摘要

Objectives: To propose a practical, complication-aware clinical algorithm for diagnosis, stratification, and management of post-injectable nodules, and to clarify where RF/EBD can be beneficial versus harmful. Introduction: Nodule formation remains one of the most frequent short- and long-term adverse events after injectable treatments. Clinical presentation may occur weeks to years after injection, creating diagnostic uncertainty and heterogeneous management. Energy-based devices (EBD), including radiofrequency (RF), are increasingly combined with collagen stimulators and fillers; however, EBD may function as both a therapeutic tool and a potential trigger that amplifies inflammatory responses when used with aggressive sequencing. Materials / method: A structured algorithm was developed based on: (i) phenotype stratification (inflammatory vs non-inflammatory), (ii) timing (early vs late/deferred onset), and (iii) suspected drivers (technique-related superficial placement or high local product density; immune/infectious triggers). Management pathways include stepwise escalation: observation and massage for early non-inflammatory nodules; intralesional normal saline irrigation/injection as a minimally invasive option; antibacterial therapy where infection is suspected; intralesional corticosteroids for persistent inflammatory nodules; and ul Results: In published data cited within the presentation, granulomatous/nodular events after poly-(L,D)-lactic acid have been reported with complete resolution after tailored treatment in documented cases, including ultrasound-guided techniques. A bipolar RF case report demonstrates rapid clinical improvement of intractable nodules after filler injection. The algorithm highlights key risk amplifiers: superficial placement, excessive volume per point, early immune reactions, late immune reactions, and potentially premature or overly aggressive EBD combinations. Conclusion: A phenotype- and timing-driven approach improves clinical decision-making for nodules after injectables. RF/EBD can be effective in selected non-inflammatory nodules when applied with appropriate depth and conservative parameters, yet may increase risk when used too early or too aggressively after collagen stimulation. Standardized sequencing and complication-aware device selection should be integral to modern combination therapy