KiwiGrower
Hi guys,

I'm new to the forum and although this is my first actual post, I've been following Phalloboards for a while now. 

I've hit a crossroads and need some advice. 

I'm very fond of my foreskin and so is my partner of 3 years. I'm gutted to have learned after years of research that there is only a very risky and slim chance of successful girth PE options for those of us who are uncut. It seems everything from grafts, FFT, implants and PMMA injections have a high failure rate in uncut patients, with some surgeons even flat out refusing to touch a prospective client who wishes to retain their foreskin. This is due to issues such as migration of filler product/grafts through to poor aesthetic results. Worse case scenario appears to be a combo of both those things as well as an increased risk of infection and/or skin perforation in the case of silicone implants. 

I think I would rather keep my foreskin than pursue PE any further in terms of girth, but I'm very dissatisfied with my 4.7" MSEG size and my partner has admitted that more girth would be nice after she had a big cock experience lately. 

Why is the foreskin so damn tricky to work around after decades of surgical and non-surgical advancements in PE?

Has anyone who is uncut had positive results from any type of permanent procedure? I've heard an extremely modest round of low CC, low ml PMMA can be achieved when people have a foreskin, but the "accordion effect" is still noticible and I can't really justify the additional cost of leaving a country as isolated as New Zealand to undergo any procedure that is going to produce any less than an inch in girth gain. 

Does anyone have any suggestions?
Starting Stats:
NBPEL-
 12.2cm / 4.8"
BPEL - 14cm / 5.5"
MSEG - 12cm / 4.7"

Goal Stats:
NBPEL-
15.24cm / 6"
BPEL - 
17.78 / 7"
MSEG -
14 / 5.5"
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Reklaw
Dr Casavantes best pmma results are on those who are uncut who’ve had a small amount of 10%
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KiwiGrower
Hi Reklaw,

He seemed pretty adamant about patients being circumcised on his website. The illustration of the "accordion effect" was a bit confronting, I must admit. I have a loose foreskin overhang that extends about 1cm beyond the end of the glans. Do you think a partial circumcision to rid myself of the excess might reduce my risk factor? 
Starting Stats:
NBPEL-
 12.2cm / 4.8"
BPEL - 14cm / 5.5"
MSEG - 12cm / 4.7"

Goal Stats:
NBPEL-
15.24cm / 6"
BPEL - 
17.78 / 7"
MSEG -
14 / 5.5"
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Reklaw
I have a partial circumcision. If I were in your position I wouldn’t have a circumcision under any circumstances.
There was a doctor on here from Virginia US (I think) who claimed acordition effect wasn’t purely a result of being uncircumcised.
Obviously accordion effect is a possibility, but you have to take into account the downsides of  pmma on a circumcised penis, such as having the pig in a blanket, which looks gross.
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Avanti Derma
Hello guys,
It's probably time for me to kick in with my personal opinions.
  • I don't have a statistical number, but most patients that get a circumcision as adults are happier than before.
  • I understand patients avoiding GE procedures to preserve their foreskin, though.
  • The accordion effect happens in both uncut patients (almost always) and loose-skinned or partially circumcised patients.
  • Circumcised or not, I will stay away from the so-called "soft" silicone implants; they are destined to fail no matter what.
  • Pursuing a girth gain of 3 1/4 cm in a BPEL of 14 cm is a little unrealistic if aesthetics are in mind. 
  • If it were entirely my decision, nobody would walk away from my office with more than 1.25 cm of circumference increase. It seems like a mediocre gain, but it is not; it is substantial, and it preserves the looks of the organ, an important thing for guys who like to foreplay.
  • Some of my patients come uncircumcised but understanding that they may face circumcision down the road; others get circumcised in advance. I always recommend a high, tight circumcision in both scenarios.
  • The tricky deal of phalloplasty is to work with the impressive dynamics of the foreskin, which are impossible to preserve when we start messing with it.
  • As Recklaw stated, a combo of low volume / low concentration is the way to go in the uncircumcised; he also addressed another point: moderation in the equation! Accordion effect, pig in a blanket, overcorrections... stay away from them.
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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KiwiGrower
Hello guys,
It's probably time for me to kick in with my personal opinions.
  • I don't have a statistical number, but most patients that get a circumcision as adults are happier than before.
  • I understand patients avoiding GE procedures to preserve their foreskin, though.
  • The accordion effect happens in both uncut patients (almost always) and loose-skinned or partially circumcised patients.
  • Circumcised or not, I will stay away from the so-called "soft" silicone implants; they are destined to fail no matter what.
  • Pursuing a girth gain of 3 1/4 cm in a BPEL of 14 cm is a little unrealistic if aesthetics are in mind. 
  • If it were entirely my decision, nobody would walk away from my office with more than 1.25 cm of circumference increase. It seems like a mediocre gain, but it is not; it is substantial, and it preserves the looks of the organ, an important thing for guys who like to foreplay.
  • Some of my patients come uncircumcised but understanding that they may face circumcision down the road; others get circumcised in advance. I always recommend a high, tight circumcision in both scenarios.
  • The tricky deal of phalloplasty is to work with the impressive dynamics of the foreskin, which are impossible to preserve when we start messing with it.
  • As Recklaw stated, a combo of low volume / low concentration is the way to go in the uncircumcised; he also addressed another point: moderation in the equation! Accordion effect, pig in a blanket, overcorrections... stay away from them.


