Ellansé removal in Singapore:
what can be done when it cannot be dissolved

Can Ellansé be dissolved?

No. This is the single most important fact about correcting Ellansé, and the one most often misunderstood. Hyaluronidase, the enzyme used to dissolve filler, breaks down hyaluronic acid. Ellansé contains no hyaluronic acid. It is made of microspheres of polycaprolactone (PCL), a biodegradable polymer long used in medicine, suspended in a carboxymethylcellulose gel (Christen 2020; de Melo 2017). Neither part responds to the enzyme: in a review of 1,111 treatments, the authors note that polycaprolactone filler cannot be immediately removed by injecting an enzyme (Lin 2020).

When hyaluronidase still has a part to play

Where Ellansé has been layered with hyaluronic acid filler or skin boosters in the same area, the hyaluronic acid can be dissolved selectively, which sometimes reduces the fullness around the Ellansé. The scan shows whether that applies. The enzyme will not change the polycaprolactone itself.

What Ellansé is, and why it behaves differently

Ellansé is a collagen stimulator. When it is injected, the gel gives volume straight away. The body then absorbs the gel, while the polycaprolactone microspheres stay in the tissue and prompt it to lay down collagen around them, which carries the longer-term volume. Different versions are made to last different lengths of time before the microspheres themselves are broken down (Christen 2020).

This is why Ellansé problems change over time. Early on, the gel and normal swelling can make an area look fuller than it will be. Later, a nodule may be a cluster of microspheres with collagen around it: firm, and not softened by massage. More on the product is on Ellansé in Singapore and in the glossary under polycaprolactone.

“What you see on the day after Ellansé is gel and swelling sitting over the product. I do not call it the result, and I do not add to it, until the gel has gone and the collagen has had its say.”

Dr Sin YongOn judging Ellansé

Common problems after Ellansé

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In the review of 1,111 polycaprolactone treatments, the most common problems were swelling and bruising, and nodules and granulomas were described as rare (Lin 2020). Lumps from collagen-stimulating fillers can still be persistent: in a series of 55 such complications, nodules were the most common problem, and hyaluronidase helped only where hyaluronic acid had been mixed in (Ianhez 2024). A granuloma is managed with anti-inflammatory treatment, ideally guided by ultrasound (Cerón Bohórquez 2024), which is why a lump that is red, tender or growing is treated medically before anything else. The differences between collagen-stimulator nodules and migrated product are set out in collagen-stimulator nodules and migration.

Ultrasound mapping of Ellansé

Ultrasound is the first step for any Ellansé problem. Polycaprolactone has its own appearance on the scan, with bright specks and small comet-tail artefacts inside the deposit, which sets it apart from the dark, uniform pockets of hyaluronic acid (Wortsman 2017; Wortsman 2015).

The scan shows:

• where the microspheres sit, and how deep;
• whether a lump is a cluster of product, collagen around it, inflammation, or something unrelated such as a cyst or a lymph node;
• whether hyaluronic acid filler or skin boosters have been layered in the same area;
• the vessels nearby, which matter for any further treatment.

Some patients come only for mapping, to know what is there before deciding anything; that is a valid reason for an assessment. Dr Sin Yong performs the scan himself.

Time Freeze Laser LCLR® for Ellansé nodules and excess

LCLR® stands for Laser Collagen Lipo Remodelling. It is a proprietary protocol developed by Dr Sin Yong on a long-pulsed 755 nm and 1064 nm laser platform, and he performs every treatment himself. Its Sculpting mode is built to target excess material. For Ellansé, it is the tool he uses on polycaprolactone nodules and excess, including where they sit with hyaluronic acid or skin boosters, and including under the eye after assessment and ultrasound.

• No incision and no stitches.
• No redness, no downtime.
• The area is reassessed before you leave, and any further visit is planned from what is seen.

Every face and every nodule is different, so the response varies from person to person. Like any medical treatment, laser has its own risks and limits, which are explained at the assessment alongside the alternatives. More on the protocol is on Time Freeze Laser LCLR®, and on the mode used for nodules in the Sculpting mode of Time Freeze Laser LCLR®.

Other options: medical treatment or waiting

• Waiting and review. Early fullness after Ellansé is partly gel and swelling, which settle. An area is judged once that has happened, unless something is clearly wrong.
• Medical treatment. A lump that is red, hot, tender or growing can be inflammation or infection, and is treated medically first.
• Massage. Massage does not break up an established nodule, and firm pressure can irritate an inflamed one.

Consensus recommendations on filler complications advise identifying the type of lump before choosing a treatment (Urdiales-Gálvez 2018), which is the reason the scan comes first.

What happens at an Ellansé assessment

1. History. When and where it was injected, which version if known, how much, and any other fillers or skin boosters in the same area.
2. Examination. At rest and in expression, with photographs for your own comparison.
3. Ultrasound. Each area of concern is mapped.
4. A plan in writing. What would be treated and how, what would be left, and what decides the fee.
5. Treatment. Where it suits, treatment can follow in the same visit. Inflamed lumps are treated medically first.

You do not need to have been treated here. Patients travelling to Singapore can plan their visit through international patients, and doctors can refer through for GPs.

Tried other treatments and almost given up?

Many patients who come to see Dr Sin Yong about Ellansé problems tell him they have tried almost everything else and had given up hope. Having tried other treatments does not, on its own, rule out further options; what can be done depends on what the scan shows.

That history is useful. Knowing what was injected, when, and what has already been tried often explains why a problem has stayed: hyaluronidase acts only on hyaluronic acid and only where it reaches, some fillers are not hyaluronic acid at all, and swelling or fluid can look like filler. Ultrasound helps show which of these applies, and the plan starts from there. For material that cannot be dissolved, Dr Sin Yong uses the Sculpting mode of Time Freeze Laser LCLR® for nodules large and small, without an incision. How each person responds varies.

If you have been told nothing more can be done, it is still worth having the area scanned: ultrasound helps show what is there, and what, if anything, can be done is discussed from that. Bring any records of past treatments, product names and dates if you have them. More on this is in when filler dissolving has not worked.

How Dr Sin Yong approaches Ellansé correction

The first job is to work out what the lump actually is. Dr Sin Yong maps before he treats, does not inject an enzyme that cannot work, dissolves any hyaluronic acid layered in the same area selectively, and uses the Sculpting mode of Time Freeze Laser LCLR® where excess collagen-stimulator material is the problem. The plan, including what he would not do, is set out in writing.

For lumps under the eye, see non-hyaluronic acid filler lumps under the eye; for hard lumps after mixed products, see filler complications; for fillers that can be dissolved, see filler dissolving in Singapore.