Non-Surgical Repair of Lumps & Bumps After Girth Enhancement
Lumps, bumps, or uneven areas are an upsetting but common side effect after penile girth enhancement.
These irregularities can happen after:
- Fat transfer (FTT)
- Hyaluronic acid (HA) fillers
- PMMA-based fillers
- Or other substances that may not have been clearly explained to you
At Rejuvall®, we focus on identifying the cause of the lump and then choosing the least invasive, medically appropriate way to fix it. Many problems can be treated non-surgically in our clinic. More complex cases may need minor surgical repair or full reconstruction.
Why Do Lumps and Bumps Form After Girth Enhancement?
Most lumps fall into a few main categories:
- Fat necrosis nodules after fat transfer (FTT)
- Granulomas after hyaluronic acid (HA) injections
- Granulomas and firm nodules after PMMA or materials marketed as PMMA
- Lumps from unsafe or unknown fillers, including silicone oil
The type of lump you have depends on:
- What was injected or transplanted
- How much material was used
- Where it was placed
- How your body’s immune system responded
The first step is figuring out what is actually in your penis.
Fat Transfer (FTT) Nodules and Fat Necrosis
After a fat tissue transplant (FTT) for penile girth, have you experienced the formation of a nodule on your penis shaft?
Let’s start by outlining the components of a FTT operation in order to comprehend what causes it and how to correct it.
What is a fat tissue transfer (FTT) for girth?
A fat transfer procedure removes fat from one area of your body (such as the abdomen or inner thighs) and injects it into another area to make it look fuller. For penile girth:
- Fat is removed with thin cannulas
- The fat is washed and filtered
- The fat is injected into the penis
- Aftercare is used to improve blood flow and reduce the risk of fat cell death (fat necrosis)
Most FTT penis enlargements are done under general anesthesia. At Rejuvall®, we prefer a safer combination of IV sedation and epidural anesthesia instead.
Results from fat transfer can take up to 6 months to stabilize.
What is fat necrosis?
Fat necrosis happens when the fat cells lose their blood and oxygen supply and die. When this happens:
- The dead fat releases oily contents
- That oil can collect in a small sac (oil cyst)
- Calcium can build up on the cyst, making a firm lump
- Scar tissue can form around the area
These nodules can feel like round, firm lumps under the skin. The skin over them may look dimply, bruised, or discolored. Patients are often worried it could be an infection or even an STD, especially if a partner notices it.
Fat necrosis after FTT penile girth is more common when:
- Too much fat is injected
- The fat is not evenly placed
- Aftercare is not followed
- The surgeon or clinic lacks experience
In other parts of the body, fat necrosis lumps sometimes fade on their own. In the thin skin of the penile shaft, where blood flow is limited, they almost never do.
Symptoms usually appear weeks to months after treatment, not right away.
How does Rejuvall repair fat necrosis nodules?
Treatment depends on the size and location of the lump. Options may include:
- Fine-needle aspiration to drain an oil cyst
- Tiny incisions under local anesthesia to remove firm nodules
- Use of nitrous oxide (“laughing gas”) for anxiety relief if needed
Low-intensity shockwave therapy has been tried in some settings, but in our experience, nodules often recur and require more visits. Because about 90% of our patients travel from other states, we usually recommend more definitive techniques that resolve the problem with fewer treatments.
Granulomas After Hyaluronic Acid (HA) Fillers
With the rapid growth of non-surgical penile filler clinics, we are seeing more men with granulomas after HA injections.
What is a granuloma?
A granuloma is a small, organized cluster of immune cells that forms when your body reacts to a foreign substance. Patients usually describe them as “nodules” or “bumps” under the skin.
Granulomas can form around almost any filler if:
- Too much material is injected
- The product is placed too close to the skin
- The area becomes infected or irritated
- The immune system overreacts
The most common granulomas after HA penile filler are called foreign body giant cell (FBGC) granulomas—big clusters of fused immune cells trying (and failing) to handle the filler.
Why are granulomas more common in the penis than the face?
Penile augmentation with hyaluronic acid often uses 5–15 mL per session. By comparison, cosmetic facial fillers are typically 1–2 mL per area.
That means:
- The penis receives much higher volumes than the face
- The risk of granuloma is many times higher
- Placement and technique matter even more
The risk of FBGC formation goes up with:
- Higher total volume
- Poor depth or placement (for example, filler placed too superficially)
- Use of cannulas in ways that spread product unevenly
- A compromised or stressed immune system
This is why Rejuvall does not use cannulas for penile filler injections and uses a structured, layered technique instead.
