Everwrinkle side effects and nodules — what can happen, and how do we lower the risk?
A word people considering PLLA often type into the search box is “nodules.” It is a side effect worth taking seriously. But there is data showing it is not a matter of luck; it depends a great deal on dilution, layer and aftercare.
The short answer
Everwrinkle side effects fall into two groups: common ones like bruising, swelling and redness that settle within days, and nodules, which need to be managed specifically with PLLA products. In data on Sculptra, also PLLA, nodules fell from 17.2% in the 5 mL dilution era to 1.0% after moving to 9 mL, and in a randomized comparison the more diluted group was lower too, 1.3% vs 8%. PLLA does not dissolve with hyaluronidase, so the layer and amount at the first session matter. At Miso Clinic, 4F Bombom Building, 125 Dongdeok-ro, Jung-gu, Daegu (Exit 1, Kyungpook Nat'l Univ. Hospital Station), +82-53-428-2700, we mix it thoroughly following the product instructions and place it in deep layers over divided sessions.
What side effects can Everwrinkle cause?
| Type | What it is | Course |
|---|---|---|
| Common | Bruising, swelling, redness, tenderness when pressed | Usually a few days to 1–2 weeks |
| Needs management | Palpable nodules (small lumps) | Weeks to months after treatment |
| Rare | Infection, vascular problems, granuloma | Needs prompt medical care |
Since this is an injection, some bruising and swelling can happen. The real issue is a nodule you can feel weeks or months later. This column focuses on that.
Why do PLLA nodules form?
PLLA particles need to spread evenly in the skin. If they clump in one spot, go into too shallow a layer, or pool where muscles move a lot, collagen forms in a concentrated way around them, and you may feel it as a lump.
- Not enough dilution, so it goes in too concentrated
- Placed in too shallow a layer
- Placed where there is a lot of movement, such as around the mouth or eyes
- A large amount placed at once
How high is the risk of nodules?
There is no data yet on the nodule rate for Everwrinkle itself. In the US approval data for Sculptra, also PLLA, nodules occurred in 17.2% of 116 people when it was mixed with 5 mL, and fell to 1.0% of 97 people after mixing with 9 mL. In a randomized comparison of 150 people, the group with a thinner 10–12 mL dilution had 1.3%, against 8% with standard dilution.
What these numbers tell us is that nodules are “a risk you can reduce.” So how the product is prepared and placed matters as much as which product you choose.
How do we lower the risk of nodules?
- Mix thoroughly according to the product instructions and let it disperse well before treatment
- Place it in the deep dermis or subcutaneous layer — the approved layers
- Divide it into sessions rather than putting a lot in at once
- Avoid areas with a lot of movement or thin skin, or use very little there
- Follow the massage instructions for the first few days
With PLLA products, you are often asked to gently massage the treated area for a few days afterward. I will tell you exactly how and how often on the day of treatment.
What happens if a nodule forms?
PLLA does not dissolve with hyaluronidase. So unlike hyaluronic acid filler, it is not a case of “dissolve it and you are done.” Most nodules soften over time, though, and data on PLLA report improvement in 85–96% with conservative management.
Depending on size, timing and whether there is inflammation, we consider watching it, massage or injection treatment. If you feel a lump, do not press or squeeze it yourself; come in to be seen. More detail is in my column on nodules after treatment.
What precautions apply before and after treatment?
- If there is inflammation, acne or a wound in the area, we postpone that day
- We do not treat during pregnancy or breastfeeding
- Avoid saunas, heavy drinking and intense exercise on the day of treatment
- Contact us right away if the area turns red, swollen and warm, or the pain keeps getting worse
Everwrinkle side effects: frequently asked questions
How often do Everwrinkle nodules happen?
There is no data on Everwrinkle itself yet. In data on Sculptra, also PLLA, the rate fell to 1.0% after the dilution volume was increased. We lower the risk with dilution, layer and divided sessions.
