Quick Answer: Penile filler lumps are usually either harmless nodules or immune-reaction granulomas. This guide explains how to tell the difference between penile filler granuloma vs nodule, why they form, which materials cause the most problems, and how reconstructive urologists treat each one.
- Nodules: Softer, more movable lumps caused by fat deposits, oil pockets, or clumped filler. Often improve with massage, time, or simple in-office treatment.
- Granulomas: Harder, fixed lumps caused by an immune reaction to filler material—especially permanent fillers like PMMA or unregulated substances such as liquid silicone marketed as “pharmaceutical grade” or “proprietary” fillers.
- Diagnosis and treatment: A careful exam, imaging, and knowledge of what was injected are key to choosing the right solution.
- Rejuvall expertise: Our reconstructive urology team specializes in safely resolving penile filler complications—including nodules, granulomas, and damage from non-urologist injectors.
Penile girth enhancement with dermal fillers or fat transfer is becoming more popular with men who want a thicker-looking penis.
When these treatments are done by experienced, medically trained providers using FDA-approved materials, they are generally safe. But some men notice lumps or bumps weeks or months after the procedure—especially if they were injected at a med spa, abroad, or by a non-urologist.
These lumps can be worrying and confusing. Many men wonder:
“Is this just a small harmless bump (nodule), or something more serious like a granuloma?”
In this article, we explain in simple terms how to tell the difference between nodules and granulomas after penile girth enhancement. We’ll also explain why these lumps form, which filler types carry more risk, and how urologic surgeons treat them. Knowing the difference can help you feel less anxious and get the right treatment if needed.
What Are Lumps After Penile Filler?
Lumps after penile filler can be sorted into two main types: nodules and granulomas. Both feel like bumps under the skin, but they are caused by different processes and need different treatments.
Common Types of Lumps After Girth Enhancement
The most common types of lumps after penis enhancement include:
- Nodules:
Small lumps formed by fat deposits, oil pockets, or clumps of filler material (HA or PMMA). - Granulomas:
Lumps caused by your immune system reacting to filler material, including permanent fillers and unregulated substances. - Oil cysts:
Found after fat transfer procedures, formed when oily liquid from dead fat cells gets trapped. - Scar tissue:
Less common, but possible if healing doesn’t go smoothly. - Lumps from unsafe materials:
Some men are injected with liquid silicone or “mystery gels” mis-labeled as PMMA, CMC, or “pharmaceutical grade” filler. These materials have a much higher risk of granulomas and long-term complications.
What Are Nodules?
A nodule is simply a small lump under the skin. After penile girth enhancement, nodules often form in two ways.
1. Filler Nodules
These nodules happen when hyaluronic acid (HA) filler or PMMA filler clumps together under the skin. This can occur if:
- The filler is not spread out evenly during the procedure
- Too much filler was placed in a single area
- The injector used a “bulk” cannula technique instead of a controlled, layered approach
Filler nodules usually:
- Feel smooth and slightly rubbery
- Can move a little under your skin
- Do not usually hurt
- Leave the skin above the lump looking normal
Many filler nodules soften or go away on their own with gentle massage and time—especially when the filler is HA (a dissolvable, temporary filler).
2. Fat Nodules / Oil Cysts (After Fat Transfer)
If your procedure used fat transfer instead of filler, the lumps might be oil cysts. These form when the transferred fat does not survive.
Dead fat cells turn into oily liquid, which then gets trapped in one spot under the skin. These nodules:
- May feel soft, rubbery, or sometimes firm
- Can cause mild skin discoloration
- Usually do not hurt
Over time, oil cysts often shrink on their own.
When fat cells die, your immune system tries to break them down and clean them up. Sometimes the oily liquid left behind collects in one spot and forms a lump. This process is called fat necrosis.
The oil cyst that forms is filled with liquid fat and often surrounded by a thin wall of tissue. While these oil cysts can be surprising to feel or see, they’re usually not dangerous.
Are Nodules Dangerous?