How is a granuloma from HA filler treated?
Granulomas from HA are usually treated with hyaluronidase, an enzyme that dissolves hyaluronic acid.
Once the HA is broken down:
- The inflammatory reaction often resolves quickly
- The lump softens and may disappear
- Pain and redness typically improve
In more stubborn cases, treatment may require several rounds of hyaluronidase plus medical management of inflammation.
Granulomas After PMMA and “PMMA” Injections
PMMA based fillers behave very differently from HA. In the United States, the only FDA-approved PMMA-based filler is Bellafill®.
Real PMMA vs. “PMMA” You May Have Been Sold
This is an important point.
- Real PMMA in the U.S. = Bellafill® (FDA-approved, standardized, regulated)
- Some clinics, especially outside traditional urology, now tell patients they are getting “PMMA” when the syringe actually contains:
- Silicone oil
- Unregulated PMMA mixtures
- Other mystery “permanent fillers” mixed in-house
These products are not Bellafill®, not FDA-approved, and carry a much higher risk of severe granulomas, delayed inflammatory reactions, and disfigurement.
If your provider never showed you the Bellafill® box, or could not give you clear documentation of the product, there is a real chance your “PMMA” was something else.
Why are PMMA granulomas more persistent?
Unlike HA, PMMA particles and silicone droplets cannot be dissolved by enzymes. The immune system recognizes them as foreign:
- Macrophages surround the particles
- They fuse into foreign body giant cells (FBGCs)
- These clusters sit along the surface of the material for as long as it remains in the body
- With PMMA (and silicone), that can be essentially permanent
A special type of problem, called a delayed inflammatory reaction (DIR), may appear weeks to months after injection. Symptoms can include:
- Redness (erythema)
- Firm swelling (induration, edema)
- Tenderness or pain
- Lumps that feel hard or rubbery
These reactions may be triggered by infection, defective products, poor injection technique, or exposure to unregulated materials.
How are PMMA-related granulomas treated?
Because PMMA and other “permanent” substances can’t be dissolved:
- Small nodules may sometimes be broken up or aspirated with tiny needles
- Most PMMA granulomas require small incisions to remove the worst-affected tissue
- Procedures are usually done under local anesthesia in-office
Some men were told that a simple steroid injection would “fix” any lumps. Steroids can temporarily soften inflammation, but they:
- Do not remove the PMMA or silicone
- Do not remove foreign body giant cells
- Do not cure delayed inflammatory reactions
In most cases, a combination of physical removal, precise contouring, and medical management of inflammation is needed.
Important Safety Note About “PMMA” and Bellafill®
Because unsafe providers now market many different substances under the “PMMA” label, it’s important to understand:
- At Rejuvall, PMMA means Bellafill®, an FDA-approved PMMA-based filler with a long safety record.
- We do not use bulk PMMA powders, in-office mixtures, or silicone oil labeled as PMMA.
- We see many men whose “PMMA” was actually silicone or an unknown product, which makes repair more complex.
If you are not sure what was injected, we may recommend imaging, biopsy, or both to help identify the material before planning treatment.
Experiencing Bumps After Girth Enhancement?
If you notice new lumps, bumps, or hard areas after girth enhancement — whether from fat transfer, HA filler, PMMA/Bellafill®, or a substance you don’t fully understand — it’s important to get evaluated by a urologic team with experience in this exact problem.
Some nodules can be treated simply and non-surgically. Others require careful surgical planning to protect both appearance and function.
You do not have to figure this out alone.
Fill out and submit the form below to tell us about your situation and schedule a free 30-minute phone consultation. We’ll review:
- What procedure you had and when
- What material you were told was used (PMMA, Bellafill®, HA, fat, “permanent filler,” etc.)
- What your lumps look and feel like now
- What treatment options may be safest and most effective in your case
Frequently Asked Questions
Not always, but they should never be ignored. Some are simple and easy to treat; others signal a foreign body reaction or tissue damage that needs expert care.
Often yes. Many HA granulomas can be treated with hyaluronidase, an enzyme that dissolves the filler.
We frequently see men who were told they received PMMA, but imaging or surgery later reveals silicone or other unsafe materials. If the product was not clearly documented as Bellafill®, further evaluation is important.
No. These materials do not dissolve. While symptoms may flare and calm over time, the foreign material remains and often needs targeted treatment.