Avanti Derma
We have been approached repeatedly by prospective patients interested in girth enhancement with PCL (Ellansé).
Ellansé is a micro-sphere based soft tissue filler, just like PMMA (Linnea Safe) and CaHA (Radiesse); the three products have a couple of resemblances:
  • Same micro-sphere size (between 25 and 50 microns)
  • Same vehicle (carboxy-methylcellulose) that absorbs quickly leaving the microspheres in the tissues.
  • Same grafting technique (whatever technique that your physician uses).
The differences between them are listed below:
  • PMMA (Linnea Safe): Non-absorbable 40-micron microspheres of polymethylmethacrylate which form a permanent implant.
  • PCL (Ellansé): Absorbale 25 to 50-micron microspheres of polycaprolactone with reported longevity of one to four years.
  • CaHA (Radiesse): Absorbable 25 to 45-micron microspheres of calcium hydroxylapatite that offers the shortest longevity of the three.
Many patients opt for the non-absorbable products to avoid the up and down effectivity curves.
A good number of patients that like their results with temporary fillers, eventually move to non-absorbable PMMA to have a stable, finished and permanent result.
Ellansé is the new kid on the block. My best wishes, but I'm waiting to see if the manufacturer's reported longevity will be real; my skepticism comes from almost 30 years of history on soft tissue fillers showing that published results and clinical results are very different oftentimes.
😏
Some of you have noticed the absence of a big player in this posting: Hyaluronic Acid (Juvederm Voluma)
The latest is a totally different soft tissue filler, a gel that remains like that in the tissues and absorbs in months. In my experience, the longevity of HA and CaHA are similar.
And how about the final clinical results when comparing the mentioned tissue fillers? (better said: "how is my penis going to look and feel at the end?"). Results are very similar; the penis will look good when the volume of the filler is moderate and will look terrible if the volume is exaggerated. My advice will always be to play safe and maintain normalcy; it's not just about the size... it's about shape as well.
Dr. Morales and I offer phalloplasty with the four fillers mentioned in this posting.
DrC
Dr. Luis Casavantes / Dr. Palmira Morales
https://www.avantiderma.com

Reception: info@avantiderma.com
US Phone lines: +1 (619) 308-7268 & 308-7269
Mexico: +52 (664) 687-4848 & 686-5636
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HatchetHarry
We have been approached repeatedly by prospective patients interested in girth enhancement with PCL (Ellansé).
Ellansé is a micro-sphere based soft tissue filler, just like PMMA (Linnea Safe) and CaHA (Radiesse); the three products have a couple of resemblances:
  • Same micro-sphere size (between 25 and 50 microns)
  • Same vehicle (carboxy-methylcellulose) that absorbs quickly leaving the microspheres in the tissues.
  • Same grafting technique (whatever technique that your physician uses).
The differences between them are listed below:
  • PMMA (Linnea Safe): Non-absorbable 40-micron microspheres of polymethylmethacrylate which form a permanent implant.
  • PCL (Ellansé): Absorbale 25 to 50-micron microspheres of polycaprolactone with reported longevity of one to four years.
  • CaHA (Radiesse): Absorbable 25 to 45-micron microspheres of calcium hydroxylapatite that offers the shortest longevity of the three.
Many patients opt for the non-absorbable products to avoid the up and down effectivity curves; some choose absorbable, which is a good idea since the body modification will reverse.
A good number of patients that like their results with temporary fillers, eventually move to non-absorbable PMMA to have a stable, finished and permanent result.
Ellansé is the new kid on the block. My best wishes, but I'm waiting to see if the manufacturer's reported longevity will be real; my skepticism comes from almost 30 years of history on soft tissue fillers showing that published results and clinical results are very different oftentimes.
😏
Some of you have noticed the absence of a big player in this posting: Hyaluronic Acid (Juvederm Voluma)
The latest is a totally different soft tissue filler, a gel that remains like that in the tissues and absorbs in months. In my experience, the longevity of HA and CaHA are similar.
And how about the final clinical results when comparing the mentioned tissue fillers? (better said: "how is my penis going to look and feel at the end?"). Results are very similar; the penis will look good when the volume of the filler is moderate and will look terrible if the volume is exaggerated. My advice will always be to play safe and maintain normalcy; it's not just about the size... it's about shape as well.
Dr. Morales and I offer phalloplasty with the four fillers mentioned in this posting.
DrC


