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HA injectable Phalloplasty - for safety

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Skeptical One and members,

I am a doctor providing injectable penis augmentation with HA in Australia. So remember to take anything I say with the understanding that I will probably write to support what I do. But I will try and explain why i do it and why I don't think there is anything better available at the moment. When I find something better, then we will look to change.

I have been working in the area of cosmetic surgery for 17 years after originally training in ENT surgery. Yes this is a significant career change. I mostly did facial plastic surgery for 15 years but had occasional requests for phalloplasty. After seeing how the surgery was done I did not really want to take it up - I did not think I would want it myself. But there were a number of articles published in the medical literature using HA's that interested me.

I began injecting cosmetic fillers (Collagen and Hylaform) back in 2000. I have seen a number of permanent fillers come and go. I have seen some significant complications of permanent fillers. I have also seen complications of temporary fillers - but the complications were temporary as well.

For any cosmetic surgery safety is the most important thing. It is not like cancer surgery where scars or significant issues are accepted. This is why I have avoided the permanent fillers. I have also avoided stimulatory fillers (Newfil, Elanse, Radiesse). Stimulatory fillers may be fine - but the risks are somewhat increased and not acceptable when we were starting a new procedure.

The issues to overcome were making sure it was painless, did not risk obstructing the penile artery or urethra, being smooth and even and minimal down time.

We are happy that we can get the penis nice and numb. Without needles.

The injecting layer (essentially just below the skin, between the Dartos and Buck's fascia) is easy to get into and stay in using blunt cannula. By using blunt cannula and staying in the right layer there is no risk of blocking a vital structure.

Getting it even is usually not difficult. The advantage of a cosmetic doctor over a urologist for this procedure is that we are experienced and skilled in performing cosmetic injectables. We know how to get it nice and smooth. But even then there is the occasional penis with (circumfential) bands which can be difficult to even out completely.

Injectable phalloplasty is a walk-in/walk-out procedure. We ask guys to give it a rest for a few days - but guys love to come back and tell us how they put it to use that night. Preferably give him a rest.

One of the great advantages of HA's is that they are completely reversible with a medication called Hyalase which is an enzyme to dissolve HA. This is one reason why it is our main injectable filler anywhere - you can get rid of it if you need to. In the penis the great thing is that if, for any reason, you were not happy we could do a few small injections and get rid of it all in a few minutes.

Obviously the main problem with HA's is that they are not permanent. We use Voluma (part of the Juvederm range) made by Allergan. This is the world number 1 HA by the biggest company in the business with the most research to back it up. They(Allergan) are intrigued by its use in injectable phalloplasty but it is strictly off-label. That means the company has not researched it and had it approved for this use in Australia.

After reading all I could, trying to get in contact with the Korean doctors (but failing), we tried our first patient in 2014. With just 5 ml of a different HA (initially tried a different HA because HA's are really expensive in Australia and the other company was willing to let me have some at a discounted price for the trial). He was happy - as was his wife. We did another 5ml.

Then I honed the technique on number of friends (quite an unusual experience, handling your friends penis's - and sticking a needle into it). We gradually improved the early results and waited to see how it would last. The Korean's had 90% retention after 18 months with what I feel is an inferior HA. Even in the last 6 months we have made further refinements to technique to improve results.

To improve longevity we have switched to Voluma. I have it in my face and it has lasted over 2 years. Voluma has the best researched longevity of any HA. HA's always last longer when injected in large amounts. HA's should have good tissue integration when injected correctly. That is it should not be injected in 1 big blob. With correct technique there are lots of fine collagen bundles around and it will not move. There are places in the face, such as the tear trough, where HA's last much longer (routinely years). It is hoped the penis will be another of these locations where there is less local, natural hyaluronidase (the dissolving enzyme) so it will last a decent time.

So yes we do have clinics on the east and west coast of Australia. I believe we do more injectable phalloplasties than anyone else in the country - but we have really only been doing it a relatively short time. We focus on safety first.

