Bilateral temporal non inflamatory nodules following poly-L-lactic acid PLLA inj

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Anonymous

November 16th, 2025 21:24

Patient description

52-year-old female patient who developed bilateral temporal nodules after Poly-L-lactic acid injection. Her medical history is unremarkable, and she reports no known comorbidities

Case description

On June 17th, 2025, I injected one vial of Lanluma V (210mg/17ml of PLLA) for a full face treatment using a 22G canula. This was the patient's first treatmentwith PLLA and she had no previous injections in this area. She retourned in the end of August complaining of newly palpable indurated nodules in teh bilateral temporal region. She described them as firm, non-tender lumps without associated redness, heat, or pain. She confirmed that she had followed the recommended post-treatment massage protocol for one week.

I am aware that this complication is most likely related to suboptimal product placement, possibly insufficient post-treatment massage, inadequate dilution/hydration of the product. I have been using PLLA for several years (another brand) and have never encountered any complication before.

Since late August I have seen the patient at least 10 times.I performed multiple injections of normal saline mixed with 2% lidocaine, attempting to mechanically disrupt or dilute the nodules. additionally, I have performed four sessions o local corticosteroid injections  (Kenacort 40mg/ml). Despite these interventions the improvement has been minimal. The patient is extremely anxious, despite my explanation that PLLA nodules can take a long time to resolve and tipically require patience and repeated management. 

Questions to the community: 

  1. Would you recommend the use of collagenase or recombinant enzyme injections to treat PLLA-induced nodules in this region?
  2. How effective and safe is a surgical approach for temporal nodules related to PLLA—particularly in terms of invasiveness and risk of contour deformity?
  3. Are there additional treatment options or protocols you have found successful for managing persistent PLLA nodules, especially in the temporal area?
  4. Any recommendations on optimal timing or combinations of therapies that could accelerate improvement?
I appreciate any guidance or shared experiences. 

Thank you for your help. 

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Dr. Elaheh BEHZADFAR

MD, Iran

December 5th, 2025 21:30

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Dr. Robyn D SIPERSTEIN

Dermatologist, United States

November 17th, 2025 05:16

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Dr. Emmanuel DE SOUZA

MD, Uruguay

November 16th, 2025 22:02

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Dr. Ali AL JOBOORY

MD, Australia

November 16th, 2025 21:46

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Dr. Fadi HAMADANI

Plastic Surgeon, Palestine

November 16th, 2025 21:40

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