Penile lump after a filler or implant procedure: causes and care

In short

• Four groups of cause: (1) uneven or moved material, the most common; (2) late inflammation, infection or a foreign-body granuloma (inflamed tissue around the material); (3) tissue reactions such as fat necrosis, oil cysts, scarring or calcification; (4) problems not related to the filler, such as a clot, a plaque, a cyst, or a rare tumour that must be ruled out.
• Normal firmness: after acellular dermal matrix, feeling hard in the first 3 months is expected. It softens slowly.
• Wherever it was done, the clinic can assess the lump and choose care based on the material.
• Cost: self-paid. Costs are explained at the consultation. You can also ask about costs on LINE before you come.

Get care now. Do not wait for your next visit if you have:

1. Redness, swelling, heat or pain that spreads fast, or fever or chills. This may be an infection or abscess, which can spread to the scrotum and perineum.

2. Sudden severe pain, or skin turning purple, white or black, soon after an injection. This may be a blocked blood vessel; loss of blood flow to the glans has been reported. Treatment is time-critical.

3. Broken skin, an ulcer, pus, or a leaking channel (fistula). In a review of sclerosing lipogranuloma (a hard reaction to oily injected material), ulcer or fistula was about 15.4%, skin necrosis about 4.7%, and gangrene or sepsis about 4.7%.

4. Difficulty passing urine or a changed urine stream (about 5.4% in the same review).

5. Clear pain or a change in shape during erection. With dermal matrix sheets, discomfort during erection was the most common complication.

Go straight to an emergency department, without messaging first, for item 2, sudden severe pain in the scrotum or testicle, or fever with flank pain when you have a stone or a known urinary blockage (such as hydronephrosis or a double-J stent). See sudden testicular pain (Chinese) for when you can come straight here.

Other items, if it was done here, or removed or revised here: tell us on LINE first, at any hour (a photo helps). The doctor replies and arranges care. Go to an emergency department only if LINE does not reply and the redness keeps spreading, the fever continues, or you cannot pass urine.

Other items, if it was done elsewhere and not yet treated here: during consulting hours, ask on LINE and the clinic assesses you. Outside consulting hours, go to an emergency department.

In every case, do not use heat, massage or squeezing first.

What this clinic can do

• Hyaluronic acid, local nodules: under local anaesthesia, a tiny puncture with a blade to press the material out, or removal through a small opening. This clinic does not use the dissolving enzyme.
• Petroleum jelly, paraffin, silicone oil: the reaction usually needs the material removed with the affected tissue; a small opening is not enough. If the area is large, needs a skin flap or staged reconstruction, or there is a deep abscess or skin necrosis, you are referred to a hospital with inpatient and reconstruction care.
• Dermal matrix sheet or powder: removal or revision can be assessed. Even firmness in the first 3 months does not need rushed treatment.
• After surgery elsewhere: dressing changes near Taichung after surgery in another city, and antibiotics for infection, are possible here (self-paid). For dermal sheets placed at other Taichung clinics, this is during consulting hours.

Dr. Chao-An Chen (board-certified in urology and in surgery) or Dr. Kai-Wu Yang does the removal, revision and dressings; you can choose. What can be removed, and what remains: penile filler removal and revision.

Timing is the first clue

Hyaluronic acid nodules are usually felt from about two weeks after injection. Poly-L-lactic acid granulomas usually appear after two months. Granulomas from paraffin, silicone and other non-medical materials appear after a median of several years, sometimes over ten years. So “it came long afterwards, so it is unrelated” is not a safe conclusion.

Not every lump comes from a filler

Filler nodules, earlier penile beads and sebaceous cysts usually sit under the skin. A Peyronie’s disease plaque sits deeper, on the tunica albuginea (the firm layer around the erectile tissue).

More: Peyronie’s disease and penile curvature (Chinese).

Hyaluronic acid

• Nodules come from uneven spread or too much in one spot. If smaller than 1 cm, painless and not inflamed, they are usually first managed with massage and observation. Further treatment is considered if larger than 1 cm or not improving.
• How often: in a series of 230 men followed for 6 months, complications were 4.3%: nodules 2.2%, bleeding under the skin 1.3%, infection 0.9%.
• Late reactions (redness, swelling or nodules more than two weeks after injection) may come from a low-grade infection on a biofilm (a layer of bacteria on the material) or a delayed (type IV) allergy. They are hard to tell apart, and routine cultures are often falsely negative. So infection is treated first, before any steroid.
• A blue tint (Tyndall effect) means the material sits too close to the surface. It is a depth problem, not spoiled material.
• Atypical mycobacteria (such as Mycobacterium abscessus) can cause late infection: a wound that does not heal and responds poorly to usual antibiotics. Acid-fast smears and cultures are needed.

Your own fat

Fat cells can be damaged during the transfer, or the centre of a large injection can die from lack of oxygen (fat necrosis). A larger area can form an oil cyst, and inflammation around it may lead to calcification. This is a possible path, not a certain one.

The only figures come from a meta-analysis of the breast, face, buttocks and jaw (42 studies, 6,268 people): complications 4.2%, fat necrosis 0.7%, infection 1.0%, hardening or calcification 0.6%, oil cyst 0.1%. It did not include the penis, so it cannot be applied directly, and reported fat survival varies widely.

One or a few painless round lumps 3 to 6 months after surgery are usually oil cysts or local scarring, and do not always need surgery.

Acellular dermal matrix: normal or not?