Free fat transfer can give good results. But I have also seen infections, resorption, unevenness. PMMA/Megafil/Silicone/Articol etc are too great a risk. I am sure there are guys with great results they are very happy with. The question to ask yourself is "If I get one of these minor/major problems how am I going to cope?". Surgery with lengthening and dermal fat grafts can be successful, with the right surgeon. But is major surgery, very expensive (>$30K in Australia) and has protracted down time.

I am happy to answer questions - but remember again - I have a commercial interest in this. But that commercial interest requires happy patients.

The Effects of Penile Girth Enhancement using Injectable Hyaluronic Acid Gel, a FillerTae Il Kwak MD1, MiMi Oh MD1, Je Jong Kim MD2 and Du Geon Moon MD2,
The Journal of Sexual Medicine Volume 8, Issue 12,  3407–3413, December 2011

Use of Macrolane VRF 30 in Emicircumferential Penis Enlargement
Giuseppe Sito, MD,Sergio Marlino, MD,Adriano Santorelli, MD
Aesthetic Surgery Journal February 2013 vol. 33 no. 2 258-264

Human glans penis augmentation using injectable
hyaluronic acid gel
JJ Kim1, TI Kwak1, BG Jeon1, J Cheon1 and DG Moon1
International Journal of Impotence Research (2003) 15, 439 - 443


Category: General Phalloplasty Discussion


Confirmed for girth, biceps and delts on May 9th and 10th

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I have been reading this board for months and wanted to thank all of you for your insight. I have been obsessed with the idea of having a thicker penis especially with less retraction.



There is no perfect option. I have seen the risks and PMMA with Dr. C seems to be the best permanent option. I have been pumping for years and love the results and always feel small when the swelling goes away. I am also hoping that it will slightly increase my sensativity as well, but at this point just the visual appeal alone has me sold.



I chose to have the bicep and shoulders done at the same time as I have been working out with a trainer three days a week with a solid diet for two years and I am still not happy with my arms. Yes this is a bit vain, but it is hard to feel satisfied with what we have.



I will try and cover all my stats and document my experience to share with the rest of you.



Again to all of you posting I really appreciate it.







Category: General Phalloplasty Discussion

Non-Permanent PMMA?

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Today I've read twice that no matter the material, as long as it is under a certain size your macrophages should be able to swallow it up and get rid of it, rendering the procedure non permanent.
Is this true? Can your body really swallow up anything under a certain size (even accrylic beads) and get rid of it? If so, do you think a tiny beaded version of PMMA could provide permanent size without the risk of keeping the accrylic beads?

I would guess that the only thing <80 micron PMMA would do is provide temporary girth. Since it seems walling off with collagen only happens when macrophages can't swallow/remove the beads. But maybe not? What do you vets think about this?




My 'evidence':

One doctor on RealSelf (responding to a patient complaining of PMMA lumps): 'This is a very difficult problem and is probably due to the variability in particle size of precise.  Anything less than 80 microns can be gobbled up (phagocytized) by macrophages in your immune system. So in this case, your body is attempting to attack and wall off the particles.'

Then a (non medical doctor) who answers emails for one of the injectable filler doctors here told me:   'There are forms of PMMA with a partial size small enough for macrophages, so non-permanent biostimulators too.'

Category: General Phalloplasty Discussion

No PMMA in Circ Scar? (tunnel theory)

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After 2 full rounds of 30% PMMA, my circ scar looks like shit (especially when flaccid). It's much wider than my glans and also the rest of my shaft...honestly the exact look I was not hoping for.

So in this next session, I'm hoping to get PMMA placed only behind my circ scar - I want NO additional PMMA to be placed in the circ scar. I would actually be very upset if any more size did accumulate in the circ area.

I asked Wade if this was even possible, or if the PMMA will flow up toward the circ scar even if not injected there. His response:

'If we taper PMMA from your base to the circ scar, there should not be any migration to areas where we did not do tunneling with the micro cannula.'

I'm somewhat skeptical of this though because so far after each session my entire unit has swelled up, including the circ scar, and it's not like the Dr. ran the cannula over every square inch of my dick to make a tunnel everywhere first. Is Wade correct about being able to totally exclude the circ area and am I worrying for nothing? Have any of you ever asked for NO additional PMMA to be placed in the circ scar, and did they deliver?

