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Restoration

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Reply with quote  #46 
Hi Dr. Oates,

Thanks for contributing here.

I have had a complicated case. I had Peyronie's disease which decreased the size of my penis about 30%.  I had two rounds of PMMA which went fine.  The third round was a disaster, and I had (and still have) rock hard lumps all over my penis.  Do you know why something like that would have happened?

I had some of the lumps excised, but the excisions wouldn't close - and I had to go to a reconstructive urologist to close them by excising a lot of of skin (1 square inch - which is a lot considering I am 5.5-6" erect).  This left the penis looking even more strange, in a way, since it exaggerated other lumps by pulling the skin very tightly around them.

I tried to fix this in November by camouflaging the abnormalities with radiesse.  I only used 1.5 cc.  It is now April, and I am nearly back to where I started.   Do you think HA can help me, and if so - what kind of cost am I looking at?  $1500 / year? Thank you.

Image-1.jpg
Left - after all excisions, still with numerous lumps
Middle - after radiesse 1.5 cc 
right - 6 months after Radiesse


__________________

Part 1:  The first year - recovering 1/2" girth lost to Peyronie's Disease (Round 1 & 2 Metacrill PMMA)
Part 2:  Things starting to go bad (I had nodules removed and excisions wouldn't heal)  (After Round 3)
Part 3: Resolving Round 3 problems caused entirely by USA doctors.
Part 4: All PMMA (from all 3 rounds) hardened 6-12 months after round 3.

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Dr Oates

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Reply with quote  #47 
Hi Restoration,

Sorry to hear of your problems. Now, as you say, a complicated case.

PMMA is tiny balls of plastic in a carrier for injection (as you know). The carrier breaks down leaving the plastic balls which stimulate a foreign body reaction causing collagen/scar tissue production. Why some guys get nice smooth results and some lumps is not entirely clear. Some people get granulomatous (excessive tissue reaction) to injectables - that goes for all fillers even HA.

The problem with injecting HA now is the risk of starting up problems - especially infection. As you have already experienced, healing after excision is an issue with granulomas. This is also why all injectable manufactures recommend against using their product where a different companies product (especially permanent) has been injected.

So could HA help to even out the lumps and bumps on your shaft? Yes it could. Is there a risk it could start up a problem with the PMMA, yes it could. That could be worse than just having lumps. We could add in extra precautions such as antibiotic cover and even more sterile drapes while doing the procedure - but some risk remains. The clever thing for me is to say no - and not risk my reputation.

But lets keep talking. I hate to tell people "you are stuck with your problem - I don't want to risk it". But want you to understand the risks are there.

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Restoration

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Reply with quote  #48 
Thanks Dr. Oates.  If it is done with sterile technique (as opposed to the usual "clean technique" with injectables in the face) do you think that would help? I am talking about a chlorohexidine w/ alcohol wash.  Is there something else that contributes to the risk of infection, if not for the skin surface and cannula / needle impregnating the PMMA tissue with bacteria?  I know this is always a risk when injecting filler around a facial implant, but PMMA has caused a tremendous amount of scar tissue to form, rather than just sitting there as an inert implant with limited immune cell access.  This scar tissue is full of lymphocytes (histocytes, multinucleated giant cells) - so I wondered if that would actually make it more difficult to get an infection, given their presence.  I posted my pathology slide before here.  Even though I had those open wounds, they were never infected - oddly enough.  Perhaps if the session was limited to <1 hr and just 1-2 entry points (with a long cannula) that could cut down on the risk of infection as well?

Infection issues aside, the penis is so complicated that I wonder if I am just going to be chasing my tail to try to put 1 cc here and 1cc there and then 2 months later it'll be gone or have shifted.  I still am having a hard time understanding  how non-particulate HA is placed flaccid, when the penis (at least in my case) is drastically different erect.  (This is why I used radiesse at the time - though I suppose the CMC had a long duration as well and now I just am seeing now actual growth from the calcium particles).   Anyway, it seems like HA would move around a lot and suffer from an accordion effect as the penis changes from erect to flaccid.  And, if I am trying to camouflage PMMA nodules, I might just be playing darts with a moving dartboard.  Having no HA experience, it's just something I've wondered.  I really liked my penis after the radiesse, but unfortunately that was short lived. 

Thanks again.

__________________

Part 1:  The first year - recovering 1/2" girth lost to Peyronie's Disease (Round 1 & 2 Metacrill PMMA)
Part 2:  Things starting to go bad (I had nodules removed and excisions wouldn't heal)  (After Round 3)
Part 3: Resolving Round 3 problems caused entirely by USA doctors.
Part 4: All PMMA (from all 3 rounds) hardened 6-12 months after round 3.