Acellular dermal matrix (ADM) is a collagen framework that your own cells and small blood vessels slowly replace. Powder can feel stone-hard just after injection; a sheet feels firm for the first 3 months. Both soften, though a sheet may still be felt. Usually normal: even, painless, not red, softer with time. Come back: a single lump, pain, a growing area, redness, leaking fluid or fever.

The largest report on sheet implants (Xu T, et al., J Sex Med 2019, 78 men):

The authors concluded that complications are common and should not be ignored. A “stamp-like” change (a firm patch with sharp edges) has also been described. It does not always mean infection, but with pain, a change in shape during erection, leakage or fever, come back. An infected ADM implant usually needs removal.

For powder ADM there are no useful complication data, so no rates are given. What needs assessment is local unevenness from uneven absorption, and infection, which is uncommon.

Liquid silicone and unknown injected substances

These cases are seen in Taiwan and Southeast Asia. In a series of 35 men from one medical centre, the substances were mainly silicone 45.7%, liquid paraffin 22.9%, petroleum jelly 11.4% and baby oil 8.6%.

• Long timeline: on average 7.8 years from injection to seeing a doctor (1 day to 20 years).
• Problems: unhappy with how it looks 57.1%, pain or swelling 45.7%, a foreskin that cannot be pulled back (phimosis) 22.9%, necrosis 8.6%. In a systematic review of 918 men, 77.9% had pain, swelling or deformity.
• Surgery: needed in 91.4% of the series, and 60% needed more than one operation (up to 5); 78.8% in the systematic review.
• No cure without surgery: painkillers and antibiotics do not cure sclerosing lipogranuloma, and no case has been reported to go away by itself. Surgery is advised at least 6 months after injection, when inflammation and scarring have settled and the tissue layers are easier to see.

These materials cannot be dissolved by an enzyme. For implanted objects, see removal of penile beads and implanted foreign bodies.

How the clinic examines a lump

• Examination: position (top or underside), layer, how it moves, tenderness, whether the skin moves over it, and shape during erection. This separates most clots, lymphangitis, plaques and filler nodules.
• Ultrasound with a high-frequency probe and colour Doppler. Early hyaluronic acid looks dark with clear edges; silicone-type oils look bright with a “snowstorm” shadow; an oil cyst looks dark with brighter tissue behind. Ultrasound also tells an abscess from sterile inflammation, which decides whether antibiotics come first.
• MRI is not routine. It is kept for deep lesions or surgical planning.
• Elastography has no evidence for filler lumps, so it is not routine here.
• Biopsy is considered when the diagnosis is unclear, an ulcer keeps coming back or does not heal, treatment fails, or cancer must be ruled out. The doctor decides.

Treatment options and their limits

• Observation: small, painless lumps that fit normal recovery.
• Treat infection first if infection or biofilm is suspected. The doctor chooses the medicine and length. A negative culture does not rule out infection.
• Steroid injection into a foreign-body granuloma: common, but never before infection is controlled.
• Puncture or small-opening removal: for hyaluronic acid and local nodules that remain after conservative care, under local anaesthesia.
• Enzyme dissolving: works only on hyaluronic acid, not on fat, ADM, poly-L-lactic acid, silicone or paraffin.
• Surgical removal: when conservative care fails, for infected implants, nodules over 1 cm that affect appearance or function, and non-medical substances.

Limits. The penis usually cannot return to how it looked before if the material is woven into scar tissue, there was skin necrosis or an ulcer, a large removal with a skin graft or flap is needed, or there is scar contracture after several operations.

Shockwave therapy is not a treatment for filler lumps, and there is no evidence for it. For erection problems, see shockwave therapy for erectile dysfunction.

About hyaluronidase

This clinic does not use hyaluronidase (the enzyme that breaks down hyaluronic acid). It acts only briefly, may take days to work, and may need more than one session. It works less well once a granuloma has formed, and is not suitable during active infection, because it may help spread it.

In Taiwan it has no local drug licence. It is a special-project import run by the Taiwanese Dermatological Association for the Ministry of Health and Welfare, and each hospital or clinic must apply. Its approved use does not include dissolving cosmetic fillers, so this use is off-label.

Your first visit

• Note three things: when you found the lump, what material was used, and whether it hurts now. Bring the material name, date, consent form or receipt if you have them; without them, assessment takes longer.
• The first visit is an assessment. The doctor explains the method, anaesthesia and costs, and books a procedure if needed. You do not have to decide on the spot, and no deposit is taken.
• The clinic does not comment on the original provider’s responsibility or costs.

Frequently asked questions

Appointments and access

Consultations are conducted in Mandarin, and can also be conducted in English.

On LINE, tell us the material, when it was done and your symptoms now. You do not need to explain why you are here in the waiting area; the clinic has private consulting rooms.

昭安泌尿科診所 (Morning Urology Clinic)
No. 98, Boguan 2nd St., West District, Taichung City 403, Taiwan（403 臺中市西區博館二街98號）
Consulting hours: Monday to Saturday (closed Sunday). Online booking is open 24 hours.

This page was produced by 昭安泌尿科診所 (Morning Urology Clinic). Medical content last updated: October 2026 (same as the Traditional Chinese version). English version published: 5 November 2026. Medically reviewed by Dr. Chao-An Chen, urologist.

Sources: Xu T, et al. J Sex Med. 2019;16(12):2011–2017. DOI: 10.1016/j.jsxm.2019.09.010 / Transl Androl Urol. 2025 (review of complications and management) / EAU Guidelines / Taiwanese Dermatological Association (hyaluronidase special-project import) / Taiwan Food and Drug Administration.

This page provides general medical information and does not replace an individual diagnosis or treatment plan.