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Avanti Derma

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My name is Luis Casavantes (known as "DrC" to some of you).

I graduated as a Dermatologist around the time of the introduction of botulinum toxin, hyaluronic acid, lasers and other products and services that revolutionized my medical specialty.

By the turn of the century, I had developed my reputation as a Cosmetic Dermatologist; my practice popularized through my success in treating young individuals with what I believed to be was a mere "premature aging." 

I had no idea of the cause of this strange phenomenon until I read a publication from Dr. Andrew Carr (an Australian Infectologist) describing the HIV- associated lipodystrophy syndrome, a terrible epidemic that disfigured faces and bodies in patients under treatment with certain drugs that caused redistribution of the patient's body fat. [1]

The recognition of this affliction (predominantly known as "facial wasting") quickly became apparent to doctors, patients and the general public. It created a stigma that generated an incredible demand for high-volume soft-tissue fillers that were permanent and more affordable than the temporary alternatives that were being offered with hyaluronic acid (Restylane) or L-polylactic acid (NewFill, now Sculptra).

I found a good alternative: PMMA from Brazil. After an intense training with Dr. Nácul, the developer of the bioplasty technique, I discovered the micro-cannulas and a mechanical injection device for safe and efficient injections of soft tissue fillers. Based on this experience, I developed the "Metered Implant Technology" (MIT) that ensures the mechanical delivery of standard volume and helps to reduce the irregularities of manual injections.

By 2003-2004, my dedicated team and I worked almost seven days a week for two consecutive years, to meet the demand of patients seeking a solution for facial wasting. 

I performed thousands of facial reconstructive procedures, attended local, national and international medical meetings as a faculty member. As a result became very proficient in using all types of soft tissue fillers.

My practice continued expanding with patients seeking cosmetic enhancement of their faces and other body areas, penis included.

I performed my first penile girth enhancement treatment using PMMA back in September 2007. I have since personally treated more than 1,500 patients and performed a conservative number of 3,000 girth enhancement procedures. Last year I published a peer-reviewed report of 729 patients in the Journal of Sexual Medicine [2] with Dr. Gottfried Lemperle (a German Plastic Surgeon, developer of PMMA as a soft tissue filler) and Dr. Palmira Morales (my associate), as co-authors.

Based on the results of our publication, we have a satisfaction rate of 8.7 which is very similar to the reports on facelift surgeries.

We currently offer three different options to our patients: the permanency of PMMA (Metacrill, Linnea), the longevity of CaHA (Radiesse) and PCL (Ellanse), and the reversibility of HA (Belotero, Juvederm). Voluma has been removed from the market in Mexico.

As an avid reader of scientific publications regarding soft tissue fillers, I have realized that most complications and accidents are technique-related (intra-vascular injections with needles, occlusion by pressure, rupture of ducts, and so on). There is no doubt that experience, skill set, and technique ensure safety independently from the nature of the substance injected.

At almost ten years of experience, performing an average of 1.5 procedures per working day and with patients coming from five continents, we are amongst the world leaders in the number of patients treated. 

I am pleased to join the Phalloboard forum discussion and help bring clarity to some of the  questions asked regarding our distinct and unique phalloplasty procedures. To expedite my responses, my highly skilled nurse of 8 years Wade Zobel, will also be participating to provide the support needed. 

Last but not least, I'd like to remind everyone that our participation in this forum is exclusive to discuss only girth enhancement. All personal communication with Avanti Derma must use our dedicated phone lines, email addresses, and website listed below.

Best regards.

 

1) Carr A, Miller J, Law M, et al. A syndrome of lipoatrophy, lactic acidaemia and liver dysfunction associated with HIV nucleoside analogue therapy: contribution to protease inhibitor-related lipodystrophy syndrome. AIDS 2000;14(3):25-32

2) Casavantes L, Lemperle G, Morales P. Penile Girth Enhancement with PMMA-Based Soft Tissue Fillers. J Sex Med 2016;13:1414-1422.


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Dr Morales, MD
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Skeptical One

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Reply with quote  #2 
@ Forum Members:

This is a reminder that this thread is a Q&A and not patient inquiry. All pertinent patient-related questions need to be sent directly to Avanti Derma's office.

For newer members, the significance of Dr. C joining the discussion is huge. Dr. C & his procedure is by far the most discussed on this forum, going back at least 5 years. This is a great opportunity to get direct answers on matters related to PMMA, alternative fillers, technique, etc.

@ Dr. C & the team at Avanti Derma

Thanks for joining our community and we look forward to bringing clarity to the topics of PMMA and penis enlargement.


