ive been lurking around this board for about a year now reading and reading and i can’t find a single procedure that seems to be 100% legit in the United States or any country for that matter. If it is being performed in Mexico or another country then i would imagine it’s not being performed in the states for a reason. Am i missing something here?
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There are basically 2 main reasons why there is no "gold standard" for PE procedures in the US.

Firstly, the penis is a dynamic organ, which makes it difficult enhance. In basic terms, because it varies so much in both size and feel when it is either flaccid or erect, it's hard to find a suitable implant material. 

Secondly, the best implant materials that are used in this application, are micro-sphere based soft tissue fillers. These are PMMA products and Ellanse (there is also Radiesse, but not popular). Unfortunately, the PMMA product available in the US, Belafill, doesn't use the same carrier (gel in which the micro-spheres are suspended) as the Brazilian products, which doesn't make it ideal for use in the penis. Also, it is considerably more expensive than the Brazilian products, making it cost prohibitive in most cases. Ellanse doesn't have FDA approval at the moment, but that us likely to change in the near future. 

In short, the penis is a tricky organ to enlarge and the best of the current options aren't available in the US due to patent laws and pending FDA approval. 

But based on complications and patient satisfaction etc, I'm not convinced that the current PE options available in Mexico, Brazil, Australia and Europe are any less "legit" than the face lifts and boob jobs performed every day in the US. You only need to look at the porn industry to see how frequently American girls are deformed by the "wizardry" of US plastic surgeons.   
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I agree with hoddle10. The penis is such a dynamic organ and we all differ in shapes and sizes. Even with other cosmetic surgeries (and disasters), natural is always real and surgery enhancements are just that - enhancements - such as boob jobs, that may make a woman's tits look better in shirts, but are still not quite the real thing when undressed and in bed. They may even look better, but not the real thing. People go to great lengths to change themselves and many turn into freaks. I lived in LA for a number of years and was astonished by how normalized it is now to have a tight-pulled face with big boobs at any age. I always wonder if we will look back in history at this time and think, "What the hell were they all thinking?" Thus, the natural penis - those blessed with gorgeous cocks, will always look better than those who are enhanced in my opinion. Having expectations of "building" one's cock to look like the blessed hung guy with an 8-inch dick, veiny, perfect color, head, etc. is just not reasonable. The penis is much trickier than the tit. It's always a risk. Just stay away from the Elist implant for sure!!!
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Great input guys and i really appreciate it! Lots more to learn and some very valid points! Another question I have is do you all think the procedures done in other countries are safe? I’ve heard loads of terrible stories about having many medical procedures done in other countries to save a buck and they end very very badly! All input is greatly appreciated! 
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Avanti Derma
Jamesfab wrote:
Another question I have is do you all think the procedures done in other countries are safe? I’ve heard loads of terrible stories about having many medical procedures done in other countries to save a buck and they end very very badly!

Hello @Jamesfab 
Of course, my comment is biased, but I suggest you open your criteria a little bit.
Medical procedures performed abroad are not necessarily inadequate, and the opposite also applies: not all procedures done in the USA are necessarily right. 
I am a Mexican doctor with US citizenship, and I have lived my life with one foot in each country; I understand both cultures very well, and I see how CNN, Botched and so seed the wrong ideas.
My practice is an international melting pot of colleagues and patients from all over the world, and I have witnessed good and bad everywhere. No borders or passports here.
Dr. Luis Casavantes / Dr. Palmira Morales

Reception: info@avantiderma.com
US Phone lines: +1 (619) 308-7268 & 308-7269
Mexico: +52 (664) 687-4848 & 686-5636
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@Jamesfab  I think anytime you go "under the knife" so to speak, you take your chances. 
I am a patient of Avanti Derma, and I can say wholeheartedly that I am completely satisfied with my outcome, and I'd do it again without second thought. (Look up my journal for b4/after) However, I also did everything in my power to maximize my chances of a great outcome. I exercise regularly, eat a healthy balanced diet, don't smoke or drink, and took all the recommended supplements.
I think a lot of poor outcomes are a result of poor aftercare, poor diet and nutrition, unhealthy life styles, etc. Look at liposuction. If that isn't a surgical solution to poor life choices, I don't know what is. So, would it be a surprise if their procedure didn't turn out so well? 
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There certainly isn't a procedure that produces a perfect outcome every time, but pmma is pretty damn good. I was nervous about having a procedure done on Mexico, but I'm very happy with my result.
Before PE, August 2017:
E: 6 1/4 x 5 1/8
F:  4 1/2 x 4 1/4

July 2019, after 2 years manual PE, immediately before PMMA round 1
E: 6 7/8 x 5 1/4
F: 4 1/2 x 4 1/2

October 2019, final result after 1 round PMMA
E: 6 3/4 x 6
F: 4 3/4 x 5 1/4
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Just got back from my procedure with Dr C.  He and his staff are the epitome of professionalism.  The man has done this more than anyone in the world — I’ll take experience.

I do know that the aftercare is everything , and they encourage you to come back for manipulation  — every 2 hours if need be.
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