Filler Complications Glossary
Short definitions of the terms used when filler has not gone to plan, written and reviewed by Medical Director Dr Sin Yong. Each entry links to the page that explains it in full.
See also: filler complications in Singapore and dissolving filler and filler correction.
WhatsApp to Enquire →Key facts ↓This glossary defines the terms used for filler problems and their correction: pillow face, facial overfilled syndrome, filler migration, lumps, nodules, granuloma, Tyndall effect, malar oedema, biofilm, delayed reaction, vascular occlusion, hyaluronidase and others. Definitions are brief and factual, with a link to the full guide for each. It is written for patients in Singapore and reviewed by Dr Sin Yong, Medical Director of IN Eternity Clinic.
- Only hyaluronic acid filler dissolves: hyaluronidase has no effect on other filler materials [1].
- A lump is not always filler: ultrasound helps tell filler from swelling, a cyst or scar tissue [2].
- Timing separates causes: problems in the first two weeks are usually swelling or placement; those that appear months later are more often inflammatory [3].
- Colour change and pain are urgent: pale or dusky skin, severe pain or a change in vision after filler needs same-day care [4].
30 filler complication terms, defined
Biofilm · Blanching · Bolus · Cannula · Collagen stimulator · Cross-linking · Delayed-onset nodule · Dissolving · Facial overfilled syndrome · Fat grafting · Filler fatigue · Filler migration · Foreign body granuloma · Hyaluronic acid filler · Hyaluronidase · Lump · Malar oedema · Necrosis · Nodule · Non-dissolvable filler · Overcorrection · Permanent filler · Pillow face · Skin test · Staged dissolving · Swelling · Tear trough · Tyndall effect · Ultrasound mapping · Vascular occlusion
Biofilm
A thin layer of bacteria that attaches to filler and protects itself from the immune system and from antibiotics. It can cause low-grade swelling or nodules that flare weeks to months after injection. Filler infection and biofilm.
Blanching
Skin that turns white during or just after an injection because blood flow has been interrupted. Blanching that persists is a warning sign of vascular occlusion and is treated at once. Vascular occlusion after filler.
Bolus
A single, larger deposit of filler placed in one spot. A bolus that is too big or too shallow can be felt or seen as a lump. Lumps after filler.
Cannula
A blunt-tipped tube used instead of a sharp needle to place filler. It lowers, but does not remove, the risk of bruising and of entering a blood vessel. Filler complications.
Collagen stimulator
An injectable that prompts the body to form its own collagen over months, such as poly-L-lactic acid, polycaprolactone or calcium hydroxylapatite. It cannot be dissolved with hyaluronidase. Also called a biostimulator. Collagen stimulator side effects.
Cross-linking
The chemical bonding that makes hyaluronic acid gel firm and long-lasting. More cross-linked fillers hold their shape longer and tend to need more enzyme to dissolve. How long hyaluronidase takes to work.
Delayed-onset nodule
A lump that appears weeks to months after filler. It is often inflammatory and is sometimes triggered by an infection, dental work or a vaccination. Delayed reaction to filler.
Dissolving
Breaking down hyaluronic acid filler with injections of the enzyme hyaluronidase. It works within hours to days and is reviewed at about two weeks. Also called filler reversal. Dissolving filler in Singapore.
Facial overfilled syndrome
The medical description of a face distorted by too much or misplaced filler: wide, heavy cheeks, eyes that look smaller and a loss of natural contours. Popularly called pillow face. Pillow face correction.
Fat grafting
Transfer of your own fat to the face by a surgeon. It is living tissue, so it cannot be dissolved, and it changes with body weight. Fat grafting correction.
Filler fatigue
An informal term for the heavy or puffy look after years of repeated filler, or for being tired of maintaining it. It is not a diagnosis. Filler fatigue.
Filler migration
Filler that sits somewhere other than where it was intended, for example above the lip border or below the tear trough. It may have moved, spread or been placed there. Filler migration.
Foreign body granuloma
A firm inflammatory lump formed when the immune system walls off filler material. It appears months to years later and is treated with anti-inflammatory injections, not massage. Lumps after filler.
Hyaluronic acid filler
A gel made from a sugar molecule found naturally in skin. It is the most widely used filler type and the only one that can be dissolved. Often shortened to HA filler. Dermal fillers.
Hyaluronidase
The enzyme that breaks down hyaluronic acid. It is injected to dissolve HA filler and is the emergency treatment for vascular occlusion caused by HA filler. How dissolving filler works.
Lump
Any raised or firm area after filler. Early lumps are usually swelling or product; persistent or late lumps need assessment to tell filler from inflammation. Lumps after filler.
Malar oedema
Persistent puffiness over the cheekbone below the eye, caused by fluid held in the tissue, often after under-eye or cheek filler. It can last months and usually improves when the filler is dissolved. Under-eye filler problems.
