Six Problems · Assess First · CityLink Mall
When filler goes wrong, it usually does so in one of six recognisable ways, and each calls for a different answer. This page explains how Dr Sin Yong tells them apart at Atelier, which problems hyaluronidase can reverse, and which one is an emergency.
Most problems after dermal filler fall into six patterns: early lumps, late nodules, migration, overfilling, the Tyndall tint and vascular occlusion. Some show within days, others months or years later.
Not every uneven patch is a complication. Swelling and bruising often make a treated area look irregular for a while, and that is ordinary settling. What deserves an assessment is a lump that has not settled, filler that has shifted or a bluish-grey cast that stays. Skin that turns pale or dusky, with pain that keeps building, needs a doctor the same day.
Types
By what you would notice, the six problems fall into four types. The look of migrated filler is described on filler migration signs, and its causes in what went wrong with migrated filler. Under-eye problems start at under-eye filler lumps and the Tyndall effect.
The Decision
At Atelier, Dr SY starts with what was injected, where and when, and examines the area once any swelling has gone. An early lump is not judged on the day it appears.
Hyaluronic acid. Hyaluronidase breaks down hyaluronic acid and nothing else. Lumps, migration, the Tyndall tint and an overfilled face can usually be corrected in stages: dissolve conservatively, settle for two to four weeks, reassess, and rebuild only with a reason. The sequence is set out on filler correction, and the end point of repeated top-ups on pillow face correction.
Calcium hydroxylapatite, polycaprolactone and poly-L-lactic acid. These cannot be dissolved. They are managed with time as the material resorbs, with injected medication where an inflammatory nodule is confirmed, and occasionally by referral. Lumps after PLLA are covered on PLLA nodules.
A medicine in its own right. Hyaluronidase has its own considerations, including allergy. Whether to use it, and how much, is decided after examination, never by message.
When the real change is sagging, more filler adds volume the face did not need and leaves the sag in place, so the plan may move to lifting or, once any dissolving has settled, to measured volume restoration.
Safety
Most filler problems can wait for a planned assessment. The first three below cannot.
Evidence
These figures come from the studies cited below. They describe reported cases, not your personal risk, and the vision figures are tallies of published cases, not a rate per treatment.
| Study | What was looked at | Finding |
|---|---|---|
| Kadouch, 2017 | 5,081 calcium hydroxylapatite treatments | Side effects in 3%; 96% of those were nodules, mostly not visible and settling without treatment |
| Trinh et al., 2022 | Published tear-trough cases where problems arose late (52) | Onset averaged 16.8 months; swelling 42.3%, nodules 25.0%, migration 7.7% |
| Wang et al., 2025 | Foreign-body granulomas after collagen-stimulating fillers | Reported from one week to 15 years after injection |
| Beleznay et al., 2015 | 98 published cases of vision loss after filler | Glabella 38.8% and nose 25.5% of cases |
| Doyon et al., 2024 | 365 further published cases | No recovery of vision in 68.2% |
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1 Raffles Link, #B1-28, CityLink Mall, Singapore 039393 · +65 8023 7170
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