Category: General Phalloplasty Discussion

Dr. Jane Chung in San Jose

PMMA available in California

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Hey guys I may be late to the show but thought I would post this as it might help someone. I am not interested in PMMA personally but I know a lot of guys on here are and I found a Dr. in my area who is offering PMMA (Bellafill). I stumbled across her while looking for Voluma for myself which she also does, as well as a lot of other fillers. Her name is Dr. Jane and the website was surprisingly informative. She even offers sensitivity tests (to the product) prior to injecting Ha and PMMA! Probably extra, but if they work could be a bullet dodger for some men? Only thing I thought was a little strange is Bellafill is referred to as semi permanent on her site? Anyways, I am not very knowledgeable in PMMA so this may be accurate for this particular brand? Hope this info helps someone out!



LL



http://www.jenesislipoplasty.com

Category: General Phalloplasty Discussion

can you get pmma with a penile prosthesis?

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I am 21 and after having a venous leakage my penis continues to get shrink and I can't get an erection anymore.



At this rate I'm probably headed for a penile prosthesis. Can you get pmma with the prosthesis?

Category: General Phalloplasty Discussion

What's the purpose of massaging PMMA?

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So my third full round of 30% Metacrill is in 24 hours. Over the last two rounds I've got pretty bad results, mainly stemming from aftercare. This round I plan to possibly go against the generally accepted wisdom and not use an extender/ads at all for the first 72 hours after PMMA. I feel that it may compress the beads down unnecessarily when the skin is pulled taught like that.

However, one aspect of aftercare that almost everyone agrees on (and the most preached method by Wade) is massaging your PMMA afterwards. I was just wondering what the potential negative implications of massage are? What if massaging is actually counterproductive because it compresses beads together (forming nodules?) and completely changes the injection method around?

Does anyone have any thoughts on this? Sure massage could be necessary to put product back in its original placement if it has moved during the first 2-3 days, or to flatten out an imperfection. I'm just wondering the potential negative implications of mashing those beads so closely together, as god damn I have a lot of clumping, ridges, nodules, etc.

Category: General Phalloplasty Discussion


Does PMMA reduce penis 'definition' ?

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Will significant PMMA make a penis look cylindrical, and lose some of the definition in terms of cross-sectional shape and vascularity?

For instance, on the underside where the corpus spongiosum meets the 2 cavernosum, my spongiosum juts out quite a bit and creates a nice ridge the whole way along the length of the shaft. Will this be reduced or lost, in favour of a uniformly round shape with PMMA treatments?

The same goes for vascularity, is this reduced or lost with subsequent injections?

Category: General Phalloplasty Discussion

Localized PMMA?

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Just a random curiosity but it local PMMA injection a practice? Like, if I wanted no PMMA mid-shaft or base but only towards the end. I hear PMMA migrates a bit, so would that be at all possible? Would that still a minor "permanent flaccid lengthening effect" on the injected area?

Category: General Phalloplasty Discussion

Contact Dermatitis or fungal infection

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Hello all,


About 2 weeks ago I jerked off hard, 3 times in a row and it really irritated the hell out of penis.

Here are 2 pictures. 

http://i1379.photobucket.com/albums/ah143/bwhited1/IMG_0524_zps985tsk46.jpg
http://i1379.photobucket.com/albums/ah143/bwhited1/IMG_0526_zpsmmfbnut9.jpg

What kind of cream should I get, anti-fungal, anti infection? Both?

I know I don't have an std because I got tested 3 weeks ago and after that had sex with only 1 person with a condom. 

Category: General Phalloplasty Discussion

Attention "Rifflair"

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Firstly, I am creating a new thread because Astrix1981 requested we not hijack his thread (and rightly so)...Sorry Astrix1981



Rifflair

This is what you wrote...your first ever post to the board. It's in response to a negative comment about Dr. Elist.



Post number 1 by "Rifflair"

"He has 27 patents to his name, and is employed by multiple medical research companies. I am all for sharing your opinions and insights, but any criticism that seems to go to such extremes that result in doctors being perceived as incompetent or lunatic should be at least supported by some proof. Reputation is extremely important in this field, I am pretty sure that thanks to this board Dr. Elist has lost at least 50 potential patients.

