Ellanse S or M? Picking the Right PCL Collagen Stimulator

This article is intended for qualified aesthetic practitioners and prescribers. It is not medical advice for patients, and it does not replace the manufacturer's Instructions for Use (IFU) or your own clinical training.

Ellanse (Ellansé) is a collagen stimulator made of polycaprolactone (PCL) microspheres suspended in a carboxymethyl cellulose (CMC) gel. It gives immediate volume from the gel carrier, then relies on the microspheres to drive new collagen as the gel is resorbed. For practitioners, the decisions that matter are which version to choose, which plane to place it in, and how to avoid the nodules that almost always trace back to technique. This article covers all three, with reference to the published consensus recommendations, and compares Ellanse with PLLA and CaHA so you can decide where it fits in your treatment menu.

What Ellanse is made of and how it works

The product is a CE-marked medical device rather than a medicine, which is why it sits alongside HA fillers rather than prescription-only products in your stock planning. A 2022 paper in Clinical, Cosmetic and Investigational Dermatology describes it as "a suspension of 25–50 micron diameter microspheres of polycaprolactone (PCL) (30%) in a carboxymethyl cellulose (CMC) gel carrier (70%)", measured by volume (Angelo-Khattar, 2022).

The two components do different jobs:

• CMC gel carrier provides the immediate correction you see on the treatment couch. According to the 2017 consensus paper, it "is gradually resorbed by macrophages in 6–8 weeks" (de Melo et al., 2017).
• PCL microspheres are smooth and spherical, and stay in the tissue where they stimulate neocollagenesis. The same consensus paper notes that "collagen type I becomes progressively predominant over collagen type III" over time.

In practice, this means the early result is mostly gel and the later result is mostly the patient's own tissue response. That two-phase behaviour shapes everything else: how much you inject, whether you overcorrect, and how you set expectations at consultation.

Ellanse S, M, L and E: what the letters mean

The range is split by the molecular length of the PCL chains, which governs how quickly the microspheres degrade. The 2017 consensus paper lists "Ellansé-S (short, S version), Ellansé-M (medium, M version), Ellansé-L (long, L version) and Ellansé-E (extra-long, E version) with expected in vivo longevity of 1, 2, 3 and 4 years, respectively". It also points out that the L and E figures "are based on extrapolation of clinical data with S and M versions and known PCL-degradation behavior", so treat those two as projected rather than directly measured.

In the UK, S and M are the versions most practitioners work with day to day, and they are the two Filler World stocks: Ellanse S (2x1ml) and Ellanse M (2x1ml). Both are also listed together in the Aqtis collection.

Choosing between S and M

There is no universal rule, but these questions help:

• Is the patient new to biostimulators? Many injectors start with S. A shorter expected duration is easier to live with if the patient is unsure about the result or you are still building your own experience with the product.
• How stable is the patient's face? A patient who is losing weight, or who has a big life change coming up, may suit a shorter-acting product better than a longer one.
• How thin is the soft tissue over the target area? Thin coverage raises the stakes of any visible product. Longer-acting material is less forgiving there, so be more conservative.
• Is this a repeat patient who tolerated S well? Moving to M can reduce the number of maintenance visits. Agree that with the patient in your consent discussion.

Where Ellanse is used, and where it is not

The consensus group recommends "subcutaneous or deeper, supraperiosteal placement of the PCL-based stimulator ... for the face, and subcutaneous placement ... for hands." The paper works through the forehead, lateral brow, temple, malar region, nose, nasolabial folds, submalar area, marionette lines and oral commissures, mental crease, chin, prejowl sulcus and jawline, and the dorsum of the hands.

Just as important is the exclusion list. The same paper states plainly: "It is not indicated as a treatment for lips, glabella or eyelids." Keep HA products for the lips and for fine, superficial work. This is not a product for the vermilion or for anything you would place intradermally.

Planes and devices by area

The consensus recommendations give area-specific advice. A few points worth remembering:

• Forehead: supraperiosteal, using a 22 or 25 G microcannula, with massage straight after injection.
• Temple: a 22 or 25 G blunt cannula in the relatively avascular plane between the superficial temporal fascia and the superficial layer of the deep temporal fascia. The authors advise against the inferior approach over the zygoma.
• Malar: a 22 G or 25 G cannula, with a 27 G needle as an option where you need more precision.
• Nasolabial folds: supraperiosteal in the upper third and subcutaneous in the lower two-thirds, with a 27 G needle (0.1 mL maximum per bolus) or a 25 G cannula.
• Chin and jawline: a 27 G needle or a 22–25 G cannula. Avoid injecting directly into the mental foramen.
• Hands: a 25 G or 22 G cannula, in the most superficial subcutaneous layer.