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Reklaw

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Reply with quote  #49 
Even if worst comes to worst and in the end you carnt do anything about the lumps I don't think it's the end of the world because I don't think it looks that bad.
You maybe able to pass it off as some strange form of Pyronies or tell women you have hard lumps that are a excessive collegen build up due to medication (this is something along the lines of what Hunkydory said). Mine is a big mushy mess that changes shape all the time so there is no possible excuse for that.
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hoddle10

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Reply with quote  #50 
Quote:
Originally Posted by Dr Oates
Hi Restoration,

Sorry to hear of your problems. Now, as you say, a complicated case.

PMMA is tiny balls of plastic in a carrier for injection (as you know). The carrier breaks down leaving the plastic balls which stimulate a foreign body reaction causing collagen/scar tissue production. Why some guys get nice smooth results and some lumps is not entirely clear. Some people get granulomatous (excessive tissue reaction) to injectables - that goes for all fillers even HA.

The problem with injecting HA now is the risk of starting up problems - especially infection. As you have already experienced, healing after excision is an issue with granulomas. This is also why all injectable manufactures recommend against using their product where a different companies product (especially permanent) has been injected.

So could HA help to even out the lumps and bumps on your shaft? Yes it could. Is there a risk it could start up a problem with the PMMA, yes it could. That could be worse than just having lumps. We could add in extra precautions such as antibiotic cover and even more sterile drapes while doing the procedure - but some risk remains. The clever thing for me is to say no - and not risk my reputation.

But lets keep talking. I hate to tell people "you are stuck with your problem - I don't want to risk it". But want you to understand the risks are there.


I think this could only enhance your reputation. That's the great thing about open forums like this. Usually when things go wrong with cosmetic procedures it becomes a case of "he said, she said." But in this case, everyone can see that you've made it clear that there are risks and all you can do is try and limit them. If things don't work out, I can't see why anyone would hold you responsible. But if things turn out for the best, then all credit to you.  

Simple things like honesty and go a long way in the world of penis enhancement. We are used to being lied to. Cosmetic PE is actually quite a small world, as so few Dr's actually offer these procedures world wide, but as a relative newbie to it, you probably aren't aware just how shocking the history of the industry is. Hitler has a better reputation around here than half the more prominent PE surgeons of the last 25 years! 
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Gatit

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Reply with quote  #51 
I think it's also about how everyone reacts differently to different products. I have had great results with Voluma as well as many other people here. I have had good results with macrolane as well while other haven't. It's not black and white in the world of fillers, you can go to a doctor and ask for Kylie Jenner's lips, you may not coming out with the same lips based on 3 factors:

1- the doctor's artisitc hand
2- the shape of your actual lips
3- how you reacts to the fillers, even the thinner fillers can create lumps
4- how you'll metabolize the filler, some people get 3 to 6 months in the lips with the average filler, except for Juvederm Volbella that last much longer.

Unfortunately it's all about individuality, and many of us don't react as well as other with the same procedures and products.
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Dr Oates

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Reply with quote  #52 
Quote:
Originally Posted by Gatit
I think it's also about how everyone reacts differently to different products. I have had great results with Voluma as well as many other people here. I have had good results with macrolane as well while other haven't. It's not black and white in the world of fillers, you can go to a doctor and ask for Kylie Jenner's lips, you may not coming out with the same lips based on 3 factors: 1- the doctor's artisitc hand 2- the shape of your actual lips 3- how you reacts to the fillers, even the thinner fillers can create lumps 4- how you'll metabolize the filler, some people get 3 to 6 months in the lips with the average filler, except for Juvederm Volbella that last much longer. Unfortunately it's all about individuality, and many of us don't react as well as other with the same procedures and products.


Gatit,

You can work for me! That is it exactly. Everyone believes (for all cosmetic surgery) that because the procedure has been done successfully by someone (or me), somewhere, sometime that they are guaranteed of getting the same result.

Restoration,

I inject Voluma after caverject, so with an erection (patient not mine). Lots of tiny passes of the cannula and it is integrated into the tissue - I will look for the paper and histology (microscopic) slides. So it does not move around.

Even with perfect sterile technique and antibiotic cover there can be issues. There may be existing bacteria (what is called a biofilm) on the PMMA or Radiesse which flares up with the infammation of the next injection. There was something that caused the 3rd round to have problems that you did not have in the first 2 rounds. It may not be infection just how your body is reacting to the foreign body. It is always possible to get worse - ie nonhealing ulcers

Still, as Hoddle says. So long as we discuss things fully, try to consider all problems ahead of time and prevent what we can prevent then it may be possible to use HA to camoflage.