In most cases, nodules are not dangerous. They are a common side effect after both fat transfer and filler treatments.
Doctors usually recommend simple treatments such as:
- Gentle massage
- Time and observation
- Warm compresses
- Filler-dissolving enzymes (for HA nodules)
If a lump doesn’t go away after several months or is very bothersome, treatments like needle aspiration or a small in-office procedure can remove the lump.
At Rejuvall, our reconstructive urologist can treat stubborn nodules using:
- Fine-needle aspiration
- Micro-excision under local anesthetic
- Targeted dissolution (for HA)
In most cases, these treatments resolve the problem completely without affecting the rest of the penis.
What Are Granulomas?
A granuloma is different from a simple nodule. Granulomas are caused by your body’s immune system. When your body sees filler material as a foreign substance, it tries to attack and wall it off. This creates a harder lump called a granuloma.
Granulomas form when immune cells called macrophages surround the filler and try to break it down. These immune cells can fuse together to form larger cells called foreign body giant cells (FBGC). Over time, they build up and form a firm, inflamed lump.
Granulomas are more likely if:
- A large amount of filler was used (for example, >10 mL in a single session)
- Permanent fillers like PMMA were used aggressively or without a base layer of HA to “prime” the tissue
- The filler was injected too close to the skin surface or in the wrong anatomical plane
- Your immune system overreacts to the filler material
- Unregulated substances (like liquid silicone oil, “proprietary” permanent gels, or counterfeit PMMA) were injected by non-urologist providers
Granulomas don’t form quickly. They often appear months or even years after the original procedure. This delayed reaction happens because the immune system slowly builds up its response over time.
Granulomas caused by PMMA are especially difficult because PMMA is a permanent filler. Since the body can’t break it down, the immune response can persist, keeping the granuloma active.
Granulomas from silicone oils or mystery fillers are often even more complex, because these materials were never meant to be in penile tissue at all.
Penile Filler Granuloma vs Nodule: Key Differences
It’s important to know whether your lump is a granuloma or a nodule. These two problems may feel similar at first but are treated very differently.
Nodules
- Feel soft to firm
- Often move under the skin
- Usually appear relatively soon after the procedure
- Caused by fat deposits, oil pockets, or clumps of filler
- Often improve with massage, time, or simple in-office care
Granulomas
- Feel harder and less movable
- May be tender, warm, or inflamed
- Often appear weeks, months, or even years later
- Caused by your immune system reacting to filler material—especially permanent or unregulated substances
- Usually require medical treatment (enzymes, medication, or surgery)
A typical case might involve a man who had penile HA filler six weeks earlier. He notices a small, soft lump that moves under the skin. His provider diagnoses it as a filler nodule and recommends massage and monitoring.
In contrast, another patient who had permanent filler or “PMMA” injections six months ago notices a hard, fixed lump. He later learns that he may have been injected with unregulated filler instead of FDA-approved Bellafill. His urologist suspects a granuloma, which requires careful treatment to avoid worsening inflammation.
Diagnosing the Lump
To find out whether a lump is a penile filler granuloma or nodule, a doctor will consider:
- How the lump feels (soft vs hard, movable vs fixed)
- Where it is located
- When it appeared
- What material was injected and how much was used
- Whether the injector was a board-certified urologist or a non-urologist med spa / “enhancement clinic”
Sometimes, doctors use ultrasound imaging to see the lump more clearly and distinguish between fluid, fat, and solid granulomatous tissue.
At Rejuvall, this full assessment helps give a clear diagnosis and a safe, realistic treatment plan.
Treatment Options for Penile Filler Granuloma vs Nodule
Treatments depend on what type of lump you have and what material was injected.
For Nodules
Doctors usually suggest:
- Massage and time (for mild HA or fat nodules)
- Warm compresses
- Hyaluronidase injection if the nodule is from HA filler
- Fine-needle aspiration or small excision for persistent fat nodules or oil cysts
Doctors will carefully monitor to make sure nodules don’t grow, become painful, or show signs of infection.
