TOPIC: PMMA - The Good, The Bad and The Ugly

@Hoddle10
Pre PMMA: 4.5 EG
Right after procudure: 5.8 EG
3 Month Mark: 5.5 EG
Current: 4.85-5.1 EG depending on EQ

I had round 1 done back in January so its been over 6 months.

@Smartman
I don\'t remember MikeHok\'s starting measurements but I doubt my starting stats could be considered larger. haha. Seriously though.. 4 EL/4.5 EG starting.

I\'ve also considering the fact that I smoke can be affecting the collagen.

Hi Boost,

Everyone\'s body is reacting differently than the others in regard of the amount of the new collagen formation around the PMMA beads ; (The age, smoking, steroids etc.).

We have mentioned before that the longer and thicker penis needs more PMMA volume to be injected than the shorter and thinner one just to have the same gain.

As far as I remember Mikehok\'s pre-PMMA stats was EL around 6\" and EG 5.1\" so that means you need less volume of injected PMMA than him just to have the same gain as his (0.4\" he had this gain from the 1st month till 10 months post 1rd.).

But you have 0.35\"-0.6\" gained in EG (sure that depends on EQ) which is good.

Do steroids help or hurt the growth of new collagen? I would tinkling that some of them could help.

Hi Irishfan,

Steroids will inhibit collagen formation around the PMMA beads but only for a temporary period i.e. when you stop taking them the new collagen will come back again later on.

I think we should go back to our main topic which I am interested in (how to avoid the bad and the ugly results post-pmma injection) which are imo the nodules, lumps and asymmetry :-

1- We cannot do anything with the weak carrier of the Brazilian\'s pmma products (Carboxymethyle Cellulose) which can cause clustering of the beads --> nodules and lumps formation.

2- We should listen to our treating Dr. in regard of choosing a lower conc. e.g. 10% better than the higher ones.

3- Now this point which I am interested in; the technique (the threading or tunneling and not micro-droplets) of the Dr. and the most important the aftercare and the precautions :-

As I have mentioned before the idea of avoiding nodules and even lumps is to have continuos (non-interrupted) strands-like of pmma beads running parallel to each other (i.e. along the long axis of the penis) with little space in between them (so the doctor has to inject the pmma slowly, continuously and with the same force all the way) so if the injection was interrupted by any means---> nodules and irregularities formation.

So lets say then if the Dr. did the right technique ( which I am sure Dr.C. is an expert in this) and still you have these nodules and lumps, so the Q. is why?? and how can we solve this problem or at least reduce them ?? :-

Sure the reason for that as we mentioned in (1) the clustering of the beads due to the weak carrier so how can we solve this problem ?? Massaging ?? imo not to a great point the reason :-

Let us imagine a cross-section of a penis injected with pmma which has irregularities e.g. nodules or even lumps (and we know the reason for that is the degree of the clustering of the beads (minor clustering -->nodule and major clustering -->Lump)) so that tell us these unpleasant issues are due to clustering of the pmma beads on top of each other (i.e.in a vertical plane) and not side by side (i.e. in a horizontal plane) so now how can we reduce these vertical axis or at least making them evenly with the same hight all over the shaft as much as we can.

Would really massaging (esp. vigorously) the whole penis (esp. if it was done by the patient) solve this problem ?? or not??

Imo and what I have read about the precautions and aftercare of pmma injection :-

You shouldn\'t interrupt (break) the continuity of the pmma strands formed after pmma injection otherwise ---> irregularities and nodules will form, and that is the reason why some doctors ask their patients not to massage the injected area afterward :-


1)) This is an example of Artefill injected for smile lines :-


www.ocdermatology.com/artefill-orange-county/


\"\" Aftercare: We advise you not to squeeze, massage or sleep directly on the areas for 24 hours, as this may subtly change the shape of the filler. Exaggerated facial expression during the first 24 hours may also displace the gel, so avoid prolonged laughing and playing musical instruments with your mouth.\"\"


2)) Another example the article from Lemperle:-

www.ncbi.nlm.nih.gov/pmc/articles/PMC2872009/

Precautions and Aftercare :-The implanted area should not be massaged because this may adversely distribute the ArteFill support “splint” and increase swelling and bruising. In contrast to temporary volume enhancers, ArteFill must not be spread in the tissue but remain inside the tunnel in which it was injected.The implants should be palpated for even distribution. In case of lumpiness, pressure is applied by squeezing the nasolabial fold between thumb and index finger.The treated fold should be taped with a 1-in. transparent tape (Transpore® or Blenderm®) for 3 days. The purpose of the tape is to remind the patient not to smile until the subdermal implant strands are fixated. ArteFill can be dislodged from the deep dermal implantation site into deeper layers through pronounced facial muscle movement during the first 3 days, diminishing the expected result. To prevent this, immobilization using tape is important during the first 3 days.