If you mostly work with cannulas, our earlier article on choosing a cannula for dermal filler covers gauge and length selection in more detail.

Technique points that prevent nodules

Lumps and nodules are the complication practitioners worry about most with any particulate stimulator, and the consensus paper links them mainly to technique. Its lateral brow section warns that "injections that are too superficial are likely to result in a lumpy appearance", and the same theme comes up in the submalar and mental crease sections. The practical takeaways:

1. Stay deep enough. Subcutaneous or supraperiosteal, never intradermal.
2. Keep deposits small. The paper recommends "small amounts (no higher than 0.2 mL)" per deposit, and lower limits in some areas, such as 0.1 mL per bolus in the nasolabial fold.
3. Inject while moving. Use retrograde linear threading or fanning in small gradual amounts, rather than parking a bolus.
4. Don't overcorrect. The authors explain that "the biostimulatory capacity means that there is no need for overcorrection, as the subsequent collagen synthesis will be sufficient to obtain the desired result." In areas with thin coverage, such as the nose, marionette lines and prejowl, they go further and recommend undercorrection until you have built up experience.
5. Massage. The paper advises that "the treated area should be gently massaged immediately afterward to ensure even distribution."

It cannot be dissolved like HA

PCL is not hyaluronic acid, so hyaluronidase has no effect on it. That changes your risk calculation. Material that is poorly placed cannot simply be reversed, so careful patient selection, anatomical knowledge and conservative volumes matter more than they do with HA. Your complications protocol for vascular events should still be in place, and anyone injecting a non-reversible product should have training in managing complications.

Patient selection and contraindications

The consensus paper lists contraindications that include "autoimmune disease, pregnancy, breastfeeding, current medication with high-dose steroids, uncontrolled diabetes, metabolic syndrome, any signs of infection in the treated area, active herpes and coagulation/bleeding disorders." Always check the current IFU supplied with the product, which takes precedence over any article, this one included.

Ellanse vs Sculptra and Radiesse

All three are biostimulators, but they behave differently in the treatment room.

• Ellanse (PCL): comes pre-filled and needs no reconstitution. The CMC gel gives a visible immediate correction, and there are several duration options within one family.
• Sculptra (PLLA): a powder you reconstitute before use. It gives little lasting immediate volume, because the visible early fullness is mostly diluent, and it is usually built up gradually over a course of sessions. See Sculptra 2 Vials (2x5ml), or the wider PLLA stimulators collection, and our article on PLLA filler.
• Radiesse (CaHA): calcium hydroxylapatite microspheres in a gel carrier, often used diluted or hyperdiluted for skin quality. We cover it in our Radiesse article.

Choose between them based on the area, the patient's tolerance for a gradual versus an immediate result, your preferred workflow (reconstitution or ready to use), and your own training and experience. None of the three is a substitute for HA in the lips or for superficial fine lines.

Storage and handling

Ellanse is supplied as pre-filled syringes, so there is no mixing step. Store and handle it according to the manufacturer's IFU. Check expiry dates when stock arrives, and record batch numbers in the patient's notes so the product can be traced. If you buy wholesale, only use suppliers who source through the authorised UK supply chain.

Frequently asked questions

Can Ellanse be dissolved?

No. Hyaluronidase breaks down hyaluronic acid, not polycaprolactone, so it will not dissolve Ellanse. This is the main reason to inject conservatively and deep, and to keep Ellanse out of areas where you might want a reversible option.

How long does Ellanse last?

The 2017 consensus paper gives an expected in vivo longevity of roughly 1, 2, 3 and 4 years for S, M, L and E respectively, with the L and E figures extrapolated from S and M data. Individual results vary, so present these as expected ranges rather than promises.

Is Ellanse a dermal filler or a biostimulator?

Both, in effect. The CMC gel gives immediate volume like a filler. The PCL microspheres then stimulate collagen production as the gel is resorbed over the first couple of months.

Ellanse vs Sculptra: which should I use?

Ellanse is ready to use and gives an immediate correction. Sculptra needs reconstitution and builds up gradually over several sessions. Your choice usually comes down to the treatment area, how quickly the patient expects to see a result, and your own workflow and training.

Can Ellanse be used in the lips or under the eyes?

The consensus recommendations state that it is not indicated for the lips, glabella or eyelids. Most practitioners keep HA products for these delicate, superficial areas.

The bottom line

Ellanse gives practitioners a ready-to-use collagen stimulator with a choice of duration, but it rewards discipline. Place it deep, keep deposits small, avoid overcorrection, and respect the areas it is not indicated for. Because it cannot be reversed with hyaluronidase, good patient selection and a robust consent process matter more than ever. If you want to add PCL to your range, Ellanse S is a sensible place to start before moving patients onto M.