For Granulomas
Treatment is more complex and should be handled by a provider who understands both penile anatomy and filler behavior.
HA-related granulomas may respond to:
- Hyaluronidase to dissolve the HA
- Steroid injections to calm the immune response
- Short courses of anti-inflammatory medication
PMMA-related granulomas are harder to treat and often require:
- Careful surgical debulking of the granuloma
- Micro-excision of affected areas
- Medication to reduce inflammation before and after surgery
Granulomas from unregulated materials like silicone oil or “mystery fillers” are among the most difficult cases and often need staged, reconstructive approaches.
At Rejuvall, PMMA and silicone granuloma treatment is carefully planned to preserve sexual function and appearance while removing as much problematic material as safely possible.
How to Prevent Lumps After Penile Filler
Good planning and proper technique greatly reduce the risk of lumps after penile filler. To lower your risk:
- Choose dissolvable fillers like HA first, before considering permanent options.
- Avoid unregulated substances marketed as “pharmaceutical grade silicone,” “CMC filler,” “Silikon,” or “proprietary permanent filler.”
- Limit how much filler is injected per session—especially with permanent fillers.
- Choose a board-certified urologist with specific expertise in penile enhancement, not a generic med spa or unregulated injector.
- Look for clinics that use controlled, cannula-free, layered techniques rather than bulk injections.
Each of these steps lowers your risk of nodules and granulomas. Rejuvall’s foundational approach uses HA first to “prime” the tissue and significantly reduce granuloma risk before any Bellafill (PMMA) is considered.
Why Rejuvall Is the Best Choice for Penile Filler Granuloma vs Nodule Treatment
At Rejuvall, Dr. Kenneth Jeffery Carney, MD, PHARM, FACS and his team specialize in helping men with lumps after penile filler—Whether it’s a simple nodule, a complex granuloma, or damage from unsafe injections.
What sets Rejuvall apart:
- Board-certified reconstructive urologist and cosmetic surgeon performing and managing all enhancement and repair procedures
- Experience with both HA (Revanesse Versa®) and FDA-approved Bellafill® PMMA, plus extensive experience repairing complications from silicone, counterfeit PMMA, and “mystery” fillers
- Access to both non-surgical and surgical options, so your treatment can be tailored to your specific situation
- Patients traveling from across the U.S. for expert evaluation and repair
Many cosmetic clinics simply do not have the urologic training or surgical tools to manage penile filler complications safely. Rejuvall does.
Whether your lump is new or has been there for months, seeking expert care with a reconstructive urology team is the safest path forward.
Final Thoughts: Understanding Penile Filler Granuloma vs Nodule
In summary, understanding the difference between a penile filler granuloma vs nodule is key to getting the right treatment:
- Nodules are common and usually harmless, often improving with time, massage, or simple in-office care.
- Granulomas are immune reactions—more likely with permanent or unregulated fillers—and usually need medical treatment or surgery.
If you notice a lump after penile enhancement, don’t guess. Rejuvall can:
- Help you figure out exactly what’s going on
- Explain whether your lump is likely a nodule or granuloma
- Develop a safe, step-by-step plan for treatment and long-term health
If you’ve had penis filler or fat transfer and now feel a lump, contact Rejuvall for a confidential consultation. Getting the right diagnosis is the first step toward peace of mind and proper healing.
📞 To speak with our case consultant about penile filler nodules or granulomas, call (445) 220-0765 or complete our Cosmetic Urology Assessment form to schedule your private phone consultation.
Dr. Steven L. Morganstern, M.D.
Dr. Morganstern is an internationally acclaimed, board-certified urologist, surgeon, and best-selling author specializing in men’s sexual health. A pioneer in erectile dysfunction therapeutics, Dr. Morganstern was the only private clinician selected for the original Viagra trials and has spent over four decades advancing treatments in ED, cosmetic urology, hormone replacement, and prostate health.