Hi Dr Casavantes,

Thanks for your fast and detailed response to the post. This information is extremely handy to hear first-hand. I would much rather have a natural looking penis with modest gains than something unsightly. In your opinion, would it help to gain some length using my Male Edge Extender before opting for GE? Does PMMA have any longer term side effects? 
Starting Stats:
NBPEL-
 12.2cm / 4.8"
BPEL - 14cm / 5.5"
MSEG - 12cm / 4.7"

Goal Stats:
NBPEL-
15.24cm / 6"
BPEL - 
17.78 / 7"
MSEG -
14 / 5.5"
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Reklaw
@Avanti Derma
Why is it that Dr Nemekova’s patents didn’t get the accordion effect ? Of course they had other problems but as far as I can recall it’s only Southdub who had accordion effect out of 90+% uncircumcised patients.
I’d be willing to bet most of the men in the study of men who prefer circumcision are Americans.
I fail to see how circumcised pmma results are better, the only undetectable results I’ve seen on this board are on uncut patients who’ve had 10%
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Skeptical One
Reklaw wrote:
@Avanti Derma
Why is it that Dr Nemekova’s patents didn’t get the accordion effect ? Of course they had other problems but as far as I can recall it’s only Southdub who had accordion effect out of 90+% uncircumcised patients.
I’d be willing to bet most of the men in the study of men who prefer circumcision are Americans.
I fail to see how circumcised pmma results are better, the only undetectable results I’ve seen on this board are on uncut patients who’ve had 10%


I'm not sure we have an adequate sample size of Dr. N uncircumcised patients to effectively conclude they have less occurrences of the accordion effect (to a significant degree).

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Gg82
Hopefully @Androfill would chime in about this topic, since I'm guessing they see more uncut penises than dr.C, being based in Europe.
What dr.C wrote is quite known (and sad) for us uncut guys that don't want to give up their foreskin. 
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George7
I am a Dr N patient and only had 10% 15ml. I do have the according effect. I have a lump at the left side and it is only pronounced when forcing the foreskin all the way back. For me it is not a big issue, but if I had 30% 20+ ml I would have imagined it would have been much more pronounced. One could always get uncut later on and go in for another round to fix issues then.
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Androfill
@Gg82 

We previously commented that the "accordian effect" can occur whether cut or uncut, and came under some criticism from members for suggesting this.

Perhaps other clinics have different results and see cut or uncut as relevant to accordion. A cut patient is at lower risk of filler migration, and it can be hard to get a smooth result in the area between the circ scar and the glans, but cut or uncut isn’t currently a factor considered in regard to accordion effect - but this might change if clear evidence emerges.  

Accordion effect is rare at Androfill, I have seen it 3 times. In 2 of these 3 cases there was unusually, more filler towards the glans than at the base as the moulding  / distributon of filler was not ideal. This is possibly a factor, or possibly not, but it seems plausible that it contributed to the problem. In both "reverse taper accordian" cases the patient was cut.

