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smalljay

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Reply with quote  #16 
Quote:
Originally Posted by Toolman
Dr. Oates- Thanks for joining in.  Many on  this board have had PMMA for girth enhancement for their shaft, but PMMA isn't successful in the glans (I understand).  As a result a proportional size discrepancy results between the shaft circumference and that of the glans.  The development of Voluma a few years ago (extending longevity) has provided some interest among many PMMA patients.  

Have you focused on glans-only procedures?  When the HA injections increase the glans to the normal erection size, what happens when the patient then achieves an erection?  Does the size; continue to increase, not increase as much, or not at all?  Does stretching pain occur?  Thanks, 




As a recipient of a botched glans enhancement I would have to say that you need to consider any injection of any material into the glans pretty risky. Especially thicker substances like Juvederm Voluma. Dr. Rosenthal (who does glans enhancements with HA) told me he only uses Juvederm Ultra for the glans (the thinnest Juvederm, used for lips), and feels that Voluma might cause necrosis. The thick crosslinked dextran that KittenPasteCo and I had in our glans in Korea caused necrosis in both of us.

The size difference will be the most apparent flaccid, but you still will see slight visual improvement erect (nothing crazy. With thick Lipen I gained temporarily about .25" girth erect, but that has since dwindled. Thin HA like what you need for safety might show less of a gain, but maybe not. ArcticSky seems happy with his, he went to Dr. Rosenthal).

I also just spoke with both Dr. Gelman and Dr. Alter the other day in person. Dr. Alter said that the glans is risky but using thin HA is a lot less risky than what I had in Korea (dextran). This made me feel like shit for choosing the dextran solely because it lasted longer so I wouldn't be bothered with so many trips. It was the wrong call. You always have to put safety first because you could end up with a fucked up result like me. My dick is un usable right now, looks like I have herpes on the glans where the skin turned necrotic and fell off. Dr. Gelman seemed to be more adamant against it (not to say Alter was 'for' it) and said that no matter the material, the glans should not be injected as it is too risky (too many blood vessels, no good space between the skin and the spongy tissue to inject, and the skin/spongy tissue is pretty damn homogenous anyways. He said glans enlargement is just 'not a good surgery').

If you absolutely fucking insist on doing the glans, stick with very thin HA's and go to someone with lots of experience. Like I said the literal only successful photo result I've ever seen on here is ArcticSky and he went to Dr. Brian Rosenthal in california. It's kinda crazy that there haven't been more reports from that on here, there have to be guys getting it done.

**a side note - even thin HA is not free from risk. Rosenthal himself will tell you that there is a 'rare' chance of necrosis with HA to the glans. It is impossible to truly be prepared for this risk because when it happens it's fucking there. Choose your physician wisely (and stay the fuck out of Korea, in my opinion).

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Gatit

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Reply with quote  #17 
I agree with smalljay, I will go as far saying that you should stay away from injections in the gland. I have had 2cc of voluma injected and the result wasn't noticeable. The 3 weeks bruising and the lack of real change are not worth it.
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Reklaw

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Reply with quote  #18 
"Stay away from Korea" I agree with this
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Dr Oates

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Reply with quote  #19 
Hi Toolman,

Yes there have been some instances of necrosis (tissue death due to obstructing blood flow) with PMMA.
I have been using Hyaluronic Acid gel for enhancement of the glans. Some guys have asked about it after previous surgery but my patients so far for keeping the proportion with the enlarged shaft. Not all guys come back for follow up (which is frustrating - but we are trying to contact and get them in - not everyone wants to be contacted though). Sometimes they are shy about going into details - and probably so have I.
I will ensure that we have a questionaire that all patients fill out on review so we can collate the kind of info people on Phalloboards are interested in.
My thought is that the erect size of the glans is probably not increased that much - more change is seen in the flaccid state.
What has been interesting is that they report no change in sensation - although that is the postulated reason for HA in the glans being useful in premature ejaculation.


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Dr Oates

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Reply with quote  #20 
Quote:
Originally Posted by Gatit
I agree with smalljay, I will go as far saying that you should stay away from injections in the gland. I have had 2cc of voluma injected and the result wasn't noticeable. The 3 weeks bruising and the lack of real change are not worth it.

Hi Gatit,

Interesting - certainly there is less proportional change with HA in the glans. I think it is because the injection is essentially into the spongy tissue rather than totally external to it in the shaft. I try to keep it quite superficial in the 'flare' where it seems to make a more noticable difference.

