TOPIC: 2 Rounds AD - Nodule/Granuloma

I’ve had two full rounds of PMMA at AD as documented. Click Here to Read it.

A few months after my second round in August of ‘24 I noticed several “nodules” concentrated around the circumcision line on the right side and bottom, and another more prominent noodle-like one towards the base.

The ones near circ scar -one which feels like a BB, the other like a small bean cut in half - have stabilized in size. The noodle-like one has progressively gotten bigger and more dense. What started off as “kinda annoying, will probably go away” has progressed into something more distressing.

I’m hoping to correctly identify whether these are nodules OR granulomas and arm myself with knowledge of what can be done before I speak to local providers. I reached out to Ian at AD months ago who didn’t seem too concerned and felt confident they could mitigate. I’d love to return to AD but as a foreign passing American, I’m just a bit paranoid about the border on the US side with the current state of things. (Not trying to get into any political debates here.)

I’m especially concerned about the noodle-like growth since it continues to increase in size. Is this something that can be mitigated via steroid injection? If so what compound(s) and what strength are typical? Or would it require a more invasive intervention?

Hoping to get opinions from Dr Casavantes @Avanti_Derma , Dr Carney @Rejuvall , @Dr_Rupeka , and any other providers or folks that have gone through with fixing nodules.

Attached: photo of noodle-like nodule; the other nodules are harder to see despite being very easy to feel.

That looks like a granuloma to me. They are just a conglomeration of scar tissue, white blood cells and foreign body material which would be the PMMA if it is not causing pain, I believe it can be left alone sometimes with excessive irritation, they can grow in size due to inflammation, but I also believe that overtime some of these tend to shrink

Thanks, @Toothman . Everything I’m reading about foreign body granuloma seems (to my laymen’s POV) consistent with my experience.

That looks like a granuloma to me. They are just a conglomeration of scar tissue, white blood cells and foreign body material which would be the PMMA if it is not causing pain

You're on the right track, but that is not quite what granuloma is. A granuloma isn’t just a clump of scar tissue and other stuff; it’s actually a small pocket of chronic inflammation that forms when your immune system can’t fully break down or remove something it sees as foreign.

In the case of PMMA (polymethylmethacrylate), the body recognizes the tiny microspheres as “non-self.” Most of the time this triggers a normal and controlled foreign body reaction: macrophages and fibroblasts form a thin capsule of collagen around each microsphere, which is what gives the long-lasting firmness of the filler.

A granuloma happens only when that process goes off balance,usually months or years later. Instead of a smooth, stable collagen capsule around each bead, the immune system goes into overdrive in one spot and builds a dense lump of inflammatory cells and fibrotic tissue around a cluster of microspheres. It’s not infection, and it’s not typical scar tissue, it’s an over-exaggerated immune response.

Clinically, a true granuloma often:

• Feels like a firm, round or irregular lump beneath the skin
• May be tender, red, or swollen if inflamed
• Does not move freely like normal filler
• And won’t resolve on its own in most cases

Leaving it alone usually doesn’t make it disappear; some mild ones may stabilize, but most require medical management, often with anti-inflammatory medication, steroids, or in resistant cases, minor surgical removal.

In short:

• Normal PMMA response: controlled, microscopic collagen around each bead = smooth, lasting result.
• Granuloma: uncontrolled, chronic immune clumping around many beads = visible lump that usually needs treatment.

(Edited to add) Sorry, I forgot to also share this information about granuloma from the Cleveland Clinic: my.clevelandclinic.org/health/diseases/24597-granuloma

@Rejuvall , thanks for the response and article.

“ Leaving it alone usually doesn’t make it disappear; some mild ones may stabilize, but most require medical management, often with anti-inflammatory medication, steroids, or in resistant cases, minor surgical removal.”

This was going to be my next question: if I was unbothered by the granuloma, would it be safe to leave it alone? I guess I’m trying to gauge if this is something that I need to address sooner rather than later. I’m leaning towards addressing it soon as it seems to be growing in size and I’m getting intermittent dull sensations akin to infection.


For those following along, here’s another article about filler-related foreign body granulomas (FGB) that explains pathology, histology, and management of said FGBs.

This was going to be my next question: if I was unbothered by the granuloma, would it be safe to leave it alone? I guess I’m trying to gauge if this is something that I need to address sooner rather than later. I’m leaning towards addressing it soon as it seems to be growing in size and I’m getting intermittent dull sensations akin to infection.

@richardgaines My apologies for not answering your question sooner. It's just been a busy week here and I got sidetracked, so I do apologize.

So, generally, if it's not bothering you it's probably okay to leave it alone. However, this depends on A LOT of factors, including but not limited to, what kind of filler, how long ago you got it, how long ago the granuloma developed, your age, your general health, any diseases or infections you may already have, etc, etc, etc. Just because someone has granuloma and it currently doesn't bother them doesn't mean it won't get worse, and because granuloma is an inflammatory reaction, it can get worse. But it could also eventually calm down after a while (when it does resolve itself it can take a very long time, maybe over a year, but again this varies from individual to individual). Since your symptoms seem to be progressing, I would recommend seeing a urologist who is very familiar with non-surgical girth enhancement to see what options you have to get it resolved.