Can Everwrinkle be dissolved?
PLLA does not dissolve with hyaluronidase, which is why we are especially careful with the layer and amount at the first session. Most nodules soften over time.
Do I need to massage after Everwrinkle?
With PLLA products, massage for a few days after treatment is often advised so the particles spread evenly. I will explain how and how often on the day of treatment.
Where can I discuss Everwrinkle side effects in Daegu?
Contact Miso Clinic in Daegu (4F Bombom Building, 125 Dongdeok-ro, Jung-gu, Exit 1 of Kyungpook Nat’l Univ. Hospital Station). +82-53-428-2700. Weekdays 11:00–19:00, Saturday 10:00–16:00, closed Sundays and public holidays.
Read next
Product pages
Who wrote this
Written and reviewed by Lee Chi-Hak, MD, director of Miso Clinic, Daegu. The treatment standards and injection design set out here are the ones we use in practice.
| Medical director | Lee Chi-Hak, MD |
|---|---|
| Address | 4F Bombom Building, 125 Dongdeok-ro, Jung-gu, Daegu, South Korea · Exit 1, Kyungpook National University Hospital Station |
| Phone | +82-53-428-2700 |
| Hours | Weekdays 11:00–19:00 (lunch 13:00–14:00) / Saturday 10:00–16:00 (no lunch break) / Closed Sundays and public holidays |
| Columns | All clinical columns |
| Reference library | All booster and device references |
References
- Everwrinkle and Everwrinkle V product information — PharmaResearch Co., Ltd. official website, Products > Medical Devices (accessed 2026-10-28). Everwrinkle 1 vial (121.7mg)/box, Everwrinkle V 1 vial (243.4mg)/box; ingredients PLLA (poly-L-lactic acid), CMC and mannitol; intended use “temporary improvement of moderate to severe nasolabial folds in adults through physical restoration, by injecting a poly-L-lactic acid suspension into the deep dermis or subcutaneous layer”; store at room temperature at or below 30°C, do not freeze. The product photos are also taken from this page.
- Data on PLLA nodules — Sculptra US approval documents: 17.2% of 116 people in the 5 mL dilution era (2009), down to 1.0% of 97 people with 9 mL dilution (2023). Palm et al., randomized comparison of 150 people: 1.3% with 10–12 mL dilution vs 8% with standard dilution. (As cited in the existing column on nodules, /en/column/nodules/.)
- Human studies on PLLA — Liu et al., J Craniofac Surg 2026, PMID 42594306 (nasolabial folds, 208 people randomized, PLLA vs hyaluronic acid, 89.80% vs 92.78% at 4 weeks, 55.56% vs 25.00% at 120 weeks, P<0.001) · Kim et al., Aesthetic Plast Surg 2025, PMID 40897963 (55 people, split-face, another PLLA product vs Sculptra, non-inferior at 24 months) · US FDA PMA P030050/S039 (2023, Sculptra, 149 people randomized, 70.7% vs 25.9% at 12 months). All of these are data on other PLLA products, not on Everwrinkle.
- Korean medical advertising law — Medical Service Act Art. 56(2) (no treatment testimonials, no comparisons with other clinics, no superlatives), Art. 27(3) (no inducing patients for profit), Art. 45 (disclosure of non-covered fees). This is why this column carries no prices, reviews or before-and-after photos.
- Miso Clinic treatment policy — Everwrinkle arrived and treatment began on October 28, 2026. We also carry Sculptra and the full JUVELOOK lineup. Before treatment we show you the genuine product box and approval information, and we first decide whether hollowing, skin texture or nasolabial folds are your main concern before choosing a product. Results are judged after 2–3 months with photos taken under the same conditions.
Everything in this column is general information and does not replace medical diagnosis or treatment. Effects and side effects vary with individual skin condition, age and underlying illness, and the same result is not guaranteed for everyone. Any decision to proceed should be made in an in-person consultation with a physician.