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But the doctor has to use his fingertips directly after the injection to feel for any irregularities and nodules and massage or even squeeze them (between his index and thumb) just to break them and try to distribute the pmma beads evenly.

So imo The Roller technique which I have mentioned before should be done as early as possible in the clinic which can at least reduce these vertical clustering of the beads and to have almost the same vertical hight of these beads all over the injected area by having the same force all over along the whole penis (and a hard plate can be used underneath the penis for support) i.e. the force of the roller will be more precise and controllable than the hand.

I have sent an e-mail to Lemperle about this korean paper and that was his reply :-

A) I absolutely love that roller - but I know that Dr. C.\'s assistant Wade is a master in spreading and smoothening the injected PMMA...

and his answer about using Silikon1000 micro-droplets to fill the irregularities and the small depression or would he prefer a lower conc. of pmma :-

A) Whether another filler like Silicone on top is a good idea, I doubt. I would rather carefully fill out all later bumps with PMMA 10 % (2% is nonsense in my eyes)again - and this can be done as microdroples as well !

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It is just a learning process this pmma penile bioplasty and Dr.C.\'s technique is still being perfected.And I am sure our forum can help him a lot in following the progress of his patients and improving his technique and the aftercare after pmma injection.

@ Irishfan, As I said steroid intake (esp. if it was taken continually for a long period with a massive dose) can affect collagen formation around the pmma beads :-

Dr.David Pearson answered this Q. in a RealSelf forum, check his reply on the 8th of August 2011 :-

www.realself.com/review/houston-time-filler-eyes-artefill

He said :- \"\" Glad to hear that things are getting better. Ideally, btw, Artefill is usually done over *two* sessions...to avoid over-filling. Unless you were on medication that inhibits collagen synthesis (e.g., a corticosteroid like Prednisone), you should get a 1:1 replacement of the Artefill\'s collagen with your own collagen. Perhaps your doc didn\'t use enough or didn\'t put it in the right place. Still, better than too much. For most patients, though, a single 0.8cc syringe ought to be plenty for under the eyes along the tear troughs.

Definitely give it some time before doing anything else in that area.\"\"


But if steroid was given intermittently (even if it was with a massive dose)did not alter collagen synthesis e.g. intra-lesional kenalog injection (every 4 wks) for the treatment of keloids it will enhance collagen degradation without lowering the normally high rate of collagen synthesis, thats why keloid (or in our pmma case granulomas) become softer and smaller after multiple Kenalog injections.

smartman wrote: @ Irishfan, As I said steroid intake (esp. if it was taken continually for a long period with a massive dose) can affect collagen formation around the pmma beads :-.

smartman wrote: Hi Irishfan,

Steroids will inhibit collagen formation around the pmma beads but only for a temporary period i.e. when you stop taking them the new collagen will come back again later on.

@smartman, this is not true. You are confusing corticosteroids with anabolic steroids which is what Irishfan is asking about.

Anabolic steroids increases collagen synthesis in most tests. See phalloboards.websitetoolbox.com/post/Inc...ing-collagen-5799209

Bigben wrote: By mixing in office the risk is two fold: *incomplete mixing leading to nodules (this problem seems to be more prevalent in 20% patients vs 10% or 30%).

In theory, I can see how this could lead to the irregularities we\'re discussing here, but the prevalence is hardly understood as only a small sample size has reported to this forum, and of that sample size, aesthetic satisfaction seems to vary between patients who have used 20%.

It would be nice if Metacril or Linnea Safe were to introduce a 20% Concentration as a special batch offer to Dr. C\'s clinic (or as a product altogether) - that would really bring to light some of the lingering questions surrounding Nodule & asymmetric formation(s).

