The Management of Poly-L-Lactic Acid (PLLA) Nodules: A Scoping Review and Evidence-Mapped Clinical Pathway

Poly-L-lactic acid (PLLA) is a collagen-stimulating, biodegradable filler used for facial rejuvenation and body contouring. Though relatively safe, PLLA-related nodule formation and granulomatous reactions remain significant clinical complications with no adequate evidence-based management guidelines. This scoping review aims to summarize the available literature on the prevention, diagnosis, classification, and management of PLLA-associated nodules and to propose an evidence-based management pathway. The present study conducted a PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews)-compliant scoping review by searching PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library from 2000 through April 2026. Inclusion criteria included all studies reporting PLLA-related nodules. A total of 40 studies were identified as eligible, including case reports, case series, retrospective cohorts, RCTs, systematic reviews, and expert consensus statements. Nodule formation appeared to be linked to various factors such as the dilution protocol, injection technique, reconstitution method, and injection depth. Clinical phenotype identification revealed four phenotypes: non-inflammatory, inflammatory-immunologic, infectious-biofilm, and other unusual presentations. Useful diagnostic aids included ultrasound and high-frequency ultrasound, and histopathological confirmation was recommended for atypical presentations. Various management techniques included conservative management, intranodular corticosteroids, 5-fluorouracil, antibiotics, immunotherapy, and surgery. The present study proposes a four-phenotype classification and a six-step evidence-based management algorithm for PLLA nodule presentation. Effective management appears to begin with prevention.