Necrosis
Death of skin from loss of blood supply, the result of a vascular occlusion that is not relieved. Early treatment aims to prevent it. Vascular occlusion after filler.
Nodule
A discrete, firm lump. Non-inflammatory nodules are collections of product. Inflammatory nodules are red, tender or swollen and need medical treatment. Lumps after filler.
Non-dissolvable filler
Any filler that hyaluronidase cannot break down: collagen stimulators, collagen, permanent fillers and grafted fat. Which fillers cannot be dissolved.
Overcorrection
More filler than the area needs, giving fullness that looks unnatural. With hyaluronic acid it is corrected by partial dissolving. Overfilled face correction.
Permanent filler
A filler the body does not absorb, such as PMMA or silicone. Problems can arise years later and cannot be reversed with an enzyme. Which fillers cannot be dissolved.
Pillow face
The rounded, puffy look of an overfilled face, most obvious in the cheeks and under the eyes, and when smiling. Pillow face correction.
Skin test
A small test dose of hyaluronidase placed in the skin to check for allergy before the enzyme is used. It is advised for people with a relevant allergy history. Hyaluronidase side effects.
Staged dissolving
Removing filler in small doses over more than one visit, with a review in between, to avoid taking away more than intended. How long hyaluronidase takes to work.
Swelling
Fluid in the tissue after an injection. It is normal for a few days. Swelling that returns months later is a delayed reaction and should be assessed. Swelling after filler.
Tear trough
The groove between the lower eyelid and the cheek. The skin is thin, so filler here is prone to puffiness, a bluish tint and visible lumps. Under eye filler removal.
Tyndall effect
A bluish tint seen when hyaluronic acid filler lies too close to the skin surface and scatters light. It is most common under the eyes and is corrected by dissolving the superficial filler. Tyndall effect after filler.
Ultrasound mapping
A high-frequency ultrasound scan of the face to locate filler, measure its depth and help identify the type before correction. Filler ultrasound scan.
Vascular occlusion
Blockage of a blood vessel by filler, either inside it or pressing on it. Signs are pale or dusky skin and severe pain. It is an emergency, treated immediately with hyaluronidase where the filler is hyaluronic acid. Vascular occlusion after filler.
How to use these definitions
These definitions are for understanding, not for self-diagnosis. A lump, a change in colour or late swelling can have more than one cause, and the treatment differs for each. If something does not look or feel right after filler, have it examined. See filler gone wrong: what to do next, filler complications in Singapore and dissolving filler and filler correction. Results vary between people.
Frequently asked questions
What is the difference between a nodule and a granuloma?
A nodule is any discrete firm lump. A granuloma is a specific inflammatory reaction in which the immune system walls off the filler, usually months to years later. It is identified by how it behaves, how it looks on a scan or by biopsy.
What is the difference between filler migration and overfilling?
Migration is filler in the wrong place. Overfilling is too much filler in the right place. They often occur together, and both are assessed before dissolving.
What is facial overfilled syndrome?
It is the medical description of a face distorted by too much or misplaced filler: wide, heavy cheeks, eyes that look smaller and a loss of natural contours. The popular name is pillow face.
Which filler problems are emergencies?
Pale, mottled or dusky skin, severe or increasing pain, or any change in vision after filler. These suggest blocked blood flow and need same-day treatment.
Who wrote these definitions?
They were written and reviewed by Dr Sin Yong, Medical Director of IN Eternity Clinic, Singapore, and are updated as the linked guides are revised.
Book an assessment
IN Eternity Clinic, 9 Scotts Road, #12-01 Pacific Plaza, Singapore 228210. By appointment with Medical Director Dr Sin Yong. Monday to Saturday, 11am to 8pm. WhatsApp or call +65 8815 3008. At IN Eternity Clinic a consultation fee applies, and it is waived if you go ahead with any medical treatment; the fee is S
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References
- Jung H. Hyaluronidase: an overview of its properties, applications, and side effects. Arch Plast Surg 2020;47(4):297-300. doi:10.5999/aps.2020.00752
- Wortsman X. Identification and complications of cosmetic fillers: sonography first. J Ultrasound Med 2015;34(7):1163-1172. doi:10.7863/ultra.34.7.1163
- Funt D, Pavicic T. Dermal fillers in aesthetics: an overview of adverse events and treatment approaches. Clin Cosmet Investig Dermatol 2013;6:295-316. PubMed
- DeLorenzi C. New high dose pulsed hyaluronidase protocol for hyaluronic acid filler vascular adverse events. Aesthet Surg J 2017;37(7):814-825. PubMed
Figures taken from the published papers and abstracts. Results vary between people; suitability is decided at an in-person consultation.