__________________
What ever you do, make sure it is safe.

Google calibreclinic

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Restoration

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Reply with quote  #53 
Quote:
patient not mine


lol - that would be quite unusual otherwise!  

What happens to the HA when the erection goes down?

Quote:
There may be existing bacteria (what is called a biofilm) on the PMMA or Radiesse which flares up with the infammation of the next injection.


Yeah...this may be something I am stuck with perhaps.  That was what Dr. Lemperle thought a while ago too.  There's biofilm bacteria in there possibly.  I wonder if that could be keeping the nodules so hard too...like permanent inflammation that might otherwise start to break up if it wasn't constantly being activated by the biofilm?  I am not sure how a biofilm in the layers of the penis would be treated though...if it is treated by anyone in the usa.  My urologist (who treats a lot of men with complicated issues) and wound care specialist both said biofilm assays are an "academic exercise"...mostly because I don't have redness, pain, heat, etc....

__________________

Part 1:  The first year - recovering 1/2" girth lost to Peyronie's Disease (Round 1 & 2 Metacrill PMMA)
Part 2:  Things starting to go bad (I had nodules removed and excisions wouldn't heal)  (After Round 3)
Part 3: Resolving Round 3 problems caused entirely by USA doctors.
Part 4: All PMMA (from all 3 rounds) hardened 6-12 months after round 3.

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Dr Oates

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Reply with quote  #54 
Quote:
Originally Posted by Restoration


lol - that would be quite unusual otherwise!  

What happens to the HA when the erection goes down?



Yeah...this may be something I am stuck with perhaps.  That was what Dr. Lemperle thought a while ago too.  There's biofilm bacteria in there possibly.  I wonder if that could be keeping the nodules so hard too...like permanent inflammation that might otherwise start to break up if it wasn't constantly being activated by the biofilm?  I am not sure how a biofilm in the layers of the penis would be treated though...if it is treated by anyone in the usa.  My urologist (who treats a lot of men with complicated issues) and wound care specialist both said biofilm assays are an "academic exercise"...mostly because I don't have redness, pain, heat, etc....


When the erection goes down it remains in that thin layer under the skin/Dartos fascia. If you are a 'grower' then the penis is trying to shrink. The layer of HA acts to hold it out somewhat - which is why we get some flaccid lengthening.

Imagine wrapping something, maybe like a thin layer of sponge around your erect shaft. As the erection fades the sponge holds it out. Except the HA is more mouldable and will allow some shrinkage - the more it shrinks the thicker the layer of HA becomes and the more it resist further shrinkage.

Biofilm is hard to treat because you cannot just have a course of AB's and get better. The bacterial are inactive and not susceptible to the AB's. I would consider a long (maybe 3 month) course of Minomycin (like for acne) - but it is not really based on scientific evidence.

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What ever you do, make sure it is safe.

Google calibreclinic

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hunkydory

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Reply with quote  #55 
Quote:
I inject Voluma after caverject, so with an erection (patient not mine).


A doctor with a sense of humor too!
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growely

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Reply with quote  #56 
I would like to ask, if being circumcised important for injecting HA?
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number22

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Reply with quote  #57 
Hello Dr. Oates. I'd like to ask about the effect on erect size with HA. I can imagine a significant enough effect on flaccid size, but is there a significant effect on erect size also, or does the HA spread too thinly to make anything noticeable? Is HA another 'locker-room phalloplaster' and mainly for flaccid show?

Is it possible to guesstimate the increase in diameter/circumference when erect? (i.e. when the penis is erect, not the guesstimator). For example, a normal size penis (mine!) of 6.5 x 5 ... would 10 ccs increase the erect girth to any significant degree?

Also (if you don't mind!): it's interesting that you inject HA into an erect penis. Why do you do this please? Other doctors not doing this do you put down to everyone sort of winging it in these early days and seeing what turns out best? 

Cheers, Doc!
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Crome305

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Reply with quote  #58 
Dr im in south florida in the us, do you or your affiliates have an office here or in the states ?

Also have you done or heard of The Priapus® Shot AKA The P-Shot®
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hoddle10

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Reply with quote  #59 
Quote:
Originally Posted by Crome305
Dr im in south florida in the us, do you or your affiliates have an office here or in the states ?


Dr Gitt in Arizona offers HA. He's also a member of the forum. 


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Crome305

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Reply with quote  #60 
Quote:
Originally Posted by hoddle10


Dr Gitt in Arizona offers HA. He's also a member of the forum. 




Ty very much hoddle
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