Please also take into consideration that what Dr. A has described in his patents currently has no scientific backing, using medicine used for erectile dysfunction and treatment of Peyronie disease for penis enlargement can lead to losing your medical license and livelihood due to malpractice."



There were multiple replies to Rifflair's post explaining why Dr. Elist deserves the notorious reputation he has on the board





And here is post #2 by Refflair

"Damn, not to sound like a dick here, but your reading comprehension is piss poor.

I am not defending Dr. Elist, these forums have proved that he is a butcher that should lose his license to operate his clinic. I am posting because I am highly concerned about someone trying to paint other doctors as incompetent and lunatic without providing any evidence.

Every criticism of Dr. A I've seen always seemed like a shill, so please don't leave stuff like this unchallenged"





I will not waste time explaining why this ( post #1) appears to be defending Dr. Elist because any person reading it could see why. But what does get under my skin is your attack on the members who replied as having "poor reading comprehension". So...have you even bothered reading the horror stories on this board regarding Dr. Elist and his implant? There are probably at least two or three dozen....And there are more than a few other doctors that have made their way on to the wall of shame (horrors) due to horrifically incompetent and immoral activities. These posts (accounts) are first-hand experiences with these doctors and are on this board to receive both support and to prevent others from making the same mistake as them.

One of the main benefits of this board is to get the word out...And when you say there is no evidence provided on the board, what the hell are you talking about? Countless personal accounts are not considered evidence?

And we don't only discredit physicians, we have just as many accounts of good and competent doctors...And no...we don't play favorites. The reason you can't find a positive post about Dr. Elist is because there are basically none... These posters either turn out to be shills for the doctor or the implant eventually had to be removed (usually within a year).





In summary



1. You are the one that appears to have poor reading comprehension...That is, if you have even bothered reading the threads that you are talking about.

2. And you also suffer from poor grammar (run-on sentences, poor punctuation, commas, periods, semi-colons, verb tense issues,and vocabulary (word choice issues... "lunatic")? Just saying.

3. Your writing style overall is very unclear (major clarity issues) and unfocused. At least five posters evidently misunderstood your intention(s), but instead of apologizing for the miscommunication and remedying the situation, you blame your readers for not understanding your points (in a very caustic manner I might add).

4. You wrote, "Damn, not to sound like a dick here". You do sound like a "dick".

5. I agree with your statement that Dr. Elist "is a butcher and that he should lose his license"..but aren't' you doing the very thing with this statement that you are criticizing the forum for? In fact with this one sentence you are doing exactly the opposite of what you are telling us to do...Just saying (again).







Category: General Phalloplasty Discussion

Cymetra

Pmma with mods

Urgent request - need your advice about my case

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URGENT URGENT URGENT REQUEST.  PLEASE HELP. SOS. SOS. SOS.                 
          Dear friends,
     i am a 41 year old man and currently lives in the United States.  i don't know how or where to even begin?  when i was born, i was diagnosed with ''ambiguous genitalia''.  i had a severe case of Hypospadias.  my parents would fly to Israel every year to find experienced Urologists who were willing and able to try and correct a few open fistulas, 1 located just below the shaft and the 2nd located just above where the testes & the bottom of the penis meet.  The Urologists in Tel Aviv were unsuccessful in their sincere attempts to seal the open fistulas. The Urologists advised my parents to wait until i would reach the age of puberty.
     at the ages from 11-14, i had already moved & living in the United States & went through countless, traumatic, uncomfortable Urological Dr. visits, & countless multiple failed Hypospadias reconstruction surgeries to no avail in California.  i kept getting continued recurrent episodes of ''Epidimitis'' from the bacterial infections from all the post failed multiple Hypospadias reconstruction surgeries, only to learn in my thirties, that i may have become ''sterile''.  i have kept all my medical records.
     To this very day, i have to urinate in a 16 oz. cup, because my urine does not flow normally in a ''straight stream''.  Rather it splashes like a yard hose.  Every time i go to use the bathroom, i feel trauma, flashbacks, cursed & indignant day after day, & year after year.  i have always been physically, mentally, & emotionally ''attracted to women''.  Yet i have always been tense, & embarrassed to be intimate naked with a woman.  i don't want to tell you all the questions & insulting mockeries i have received from various women whom throughout my life, degraded the ''small size'' of my reproductive life giving organ!  ouch!  i find it difficult to properly penetrate, even with viagra,ete... ouch!
     Is there any stand up reputable Urologists out there who would be so kind as to please help me find the proper modern day scientific advances, to please, please, naturally find a method like for example ''Alloderm, Dermal Matrix graft, fat injections,etc... or something ''other'' than an artificial foreign devices planted in me,etc...???  
     ''One can hire the best plumber to fix a broken sink or faucet, for example''.  However, that very plumber would require the ''proper size tools,etc... to be able to be able to properly find the latch that needs to be unscrewed to fix,etc...  If a latch is way up high below the sink or faucet, then even the best plumbers in the world, could never settle for 2'' wrench, when the job requires a 9'' wrench, etc... (as an analogy)!
      i have always wanted to get married, attempt to have children, etc... i kindly ask anyone out there to please find me a reputable Urologist to help make this happen. iyh.
Thank you.