How have patient’s experiences with Ellanse been so far for you guys?

also - when you say moderate volume looks good and exaggerated looks terrible, what is considered a moderate? (Is 1 inch gain considered exaggerated because that’s my goal)

Thanks
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123newyork

@Avanti Derma 

I am also interested in a reply to the above question. 

You also said you do all "four" fillers. Does that include HA? 
When you have a patient asking for HA, what is your response? (Do you explain that there are better benefits from another type filler?)

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Texas
@Avanti Derma 
Can answer here if better 
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Avanti Derma
Hello guys,
My proposal for phalloplasty has always been moderation.
Girth enhancement, not girth augmentation. Beefier, not huge.
As a rule of thumb, an increase of 1 inch or more is easily recognized visually and to the touch independently from the size or shape of the penis.
Longer penises or mushroom-shaped penises can get away with more volume, but missile-shaped penises will show the volume increase pretty soon because the implants dwarf the glans furthermore. My comment is general, not directed to an individual.
Yes, we offer the four most popular fillers used for phalloplasty these days, and we have offered them for almost as long as they've been in the market. It includes HA, and our patients know that the main reason why we like it is that it is reversible.
I didn't offer HA for phalloplasty for years because the physical characteristics of the product don't make it an ideal filler for the penis. I didn't offer Ellansé for years, because new kids in the block are not necessarily good kids in the block.
But at the moment, my favorites fillers are the microsphere-based products: the temporary Ellansé and Radiesse, and the permanent Linnea Safe.
My patients know about the spongy effect of HA, the accordion effect of all fillers in uncircumcised patients, the pig in the blanket effect, you name it!
I understand that we are recognized by my work on PMMA for facial reconstruction at the turn of the century, and phalloplasty since 2007. However, I used virtually every kind of filler that existed for many, many years before 2007. The first one was Collagen for superficial wrinkles (the early nineties), but I went through PLA (Polylactic acid, Newfill, Sculptra), polyalkylimide (BioAlcamid), polyacrylamide, etc. etc. I can tell that I have used every filler that exists out there, even the South Korean PMMA and Dextran-based fillers. We have learned the good and the bad; everything teaches something.
My expertise evolved from a shaking hand trying to correct a wrinkle, to full facial and buttock reconstruction in young patients that were destroyed by HIV-associated lipodystrophy. I pioneered nonsurgical phalloplasty because it was an easy task compared with the other more difficult areas that I was working on almost seven days a week.
Do I explain the patients about the pros and cons of the different fillers? I wish this was responded not by me but by my patients, but of course!... nothing makes me happier than an educated patient that knows exactly what on Earth is going to be injected into their penis. Nothing more frustrating than patients falling for marketing practices that mislead them to home-brewed silicone oil sold as "PMMA", when they can protect themselves with a simple Google search.
The three micro-sphere based products (Linnea, Ellansé, and Radiesse) are so similar (check my first posting in this thread) that a physician that uses one of them will use the others without any problem.
Dr. Luis Casavantes / Dr. Palmira Morales
https://www.avantiderma.com

Reception: info@avantiderma.com
US Phone lines: +1 (619) 308-7268 & 308-7269
Mexico: +52 (664) 687-4848 & 686-5636
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George Castanza
Thanks for the response Dr. C. I plan on scheduling an appointment with you all soon!
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think
@Avanti Derma you stressed in your youtube video that radiesse is very safe, so I assume this is very rare, but one member reported a reaction:

https://phalloboards.websitetoolbox.com/post/dermal-fillers-8145855?pid=1292721488

