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Mapping Filler Nodules: Ultrasound Characteristics and Clinical Patterns in Dermal Filler Complications
Jenny Chiang1, Yi-Hua Liao2,3
1Department of Dermatology, Taipei City Hospital, Taipei, Taiwan.
Background:
The popularity of dermal fillers in aesthetic procedures has led to an increase in complications, including nodules that can be challenging to diagnose and treat. The role of ultrasound as a noninvasive diagnostic tool across different fillers remains underexplored.
Objective:
To investigate the clinical features and ultrasound characteristics of dermal filler nodules.
Materials And Methods:
The authors conducted a retrospective cohort study from February 2018 to December 2024, enrolling 62 patients with filler nodules referred to a tertiary center. Demographic data, filler types, clinical history, and cultures were collected and analyzed. Nodules were evaluated by ultrasound for their echogenicity, border definition, and internal architecture.
Results:
Most patients were women (88.7%), with a mean age of 44.9 years. Hyaluronic acid was the most commonly reported filler, followed by polycaprolactone and poly- d , l -lactic acid. The midface was the most frequent site of nodule development. Ultrasound imaging revealed distinct, filler-specific characteristics: hyaluronic acid nodules evolved from anechoic "jelly" to hypoechoic "stormcloud" patterns; poly- d , l -lactic acid nodules presented as well-circumscribed hyperechoic "snow globe" formations; polycaprolactone ranged from fibrotic "dragon-beard candy" to layered "water ripple" patterns; and silicone resembled diffuse, ill-defined "snowstorm" echotexture.
Conclusion:
Ultrasound reveals filler nodule patterns, supporting more accurate diagnosis and safer, individualized treatment.
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