Did you notice any change in sensation?


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Gatit

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Reply with quote  #21 
Quote:
Originally Posted by Dr Oates

Hi Gatit,

Interesting - certainly there is less proportional change with HA in the glans. I think it is because the injection is essentially into the spongy tissue rather than totally external to it in the shaft. I try to keep it quite superficial in the 'flare' where it seems to make a more noticable difference.

Did you notice any change in sensation?



Hi Dr, the injections were made in the flare as well. For some reason It seems that the product has dissipated or was absorbed by the body. I have been told after the injection that it happens when the HA is injected too deeply into the gland. I did see a bit of a physical difference but norhing major ar all. In term of sensation I didn't notice anything different.
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Skeptical One

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Reply with quote  #22 
Quote:
Originally Posted by Dr Oates


Yes there have been some instances of necrosis (tissue death due to obstructing blood flow) with PMMA.



Have you personally observed these complications? If not, were these instances of necrosis published by a credible source, or was it a matter of hearsay (perhaps by fellow colleagues or friends)?

While it seems plausible that necrosis can be caused by the obstruction of blood flow, I'd have to imagine that has a lot more to do with the practitioner, experience, and skill-set than the nature of how our body reacts to the product. Or put in another way... HA should be just as capable of obstructing blood flow in the manner that you described (above) with PMMA...?


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smalljay

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Reply with quote  #23 
Embolism is embolism - lots of fillers including very thin HAs can and have caused necrosis- though the risk is much less with thinner products and HA can be chemically dissapated if u catch it in time. I've never heard of PMMA necrosis but wouldn't be surprised to hear it happened especially w sociopaths like Cho (Dr Elist of the east imo) who inject it with a sharp needle. That said, we'd never heard of a specific and credible case in the penis (but I do recall a case in the face, poor woman. And I believe that was needle injection).

I'm feeling a lot better about the safety profile of cannula injected PMMA these days, particularly after speaking in person to Dr. Alter and Dr. Gelman (allstar dick-fixing urologists/plastic surgeons). I expected them both to at least say PMMA was a cause for concern, but both docs immediately and confidently said its probably safe from a long term health standpoint. Gelman literally used the words 'not a big deal' regarding health implications of having PMMA in the penis. Their concerns were with the aesthetic problems it can cause, not w health/function concerns.
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Dr Oates

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Reply with quote  #24 
Quote:
Originally Posted by Skeptical One


Have you personally observed these complications? If not, were these instances of necrosis published by a credible source, or was it a matter of hearsay (perhaps by fellow colleagues or friends)?

While it seems plausible that necrosis can be caused by the obstruction of blood flow, I'd have to imagine that has a lot more to do with the practitioner, experience, and skill-set than the nature of how our body reacts to the product. Or put in another way... HA should be just as capable of obstructing blood flow in the manner that you described (above) with PMMA...?



I was referring to posts specifically on this forum regarding PMMA and necrosis in the glans.

Necrosis has been encountered with every filler I have heard of (I am currently in Sydney for the Allergan conference - avoiding/managing complications is always a big topic).

Necrosis is usually due to injection into a blood vessel with a sharp needle.

That is why we use a blunt cannula and HA. HA can be totally dissolved very rapidly if there was a problem - and it was picked up early.

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smalljay

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Reply with quote  #25 
Hi Dr. Oates,

There are no cases of PMMA necrosis on the glans (or any members who have reported having PMMA on the glans) here - although my guess is thats exactly what would happen if you injected pmma there.

I believe I know the thread which confused you. 'PMMA for glans enhancement can be done' - the title of that thread is a misnomer of sorts as the bulk of the thread goes on to discuss Dr. Cho's Lipen D procedure (cross linked dextran, not PMMA, but still bad news in the glans). A lot of people were getting Dr Chos Lipen P (PMMA/dextran, for the shaft only) and Lipen D (just dextran) confused because of the title of that thread.

I was an actual recipient of chos 'Lipen D' dextran in the glans and did indeed get necrosis. Someone please correct me if I'm wrong about the confusion. I think smartmans original post was actually about some obscure doc offering pmma for the glans but I don't remember any confirmed cases of necrosis.
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KittenpasteCo

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Reply with quote  #26 

You are correct. LiPen (LiCol) D is only Dextran while LiPen (LiCol) P is 10% PMMA.