Can you comment on that? Thanks.
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Avanti Derma
Hello @think
This is an example of how things are not black and white in medicine.
Statistically, Radiesse can be considered a safe filler for the face and phalloplasty, but not for glans enhancement.
@HunkChunk report on his glans enhancement is accurate; the product had to be injected too superficial because there is no other way to address the glans.
None of the micro-sphere based fillers (PMMA, Radiesse, Ellansé) are suitable for glans enhancement.
My only recommendation for glans enhancement is hyaluronic acid in low volume.
DrC
Dr. Luis Casavantes / Dr. Palmira Morales
https://www.avantiderma.com

Reception: info@avantiderma.com
US Phone lines: +1 (619) 308-7268 & 308-7269
Mexico: +52 (664) 687-4848 & 686-5636
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Dr Oates
I agree with Dr C. Was it Reklaw (sorry if my memory is off) who had a paste consistency filler injected into the glans and got a punched out/depressed scar? Gels for  the glans.

I have been asked to do a study for a permanent gel filler to go in the glans. I am looking into it. I want it to be a proper registered and set up trial with proper safe guards then we might see what it can do. It has been used for nearly 10 yrs gy a doctor who used to charge for 10ml in to the glans while doing phalloplasty under GA. I would be very surprised to get 10 ml in. So there was some question quite what was being done there.
What ever you do, make sure it is safe.

Google calibreclinic .com.au
(+61) 1300 105 505
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Dr Oates
Dr C,

You obviously have the most experience with injectable phalloplasty worldwide. We don't have PMMA available in Australia. Contura, the company behind Aquamid a polyacrylamide permanent gel filler has asked me to do a study on using it in the gans. You mentioned you have used these fillers before - but don't now. Can I ask why that is? Was PMMA just better or there was a specific issue with polyacrylamide?
What ever you do, make sure it is safe.

Google calibreclinic .com.au
(+61) 1300 105 505
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Avanti Derma
Dear Dr. Oates,
It is a pleasure and an honor talking to you.
It comes as a surprise that polyacrylamide has made it through the Australian FDA!!!
In the early 2000s, Aquamid (polyacrylamide) and especially its infamous cousin BioAlcamid (polyalkylimide) was an international nightmare that hit colleagues in Mexico (myself and my friend Dr. Francisco Perez-Atamoros, a famous Dermatologist whos patients are politicians and actors), Canada, the UK, and other countries. Please read threads in http://www.thebody.com
I tried to stop the release of BA in the UK through the Minister of Health in Puerto Rico (an acquaintance at that time), but we were ignored and many English doctors hit the wall as well.
What made Aquamid less dramatic is that they promoted it for small areas. BA was promoted for gluteal augmentation, facial reconstruction and so on.
These fillers are non-absorbable gels that create "pseudo-seromas" prone to infection and rejection. They are also very sensitive to physical trauma and manipulation, creating severe acute inflammatory reactions even years after the implant.
They came to us at the time of the crisis of HIV-related lipoatrophy and we had lines of new patients with high expectations, but months later turned into unhappy, panicked patients waiting for extraction of the product with faces that were more deformed than before their treatment. Furthermore, I documented at least one case of penile necrosis associated with BioAlcamid, but not with blood flow blockage. Fortunately, he was not my patient.
Fifteen years later, we still have patients coming for extraction of BioAlcamid, that over the years, turns into an adipose-like material and eventually liquefies and even drains spontaneously. Extrusion (face) is quite easy through an opening with a lancet or a 16G Nokor needle, but the whole experience is beyond traumatic for the physician and especially for the patient. Glutes were much more dramatic and difficult to treat.
I can elaborate on this but I'll try to keep it as short as my rocking mind allows at this moment; feel free to ask for as many details as you want, clinical pictures included. My life and my career turned around (for the good) with the discovery of PMMA and the guidance of Prof. Gottfried Lemperle and Almir Nacul 15+ years ago.
My best recommendation is to stay away from those two products. Your career and reputation are too good to risk them.
Best regards!
DrC
Dr. Luis Casavantes / Dr. Palmira Morales
https://www.avantiderma.com

Reception: info@avantiderma.com
US Phone lines: +1 (619) 308-7268 & 308-7269
Mexico: +52 (664) 687-4848 & 686-5636
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