Avanti Derma
I have been reading postings from members whose doctors recommended soft tissue filler mixtures.
As far as I know, there is no scientific evidence that this practice is logical or safe.
The ideal soft tissue filler has not yet been discovered since it needs to gather several characteristics that are almost impossible to find in a single product.
  • Safety: It has to be resistant to infection, non-allergenic, non-toxic, non-carcinogenic, etc. In a few words, it should be inert and invisible to the immune system of the host.
  • Efficacy: it must be easy to inject, of rapid recovery, not visible, of long duration, of a consistency similar to human tissues, resistant to the metabolic processes of the body and easy to remove.
The ideal soft tissue filler should be pure and simple; mixtures just distance it from its ideal characteristics.
Experienced researchers and practitioners oppose the idea of mixing soft tissue fillers before or during the injection process. On the other hand, it makes sense if the injector decides to use a different product in an area that healed or where an old soft tissue filler was absorbed already.
One of the mixtures that have been discussed in this forum is Radiesse with one brand of Hyaluronic Acid, claiming that it will last longer (lol). It is hard for me to imagine how a muddy mixture of HA gel with calcium spheres and carboxymethylcellulose can offer a good effect. 
The carboxymethylcellulose (carrier) present in the microsphere-based fillers is designed to be absorbed in days, so the microspheres are left alone in the tissues before the fibroblasts arrive and cover them with collagen. Low absorbable, water retaining HA gel will ultimately interfere with the process.
- I can see the microspheres migrating and gathering in the wrong places.
- How can we predict the chemical or physiological reactions of the substances mixed aftermarket if they haven't gone through scientific tests and clinical trials?
If there is an adverse reaction, how can we find out what's the source? Is it secondary to one or the other product, or their interaction? How can we treat the patient?
This is a long introduction for a simple recommendation:
Before authorizing the use of soft tissue filler mixtures for your phalloplasty procedure, make sure there is evidence that it is a safe (first) and effective alternative.
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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AD55
Hi DrC.

You can look for my case and it's details.
The end result is nodules at the injection sites and other places, some floating others fixed to the corpora cavernosa, not sure if I'm technically correct but you get it.
Some deep, other superficial.

I first contacted the Dr. and made the appointment for 10ml of HA only.
It was only 5 minutes before the procedure he told me he would use 2ml radiesse and 8ml HA for increased longevity.

I knew radiesse could not be easily dissolved but in my mind:
The reason I traveled to onother country was because a user of this forum was pleased with his procedure.
And 2 ml didn't seem much.

Only later talking to the other user I know he had HA only, so I'm thinking maybe I was a guinea pig.

I appreciate your recommendation DrC, already knew mixing fillers wasn't smart but sadly I felt for it.

Error or ignorance? My error, not sure about the Dr...
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Avanti Derma
Hello @AD55 
This is precisely what I am talking about.
I am not sure where the doctor's idea came from, but it was not meant to work. It is the muddy mix that I saw in my mind: microspheres suspended in carboxymethylcellulose and then mixed with hyaluronic acid doesn't seem to work.
It was a good thing that both products are absorbable when injected individually, so you won't have to endure those bad results for too long.
We all have mistakes, but since phalloplasty is already a touchy procedure, is important to create awareness for both other colleagues and all the members in general. Phalloplasty has evolved incredibly from the early surgical to the modern nonsurgical procedures, and this forum has played an important roll in such evolution.
Good luck, I hope that you return to normalcy pretty soon.
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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AD55
Thanks for the kind words, in these occasions they help a lot 🙂

I agree, we all make mistakes and we all need each other.

I have no bad feelings for Dr. Sarmentero, we talked and he showed concern for my situation. I believe he had no intention of doing a bad job, it's logic if I was pleased I would come back next year and give him more money, but unhappy I'm never doing business with him again.

When patients are willing to pay these sums for a simple procedure as injecting filler, it's the Drs interest to be responsible and keep learning from places like this forum.

Sure, I'll return to normalcy and will let you know.

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Avanti Derma
Absolutely! It looks like a legit attempt to make HA last longer. We all want that to happen but must be through other ways like heavier crosslinking, or something. We, physicians, need to wait for the researchers to come up with the solution.
Good luck @AD55, best wishes.
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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AD55
Thank you DrC, all the best to you as well.
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