 

It's been roughly a year since my procedure. My corona is still nicely filled in but most of the glans, on the left side, is missing both the flesh lost to the necrosis and dextran that leaked out along with it. So that one side is almost as small as it was before my injection. Erect, though, it doesn't get as big as it used to. Still... I'd love HA. Guess I never learned my lesson. Fortunately, my focus is going elsewhere, with cosmetic surgery. Bosley is going to cost me $5000 down and 280 a month (until 12,000 is met), if I go through with that... so yea. Crazy expensive but I'll get more out of having my hairline back than having a better head, at this point. :/


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hoddle10

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Reply with quote  #27 
Quote:
Originally Posted by KittenpasteCo

You are correct. LiPen (LiCol) D is only Dextran while LiPen (LiCol) P is 10% PMMA.

 

It's been roughly a year since my procedure. My corona is still nicely filled in but most of the glans, on the left side, is missing both the flesh lost to the necrosis and dextran that leaked out along with it. So that one side is almost as small as it was before my injection. Erect, though, it doesn't get as big as it used to. Still... I'd love HA. Guess I never learned my lesson. Fortunately, my focus is going elsewhere, with cosmetic surgery. Bosley is going to cost me $5000 down and 280 a month (until 12,000 is met), if I go through with that... so yea. Crazy expensive but I'll get more out of having my hairline back than having a better head, at this point. :/



Don't they have a dreadful reputation? There are loads of top HT specialists in the US, why go to Bosley? 
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hoddle10

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Reply with quote  #28 
Please stop!

Skeptical One Addendum: I have deleted a number of posts that are steering the topic off course. This is a Q&A and all future posts need to be directed toward Dr. Oates and not towards each other. This may put Hoddle's "Please stop" post in context. Please carry on [smile]

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Androfill

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Reply with quote  #29 

Androfill provides penis enlargement surgery and non-surgical penis enlargement in the UK.  We also inject using Hyaluronic Acid for penis girth.

A couple of patients suggested I post on this website in an attempt to add to the discussion.



Dr Oates: "...why I don't think there is anything better available at the moment. When I find something better, then we will look to change."



Androfill uses Hyaluronic Acid fillers for the same reasons expressed by Dr Oates, including safety, reversibility, quality of the result. 

We use Juvederm Ultra 4 and Voluma.  

Ultra 4 is a thinner filler with a softer feeling filler than Voluma, so we often use this with 1st time patients as it is a very gentle introduction to HA vs. the firmer feeling Voluma.

The downside is that Ultra 4 doesn't last as long and in some cases is more prone to migrate to the foreskin region for a few days following the procedure.  To address this we have used Hyaluronidaise (Hyalase) to dissolve Ultra 4 filler that has moved on two occasions.  On both occasions we dissolved the stray filler and replaced it with fresh filler at our expense around the well integrated filler.

Voluma is less likely to move about, and mostly stays where it is injected, but it is quite a bit firmer (more cohesitivity) and so is more noticeable to the patient in the first few days.

Our preference is Juvederm Voluma, it lasts for longer than Ultra 4, it's very firm (firmer than usual erections), and stays close to the injection site.

HA is the best approach currently available due to the safety, limited downtime and result. Another positive is the huge amount of research pouring into HA fillers meaning they will continue to improve.  

Desirial, for example, will have a CE approved filler for penis enlargement in the near future which should greatly enhance the results of HA procedures.



Dr Oates:  "One of the great advantages of HA's is that they are completely reversible with a medication called Hyalase "


In general there seems to be too much short term thinking among patients. At the very least, revisions are costly financially and emotionally. 



Dr Oates: "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. "



Due to the cohesitivity of Voluma it might also be slightly uncomfortable if the filler is injected in one rigid blob.  Voluma in one blob would act as a rigid scaffold pushing against the shaft.

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hoddle10

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Reply with quote  #30 
@ Androfill, has Skeptical One verified your account already?

Also, please take a moment to read the forum rules. 


  • (R5.)Members cannot advertise any commercial product or service, which includes containing links in their signature or profile which goes to a website that sells products or services. You can, however, discuss the legitimacy of commercial products designed for the penis in the "Penis Enlargement Exercises, Equipment, Supplements, & All Other Non-Surgical Methods" message board (the content, however, can still be subject to deletion).
I've removed the link to your website.

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