Seeing the Unseen: Ultrasound-Guided Treatment of a Polycaprolactone Filler Granuloma

Polycaprolactone (PCL) fillers are popular for their collagen-stimulating effect and low complication rate — but when things go wrong, they go wrong quietly. Nodules can appear months later, hidden beneath the skin, and the usual "feel-and-treat" approach often misses the mark.

In a case report published in Plastic and Reconstructive Surgery—Global Open, Dr. Jair Mauricio Cerón Bohórquez (Medical Contour, Hamburg) and Dr. Stella Desyatnikova show exactly why ultrasound has become indispensable for diagnosing and treating these delayed filler complications.

The case

A 46-year-old woman presented 14 months after an uneventful chin and jawline augmentation with 2 mL of polycaprolactone. Over the previous year, firm nodules, visible irregularities and a bluish discoloration had slowly grown along her lower face.

Four earlier intralesional steroid injections had brought no real improvement.

Diagnostic ultrasound findings

Using a 20 MHz linear probe, the team found multiple hypoechoic nodules in the subcutaneous fat and the SMAS layer of the lower face. Two features pointed straight to polycaprolactone: bright hyperechoic spots with "mini comet tail" artifacts along the borders, and perinodular hypervascularity on color Doppler — a sign of active inflammation.

A biopsy confirmed a foreign-body granuloma with multinucleated giant cells and the optically empty spaces typical of PCL.

Ultrasound-guided intralesional therapy

Rather than injecting blind, the team combined a systemic anti-inflammatory base with ultrasound-guided intralesional therapy:

• A tapering oral prednisolone course plus two months of doxycycline to settle the inflammation.
• Three monthly ultrasound-guided sessions, each placing 0.1–0.2 mL precisely into every lesion with a 27G needle — triamcinolone and hyaluronidase for the first two, then 5-fluorouracil added in the third session.

The logic is elegant: ultrasound lets you place each agent exactly where the granuloma sits, so you can lower the dose of every drug and let them work together.

Seven months later the nodules were no longer visible, the lower face had returned to its natural shape, and ultrasound showed far less residual product — though some deposits remained, so vigilance for flare-ups continues.

Clinical implications

Filler complications are multifactorial — product, technique, immune history and even recent vaccinations can all play a role. What this case makes clear is that ultrasound turns a guessing game into a guided procedure: it confirms what the filler is, where it sits, and whether a nodule is actively inflamed, then lets you treat it with millimetre precision instead of injecting into healthy tissue.

It is also a reminder that a thorough medical history before any filler treatment is non-negotiable.

About the authors

Dr. Jair Mauricio Cerón Bohórquez practices at Medical Contour in Hamburg, Germany. Dr. Stella Desyatnikova is a facial plastic surgeon based in Seattle, USA. Both are listed on the Scan Your Filler directory.

Source

Cerón Bohórquez JM, Desyatnikova S. Ultrasound-guided Treatment of Polycaprolactone Granuloma. Plastic and Reconstructive Surgery—Global Open 12(2):e5610, February 2024. DOI: 10.1097/GOX.0000000000005610.

This article is an educational summary written by Scan Your Filler based on the cited publication. It is not medical advice. Always consult a qualified, licensed practitioner for decisions about your filler.