“Doctor, after surgery, I became the 'Five-Scar Woman'.” — Solutions for Ellansé Complications and Steroid-Induced Depressions

Every day in my clinic, I hear stories like this. When she came to me, she said, “Doctor, after surgery, I became the 'Five-Scar Woman'.” Can you imagine how that feels? Five incisions, each five centimeters long, on one face. She initially just wanted to enhance her beauty, but her journey took a drastic turn.

A year and a half ago, she received Ellansé injections. Not in one area, but five: forehead, temples, tear troughs, apple cheeks, and nasolabial folds—all at once. After the injections, her face gradually started to harden, and lumps began to emerge one by one. She underwent steroid injections—once, twice, thrice—but the lumps barely diminished. Instead, a noticeable depression started appearing on the side of her forehead. The initial overfilling was the first wrong step. But in an attempt to correct this mistake, she walked into an even more dreadful one. Steroids turned the originally convex areas into uneven depressions. And there's a high probability that these depressions are permanent. The lumps remained, and new depressions appeared—what a terrible chain reaction.

I want to emphasize here that steroid injections are not without risks. Many people are unaware that repeated steroid injections can cause fat atrophy, which has a high chance of becoming a permanent depression. While I can address these issues, I still hope everyone carefully considers their options before choosing this path.

I scanned her face with ultrasound, and the images were very clear. Ellansé is more stimulating than typical Hyaluronic Acid, and the body's reaction to it is more intense, with capsules wrapping the fibers thickly and tightly. The largest lump was on her forehead, appearing like a flattened overfilled area from the side. After repeated steroid injections, the surrounding tissue had atrophied, and that depression was irreversible. However, the material within the capsule could still be removed. I told her there was no need for surgery. A single pinhole incision, guided by ultrasound, allows for the gradual extraction of the filler material. Five areas, five pinholes—no five-centimeter incisions, no sutures, no scars. She listened, silent for a few seconds, then asked, “Why did the large hospital say surgery was the only option?” Surgery might be what they can do, but it certainly doesn't mean it's the only way.

I have been performing lump and overfilled treatment for many years. Every time I see those lumps, entangled layer by layer by fibers under the ultrasound, I think the same thing: Ellansé itself is not at fault, Hyaluronic Acid itself is not at fault, no filler material itself is at fault. The real problem lies in the decision to inject excessive amounts into a single area. It's like trying to stuff too many things into one pocket; eventually, the pocket will burst. During consultations, doctors might tell you that a full-face plan yields better, more comprehensive results, and is more cost-effective for a single session. But that advice to “do it all at once” or “add a little more each time” comes at a low cost to them, yet for you, it could lead to irreversible consequences. They make the decision; you pay the price.

Nassim Taleb wrote in The Black Swan that the truly dangerous ones are those who make decisions without bearing the consequences. In the medical aesthetics industry, the person most in need of protection is actually the one sitting in the treatment chair, completely trusting the doctor in front of them. The patient who was told she needed five incisions ultimately chose not to have surgery. I am preparing to use five pinholes to completely remove the filler material entangled by layers of fibers. She will not have any surgical scars on her face. And the depression caused by the steroid injections will also be successfully resolved here. This is the value she finds in coming to me. If you have similar concerns, or if your face has started to look a bit overfilled, I have a free online self-assessment tool. No appointment is needed; you can first check which stage your condition is in. If you need it, please leave a comment. Do you think doctors who initially recommend “full-face treatment all at once” have an obligation to tell you what to do if complications arise?