In the case of the uncut patient with accordian, he'd had 40ml of filler and was at the limit of what we were prepared to inject, however his filler was evenly distributed, so nothing to do with taper / no taper. 

A taper slightly wider at the base and narrowing slightly to the glans, might be preferrable to reduce the risk of accordian, however this is not backed up by any reliable statistics (3 cases of accordian is not much of a sample). It is simply a hunch but my feeling is more filler in the front and less at the base adds to the likelihood of accordian, aside from looking strange.  In all cases quite a lot of filler (30ml+) had been injected, so "large amount of filler" might also be a risk factor.  

kbgetbig member wrote an interesting post, below, on the Androfill 10 ml thread.
Dr Horn casually endorsed the post in passing when I shared it with him, below.  https://phalloboards.websitetoolbox.com/post?10127326&trail=15


[The accordion effect is due to the filler interacting with the dermal layer; the closer to buck's fascia the less the effect.
The skin of the penis is loosely attached to the underlying fascia called scarpa or colle's fascia, it is a loose connective tissue that allow the upper skin to behave more like a fluid than a solid object. Think of two sliding doors made of rubber passing each other, one door the outer door can move freely and isn't connected to the inner door; the outer door (the skin) can stretch, shrink and move freely past the inner door regardless of the size of the inner door (buck's fascia), however, if there are any connections between the outer door and the inner sliding door then as the outer rubber door moves past the inner door where it is attached it bunch's up like an accordion.

The other possibility which is similar to the above procedure is if too much filler is at the base between the pubic/penile ligment at scarpa fascia where both join a inadvertent binding is formed and you can get a bunching of the skin here. And there is a very thin layer of muscle tissue (thicker towards the foreskin and the scrotal web) that is just under the dermis called dartos fascia that shouldn't have filler injected into it because filler and muscle don't get along and cause bunching and nodules.]

Once again the solution is to place filler on buck's fascia on each side of the ligament, which is hard to do because the ligament fans out from the pubic bone to integrate itself with buck's fascia. Few docs understand this anatomy and that is why you see the accordion effect, it has nothing to do whether one is cut or not. A circumcised penis will do the same if one were to retract their skin, but since it is rarely done except for aggressive masturbation no one complains of it.]
Quote 1 1
think
Androfill wrote:

A taper slightly wider at the base and narrowing slightly to the glans, might be preferrable to reduce the risk of accordian, however this is not backed up by any reliable statistics (3 cases of accordian is not much of a sample). It is simply a hunch but my feeling is more filler in the front and less at the base adds to the likelihood of accordian, aside from looking strange. 

For fillers like pmma and ellanse that cause inflammation, there is a good chance of more lingering swelling in the area of the circ scar (I experienced it with ellanse, and I've read about others having it with pmma). Even with good aftercare, this can facilitate more of a chance of migration. Dr. Carney told me they now taper away as you described, for this reason. 
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Avanti Derma
KiwiGrower wrote:


Hi Dr Casavantes,

Thanks for your fast and detailed response to the post. This information is extremely handy to hear first-hand. I would much rather have a natural looking penis with modest gains than something unsightly. In your opinion, would it help to gain some length using my Male Edge Extender before opting for GE? Does PMMA have any longer term side effects? 


@KiwiGrower 
I agree with you, and I cannot insist enough on the enhancement vs. augmentation issue!
Maintaining the natural shape of the penis (or any other body part) is the best expectation that a prospective patient can have, and the best approach that physicians can offer.
Patients that have had successful mechanical penile elongation have a thick base formed by the elongated soft tissues and are a little more problematic to work with due to the lack of the typical layers of the penis. In their case, the areolar space which we need is an elongation of the pubic subcutaneous fat pad. There are technical tricks to work around it, though.
Moderation in volume goes beyond the looks, though... long-term side effects are volume-related. No more than softness issues in patients with a low amount of PMMA: Two sessions of around 20ml each, possibly a final touch-up session with less than 5ml.
Obviously, I am presenting a case of an average-size penis; the volume must be adjusted in individuals with other sizes.
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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