Case Scenario

Patient Background: A middle-aged woman who received Ellansé (polycaprolactone) injections in the cheek area approximately two years prior to address cheek hollowing. Approximately 6 months post-injection, palpable lumps developed at the injection sites, gradually enlarging and becoming more visible over time.

Treatment History:

• Returned to the original clinic; told "this is normal collagen stimulation that will resolve on its own"

• After 6 months of waiting with no resolution, sought additional medical attention

• Received 3 sessions of local steroid injections — lumps slightly softened but did not noticeably reduce in size

• Attempted 2 sessions of 5-FU injection with limited effect

• Found information about ultrasound-guided micro-extraction through online research

Presentation at Consultation:

• 1-2 palpable lumps on each cheek

• Slight skin elevation over the lumps, visible at certain angles

• Firm to touch, non-tender

• Approximately one year of conservative treatment with limited results

Deep Analysis

Root Cause Analysis

> Key Insight: Ellansé nodules are fundamentally different from hyaluronic acid nodules — they cannot be "dissolved." Conservative steroid or 5-FU treatment can only soften surrounding tissue but cannot eliminate the core PCL microspheres. When conservative treatment exceeds one year without significant improvement, physical extraction is a reasonable next step.

Related reading: Can Ellansé Be Removed?

Doctor's Perspective

Dr. Liu's analysis after evaluation:

"This patient's situation represents a typical case among Ellansé complications. Ultrasound clearly revealed multiple nodules, each approximately 8-15mm, wrapped in prominent fibrotic tissue. The positive finding was that the nodules were located in the subcutaneous fat layer at moderate depth, with no major vessels in close proximity — technically feasible for minimally invasive extraction.

Notably, because the nodules had been present for over a year and had undergone multiple steroid injections, the surrounding fibrosis was fairly dense. Greater care would be needed during extraction to separate the filler-tissue boundary. Our goal was to extract the PCL microspheres and their reactive tissue as completely as possible while preserving normal subcutaneous fat."

Treatment Plan and Process

Pre-Operative Planning

Surgical Process

Local anesthesia: Precise local infiltration under ultrasound guidance

Micro-entry: 1-2mm pinhole as the operative entry

Ultrasound-guided targeting: Real-time imaging confirms instruments reach the target nodule

Dissection and extraction: Careful separation of nodule from surrounding fibrotic tissue, progressive removal

Real-time verification: Immediate ultrasound scan after each nodule extraction

Residual assessment: Comprehensive scan confirming no significant residual material

Extracted Material Observations

The extracted tissue consisted of firm white to grayish-white masses. Cross-section revealed PCL microsphere particles encased in fibrous tissue, consistent with pre-operative ultrasound findings.

Key Patient Notes

Post-Operative Recovery

Important Notes

• Post-operative swelling is normal and does not indicate surgical failure

• Bruising may persist 1-2 weeks and can be concealed with makeup

• Temporary tactile changes at the surgical site typically resolve within weeks

• Post-extraction depressions are usually assessed after swelling subsides to determine if further treatment is needed

• Complete recovery requires 2-3 months

> Key Insight: Ellansé nodule extraction differs from simple HA dissolution — it requires physical manipulation, so the recovery period is longer. However, compared to continuing to live with nodules or pursuing conservative treatments with limited effect, micro-extraction offers a more definitive resolution.

Related reading: When 5-FU Fails for Collagen Stimulator Lumps

Clinical Takeaways from This Case

Ellansé nodules require timely and accurate assessment — prolonged conservative treatment may worsen fibrosis

Ultrasound is essential for evaluation and extraction — palpation cannot accurately determine nodule count, size, or depth

Micro-extraction is a viable option — large open excisions are not necessary

Patient expectation management is critical — recovery takes time, and final results are not immediate

If you are experiencing similar Ellansé complications, schedule a consultation for an ultrasound evaluation.

Related reading: Filler Lump Extraction Technique