Chronic swelling post Stylage filler

Patient description

Patient Caucasian background , 43 M, Fitzpatrick 1

Case description

Had Stylage filler 1 year ago done - nasolabial fold subcutaneous layer 

Lines smoothened initially , however noticed a lump 8 months post filler ( not sure when lump appeared as patient had more facial hair in the past ) . No hx of infection in the area and no medical history of chronic inflammation or autoimmune condition 

I used ultrasound and saw small scattered areas of hypoechoic regions. Decided to do one session of dissolving with hyalase ( 1500 units in 8 ml dilution ) 

Cannula - subdermal and deep subcutaneous injection all along the area of concern ( marked in picture ) 

Patient presented in 2 weeks still reporting nil changes 

I was wandering whether intralesional steroid would help, or consider MRI ( it is bothering the patient and Will to try anything that will help) 

I did use ultrasound again and I did not notice discreet regions of fillers

Thanks