D.

Category: General Phalloplasty Discussion


Quickest PMMA Turnaround?

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Avanti Derma recommends at least 6 weeks between PMMA sessions.
Has anyone here had a full round, then gone back and got another full round in less than 6 weeks? If so, how did it turn out?

I'm currently considering going in for my next round after 5 weeks and a day or two.

Category: General Phalloplasty Discussion

information overload

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i found this site about a month ago and have read and read so much information here that i seem to be more informed but more confused as to how i move forward. twelve years ago i went to a DR. in NY and had what i thought was going to change my life and get the penis i always wanted. I had both a lengthen which was a success as i gained more than an inch in length. i also had a dermal graft which has turned out to be a disaster. as a year or two went by most of it had disappeared and i was left with a hump/lump at the mid point on top of my penis It functions well but looks horrible.

Two months ago i found the website of Dr. Loria and was prepared to head to Florida to investigate and have his procedure. Then i found this website and as i said have become confused. It seems there are other better Drs. that many of you have used and other procedures that many of you have had successful results.  i want to understand better the options, results and long term results of the different options. i want to increase the girth of both my shaft as well as the head of my penis. Is there a way that you all could help me better understand so that i can make this happen.

current stat
FL 4.0
EL 6.6
FG 4.0
EG 4.5  

Category: General Phalloplasty Discussion

Is this right way to measure it feels like I get more out but feels like I'm cheating

what happened to mischiefmkr?

Nervous & excited

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So, after months of lurking and reading posts regarding PMMA,  I booked my appointment with Dr. C on June 7th. I will do my best to chronicle the whole experience, with photos, for those in my position. It seems like guys get PMMA, get the results they want, then disappear.

I am starting out with just a hair shy of 6"EL & 4.5"EG. My glans is quite large though, around 5.25", so to me, it looks like an apricot stuck to the end of a pencil.

In the interest of transparency, my wife & I were separated for a few months this past fall, and I recently found out she was seeing a guy from back in high school. He was quite little, or so she says, but upon open discussion about their "time" together, she did admit that he was able to make her orgasm. This has completely shattered my self-confidence, as previously I was the only man that had ever made her truly orgasm. In her defense, I had emotionally abandoned her, and that's what she was really looking for. But, I digress....We have since gotten back together and agreed to save our marriage, as we love each other that much.

I have set my goal at 1" MAX girth gain. My goal of this post is to get a concensus of whether or not to do this. I've already paid the deposit. 

From what I've read, guys getting 2 rounds generally don't have many issues. I'd like to keep reasonable aesthetics, but I naturally have some wee-waws anyway. My wife, of course, says she's happy with my natural size, but she didn't argue much against me getting the procedure done.

So, what do you guys think? If I have a reasonable goal, (that I WILL stick to) is it madness to do this? I really am doing this for myself, not just out of insecurity. I've put a lot of thought into this. I'd just like some feedback from those who've had it done.....

Category: General Phalloplasty Discussion

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