***TOPIC IS NOW OPEN***


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briceb

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Reply with quote  #3 
Welcome aboard, Dr. C!
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A clear conscience is the sign of a bad memory.
CURRENT: EL 8"  EG 7" midshaft  FL 7-7.5"  FG 6.25-6.5"
GOALS: EL 9"  EG 7"  FL 8"+  FG 6.5"
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Reklaw

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Reply with quote  #4 
Hi Dr C, it's great to have you on the board

One common complication circumcised people seem to have with fillers is a "pig in a blanket" effect, which is where the glans appears to be kind of hidden in the shaft during the flaccid state. It look extremely unpleasant and unatural.
This seems to be most prominent amongst people who: have a small glans, people who retract more than usual, and people who have a loose circumcision.

I actually fit all of the above stats.
When I had a procedure done 1 year ago I had an extreme "pig in the blanket" effect, however as time has gone by the "pig in the blanket" has reduced quite significantly, I'm convicted it had reduced because most of the product has migrated to the base and there is hardy and product left near the glans,
Do you think applying more product at the base and less near the glans could be a solution for people who are at risk of getting a "pig in a blanket" ?
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sexy beast

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Reply with quote  #5 
THANKS FOR YOUR EXPERTISE Dr. C

do u ever do trainings in the the united states or to be more specific, California?
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jd123

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Avanti Derma

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Quote:
Originally Posted by Reklaw
Hi Dr C, it's great to have you on the board One common complication circumcised people seem to have with fillers is a "pig in a blanket" effect, which is where the glans appears to be kind of hidden in the shaft during the flaccid state. It look extremely unpleasant and unatural. This seems to be most prominent amongst people who: have a small glans, people who retract more than usual, and people who have a loose circumcision. I actually fit all of the above stats. When I had a procedure done 1 year ago I had an extreme "pig in the blanket" effect, however as time has gone by the "pig in the blanket" has reduced quite significantly, I'm convicted it had reduced because most of the product has migrated to the base and there is hardy and product left near the glans, Do you think applying more product at the base and less near the glans could be a solution for people who are at risk of getting a "pig in a blanket" ?

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Dr Morales, MD
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US Phone lines: (619) 308-7268 or 7269.
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Avanti Derma

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Reply with quote  #8 
Quote:
Originally Posted by Reklaw
Hi Dr C, it's great to have you on the board One common complication circumcised people seem to have with fillers is a "pig in a blanket" effect, which is where the glans appears to be kind of hidden in the shaft during the flaccid state. It look extremely unpleasant and unatural. This seems to be most prominent amongst people who: have a small glans, people who retract more than usual, and people who have a loose circumcision. I actually fit all of the above stats. When I had a procedure done 1 year ago I had an extreme "pig in the blanket" effect, however as time has gone by the "pig in the blanket" has reduced quite significantly, I'm convicted it had reduced because most of the product has migrated to the base and there is hardy and product left near the glans, Do you think applying more product at the base and less near the glans could be a solution for people who are at risk of getting a "pig in a blanket" ?


Hello Reklaw,
As you guys know, uncircumcised patients are always a challenge because the implant has to settle in a loose, mobile bag that covers not only the corpus of the penis but extends into the foreskin (that must be kept free of product to maintain its function).
Low volume is one of the few things that help us reduce some of these complications, but even then, we face the most typical accordion effect.
Attached please see the difference of what is the accordion effect, even though the implant was successful, and the big difference once the patient had a circumcision and one touch up session.
The red lines in the picture show the mobility of the skin before and after the circumcision.
The best thing that you can do is a good circumcision (skin nicely tight, multiple individual absorbable stitches) and a touch-up session with 10% concentration a couple of months later.
Rather than helping, adding PMMA in your case will worsen that bunching up of the implant.
DrC.

 
Attached Files
pdf Accordion_Effect.pdf (872.60 KB, 159 views)


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Dr Morales, MD
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Reception: info@avantiderma.com
US Phone lines: (619) 308-7268 or 7269.

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Avanti Derma

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Reply with quote  #9 
Quote:
Originally Posted by sexbeast
THANKS FOR YOUR EXPERTISE Dr. C

do u ever do trainings in the the united states or to be more specific, California?


