Creator: Dr. Liu Ta-Ju
Published: 2026-02-09
Keywords: Ellansé lumps, steroid atrophy, tissue indentation, tear trough filler, ultrasound-guided injection, aesthetic repair, filler complications, hyaluronic acid

Case Spotlight: Trying to Remove a Lump, Ending Up with a Deep Crater?

"Doctor, it was just a small bump at first. After the steroid injections, how did it turn into a deep pit?" This is the real voice of a patient. After receiving Ellansé tear trough filler at another clinic, she developed visible nodular lumps. To eliminate the lumps, the original clinic administered multiple steroid injections. The result? The lumps didn't fully dissolve, but the surrounding apple cheek area collapsed as if "bitten away," forming obvious tissue atrophy.

Actual case showing tissue atrophy and indentation caused by blind steroid injection under the eye

This is not an isolated case. It is a classic example of "secondary damage from mishandled aesthetic complications."

In-Depth Analysis: Why Does It Keep Getting Worse?

This case reveals the critical differences in how aesthetic complications are managed. Why did the rescue mission become a disaster?

The Real Risk of Steroid Injection: Blind Injection and Layer Accuracy

We must clarify an important concept: steroid injection itself is not entirely unusable. When used correctly, it is indeed a tool for softening scars and tissue. However, the severe indentation in this case was caused by:

> 💡 Conclusion: Steroid injection performed without "visualization" is the primary cause of severe complications. It makes the drug unable to distinguish between "abnormal lumps" and "precious apple cheek tissue," ultimately leaving behind irreparable deep craters instead of resolving the lumps.

The Risk of Collagen Stimulators Under the Eyes

Ellansé's PCL microspheres stimulate collagen production, but in the extremely thin skin under the eyes, unpredictable excessive proliferation can easily form visible white nodules or lumps. These lumps are extremely difficult to treat (they cannot be dissolved with enzymes), and once formed, patients face the dilemma of "risking atrophy with steroids vs. having no way to dissolve them."

Doctor's Perspective: Two Safety Principles and Solutions

Based on these painful lessons, Dr. Liu Ta-Ju of Liusmed Clinic proposes two safety principles to prevent such tragedies at the source:

Principle 1: Choose Safe Materials for the Under-Eye Danger Zone

The periorbital tear trough area has complex structures and thin skin. We strongly recommend prioritizing safe, degradable hyaluronic acid (HA) products.

Principle 2: Reject Puffiness! Choose the "Non-Puffy Smooth Tear Trough Injection Technique"

Many people are afraid of hyaluronic acid due to fear of failure or unnatural puffiness (commonly called the "caterpillar effect"). This is not the material's fault — it depends on the physician's technique and injection depth.

Our clinic's "Non-Puffy Smooth Tear Trough Injection Technique":

Frequently Asked Questions (FAQ)

Q1: What should I do if I developed lumps after Ellansé injection?

A1: Do not blindly get steroid injections. Seek a clinic equipped with high-frequency ultrasound. The doctor needs to first confirm the depth, size, and whether it's a granuloma. For simple nodules, ultrasound-guided micro-injection may be attempted; for stubborn lumps, minimally invasive pinhole extraction surgery may be necessary.

Q2: Will areas indented by steroid injections recover on their own?

A2: Full self-recovery is very difficult. Steroid-induced fat atrophy is usually permanent. Repair typically requires waiting until the tissue stabilizes (approximately 3-6 months), then performing precise filling with autologous fat transfer or hyaluronic acid.

Q3: Why don't you recommend collagen stimulators for under-eye injection?

A3: Because the risk is uncontrollable. The under-eye skin is the thinnest on the entire face — even the slightest excessive proliferation becomes a visible bump. Combined with the fact that these materials have no dissolving enzyme, once problems occur, the treatment cost is extremely high.

Q4: Will hyaluronic acid tear trough fillers really avoid the "caterpillar" effect?

A4: Technique is the key. As long as the injection layer is correct (primarily deep support) and an appropriately supportive HA formula is selected, superficial accumulation causing the "caterpillar" phenomenon can be avoided. Liusmed Clinic's "non-puffy technique" was designed precisely for this purpose.

Q5: What is ultrasound-guided injection?

A5: This is a form of visualized medicine. Through the ultrasound screen, the doctor can see subcutaneous blood vessels, nerves, lumps, and needle positions in real time. This ensures medication is precisely injected into the lump rather than leaking to surrounding areas and destroying normal tissue — the gold standard for managing complications.

Q6: Is repairing indentations or lumps painful?

A6: No. We use specialized local anesthesia and pain management techniques. Even when treating complex complications or performing minimally invasive repairs, pain levels are very low, and patients typically tolerate the procedure comfortably.

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