We’ve noticed a lot of guys here talk about nodules, granulomas, or unevenness after penile filler like it’s just “part of the deal” and something everyone should expect to fix later. With our 25+ years of experience performing penile
Girth enhancement injections with FDA-approved dermal fillers, we wanted to address this commonly held belief because while these problems are unfortunately common, they’re not inevitable — and they’re almost always preventable when the right materials, volumes, and techniques are used.
Why These Problems Happen in the First Place
1. Technique — It’s Not Just About the Tool or Depth
A lot of the public conversation focuses on whether a provider uses a cannula or a needle, or how deep the filler is placed. In reality, you can end up with nodules, granulomas, or unevenness with either tool and at virtually any depth. The tool and depth don’t make nearly as much difference as people think.
The key things that do matter:
- Even distribution in small amounts rather than large blobs that can clump together.
- Multiple passes and blending so the filler integrates smoothly.
- Gentle tissue handling to minimize trauma and inflammation.
When filler is placed unevenly, in overly large deposits, or with excessive tissue trauma, your risk of irregularities goes way up — regardless of whether it’s deep or shallow.
2. Overfilling in a Single Session
This is one of the biggest contributors to the cases we end up repairing. Many practitioners will inject 15–20+ cc in a single session. That’s a lot of foreign material for the tissue to integrate at once, and it often leads to:
- Clumping because the tissue can’t absorb the volume evenly.
- Stronger inflammatory response, increasing granuloma risk.
- Skin stretching or thinning that exaggerates any irregularities.
A slower, staged approach with smaller volumes allows the tissue to adapt and gives the provider a chance to build the result more precisely.
3. Material Choice
PMMA: Long-lasting but unforgiving. High-volume injections or poor placement can trigger granulomas that require surgical
Removal or micro-aspiration. Steroids such as
Kenalog can soften these lumps but will not dissolve them.
Hyaluronic Acid: More forgiving and dissolvable if needed, but overfilling or uneven distribution can still cause lumps.
Silicone oil: Should never be injected. It will migrate, cause chronic pain, infections, and severe disfigurement, and is extremely difficult or impossible to remove completely.
4. Perspective From Frequent Repair Work
At
Rejuvall, we
Repair more post-filler complications than just about any clinic out there — nodules, granulomas, unevenness, and other irregularities from all over the U.S. and abroad. The overwhelming pattern we see is that these problems almost always tie back to preventable factors: too much filler, uneven placement, or the wrong material.
Why It’s Not “Normal”
If a provider tells you that you should plan on needing
Revision work after a filler session, that’s not an honest reflection of what’s possible with a careful, conservative approach. Yes, no procedure is risk-free — but properly planned injections with controlled volumes and sound placement can greatly reduce the odds of needing a fix later.
The Takeaway
Nodules, granulomas, and unevenness shouldn’t be viewed as an unavoidable cost of getting filler. They’re usually a sign that something in the process could have been done differently — and better. Prevention through good planning and careful technique is always easier (and less expensive) than
Repair.
Final thought: If you’re considering filler, don’t just ask what product is being used — ask how much will be placed, how it will be distributed, and what the provider’s plan is to minimize the need for future repairs. Those answers will tell you a lot more about your risk than the tool or the injection depth ever will.