Hello sexbeast,
The only training sessions that I have done abroad have been in medical congresses, only as KeyNote presentations. Never hands on.
Sneaking the product will be just as bad as performing an implant in a country where you are not licensed.
Imagine the reaction of a customs officer if he discovered somebody carrying syringes filled with white powder across the border... I'm out!
[tongue]

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Dr Morales, MD
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Reception: info@avantiderma.com
US Phone lines: (619) 308-7268 or 7269.
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Avanti Derma

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Reply with quote  #10 
Quote:
Originally Posted by jd123
1) How much is the deposit? And can you put it as a hold on my card and I pay in cash when I get there? I want to pay for everything in all cash. 2) Will there be a price increase in the new year? And can you list a current price sheet. 3) I don't live incredibly far and I'm thinking of driving there and staying in SD. Is it a bitch to drive myself back and forth across the border for check-ups if I wanted. (I'm not sure if a shuttle that goes in and out of mexico daily has like a "fast pass" type of thing at the border where it goes through an express line. I've never been to Mexico.) 4) I'm surprised nobody else has asked. What happened to the metacrill supplier and is it ever going to be available again? There's folks on here convinced LS is inferior to meta. Could you address why people may be thinking that Dr.? Talk of severely hard clumps are quite common these days after getting 30% LS. I'm happy your here to answer questions doctor.



Hello jd:
Your administrative questions will be responded by Diana. Contact information below.
We do not recommend patients to stay in San Diego! It is mandatory to come back to the office at least for your 24h check up.
Crossing the border is a waste of valuable time that can be used to relax and massage while staying at the hotel next door. Patients also miss the opportunity to come back to our office as needed during the day and ask questions or get checked up.
The preference between Metacrill and Linnea goes in both directions, and often times the trend goes for what is not available. My original girth enhancement technique was designed with "New Plastic" 10%, the precursor of Linnea Safe.
Unfortunately, patients feel that their results will be mediocre if we use L10 or M10 and typically push for the higher concentration of 30%. Sometimes I have difficulty conveying that we offer an enhancement especially for prospective patients with unrealistic expectations.
There is no science behind this: independently from the brand of product, the higher the concentration and the volume used, the higher the possibility of complications.
When patients let me decide on those two factors, our results are much better, and I can take firmer responsibility.
As of the present, future of Metacrill (or Linnea), we do not know much. We are the end consumers, not part of the importation process which is very complicated. 
DrC

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Dr Morales, MD
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Reception: info@avantiderma.com
US Phone lines: (619) 308-7268 or 7269.
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Dexterphall

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Reply with quote  #11 
Hello DrC.

You stated above an admin question be responded to by Diana - is this the correct email to use?  

 info@avantiderma.com
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Todzilla

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Reply with quote  #12 
Hello Dr. C and welcome to forum. I'm very grateful you decided to join. I apologize if this was already answered or cited somewhere in the study you published, (I have not have the time to read it yet.) You stated you have been doing girth enhancement with Pmma since 2007, other than the typical aesthetic issues, have any of your earliest pioneers reported any problems not typical that would be considered a long term side effect? Also, you mentioned in your initial post you are currently offering metacrill. Its been mentioned several times, even recently that you do not. Thank you for your time and clearing up my confusion, Im looking forward to my 2nd round soon.
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Avanti Derma

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Reply with quote  #13 
Quote:
Originally Posted by Dexterphall
Hello DrC.

You stated above an admin question be responded to by Diana - is this the correct email to use?  

 info@avantiderma.com


Correct. That's for Diana, our patient coordinator.

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Dr Morales, MD
https://www.avantiderma.com

Reception: info@avantiderma.com
US Phone lines: (619) 308-7268 or 7269.
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Reklaw

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Reply with quote  #14 
Hi Dr C/Wade
I think in your earlier reply you maybe misunderstood what I meant by a "pig in a blanket effect"
I've attached a few photos from this forum of a "pig in a blanket" that's been caused by pmma and other fillers.
If I had some more time I could probably find you at least 50 photos of this, it's an extremely common side effect that seems to happen in at least 10% of cases of people who've had fillers and it can cause people real psychological harm.
As I said in my last post, when the product in my penis migrated to the base, the "pig in a blanket" reduced quite significantly, hence why I suggested it might be a good idea to apply more product at the base and less near the glans in people who are quite susceptible to it.
In my opinion the people most at risk of getting this are people who have a small glans, people who retract more than usual, and people who have a loose circumcision.
Maybe you should look into ways in preventing this happening in the future
I think applying smaller ammounts helps.
Thanks for your time.

Attached Images
png image.png (906.62 KB, 89 views)
png image.png (1.24 MB, 83 views)
png image.png (1.18 MB, 82 views)
png image.png (1.13 MB, 82 views)
png image.png (871.35 KB, 80 views)
png image.png (1.16 MB, 92 views)

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jd123

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Reply with quote  #15 
So you do have metacrill avaliable again?
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