effect; we would then need to assess the location, depth, and tissue morphology to determine if **Pinhole Extraction** is appropriate. You mentioned that you are unsure whether the lump in your right nasolabial area is fat or **Hyaluronic Acid (HA)**—this is precisely where ultrasound is highly beneficial. It is often difficult to distinguish based on appearance alone, but ultrasound helps us determine the plane, extent, and depth of the filler, as well as whether there is any migration or encapsulation. However, I must clarify that cases like yours, which have undergone multiple fillers, revisions, and steroid treatments, usually cannot be restored to a perfectly smooth state in a single session. Instead, we must identify the primary structures causing the irregularities and improve them in stages. The treatment goal will be to "reduce the lumpiness, smooth out the contours, and achieve more natural light reflection," rather than striving to return to your original state in one go. When you come in for your consultation in July, we will first perform a comprehensive assessment. As long as the ultrasound confirms the presence of clear residual material or treatable lumps, we can then discuss **Pinhole Extraction**, **Hyaluronic Acid (HA)** dissolution, or other **Filler Revision** methods suitable for you.