I have contemplated 30% for my next round but have been very fortunate with the aesthetics (minus the nodules behind the glans which I attribute to neck entry issues) since my shaft is very natural looking and the glans are only slightly dwarfed (great taper work).

A part of me wants to minimize the number of rounds left to achieve my desired goals since (in my mind) I correlate \"frequency of rounds\" with \"chances of complication\"... so it leads me to wonder whether 30% not only gives me more bulk but possibly a lesser (??) chance of irregularity (given that it\'s not mixed)? On the flip, I have faith in Dr. C\'s expertise and he\'s gone as far as have men sign waivers when administering 30%, so it only makes me wonder which route to take.

Heck, the 20% mixture may not even have anything to do with irregularities as it\'s quite clear we\'re only beginning to figure out what\'s behind some of the aesthetic issues some of us are facing.

This concentration conversation is very important to the future of this method, that\'s for sure. If representatives of PMMA Brands are reading this - INTRODUCE MORE CONCENTRATIONS!

Skeptical One wrote: I have contemplated 30% for my next round [...]

A part of me wants to minimize the number of rounds left to achieve my desired goals since (in my mind) I correlate \"frequency of rounds\" with \"chances of complication\"... so it leads me to wonder whether 30% not only gives me more bulk but possibly a lesser (??) chance of irregularity (given that it\'s not mixed)? On the flip, I have faith in Dr. C\'s expertise and he\'s gone as far as have men sign waivers when administering 30%, so it only makes me wonder which route to take. [...]

Do you mean frequency increases chances of complications because the complications are likely to develope in the week or so after an injection? and the more injections you have, the more likely something will happen?

I\'ve had 4 rounds without complications (very very minor issues).

I would think a big round of 30% would have a higher chance of irregularities than 2 medium - big rounds of 10%. Or one round of 10% and one round of 20%.

I think post-op care has a lot to do with preventing complications.

Also if you check the same paper of Lemperle in regard of the injection technique (the tunneling technique) :-

www.ncbi.nlm.nih.gov/pmc/articles/PMC2872009/

The following points are recommended :-

1- Placing a continuous strand of material under consistent pressure .....

2- An even, continuous strand should be delivered .....

3- Immediately after implant placement, the injector should palpate the implant by gently applying pressure and eventually evenly massage with the fingernail to facilitate uniform distribution. Overly vigorous massage may spread ArteFill deeper into the fatty tissue where it does not achieve the desired effect, and massage may cause unwanted swelling and bruising.

Sizemic wrote:

Skeptical One wrote: I have contemplated 30% for my next round [...]

A part of me wants to minimize the number of rounds left to achieve my desired goals since (in my mind) I correlate \"frequency of rounds\" with \"chances of complication\"... so it leads me to wonder whether 30% not only gives me more bulk but possibly a lesser (??) chance of irregularity (given that it\'s not mixed)? On the flip, I have faith in Dr. C\'s expertise and he\'s gone as far as have men sign waivers when administering 30%, so it only makes me wonder which route to take. [...]

Do you mean frequency increases chances of complications because the complications are likely to develope in the week or so after an injection? and the more injections you have, the more likely something will happen?

I\'ve had 4 rounds without complications (very very minor issues).

I would think a big round of 30% would have a higher chance of irregularities than 2 medium - big rounds of 10%. Or one round of 10% and one round of 20%.

I think post-op care has a lot to do with preventing complications.

I mean in general. And this is true for any method. In other words, (in my opinion), if you have a stellar Round 1, you may not necessarily have the same situation for a Round 2, and with each passing round there is always room for issues/risks/etc. This is true for surgeries, with each passing surgery opens a new window for new issues. I was speaking in generalities.

As for PMMA specifically, I agree, post-op care can go a long way in preventing irregularities. I am fortunate to have a very natural looking shaft and have a few nodules (only one of which is truly noticeable) which I believe were a result of poor post-op care on my part as well as neck entry risks.

I guess what I\'m saying is that I\'d like to minimize the number of rounds I have left before I \"retire from PMMA,\" and that\'s where consideration of different concentrations come into play. I\'m sure I\'ll update my PR when the time gets closer and get more opinions on the matter. Dr. C\'s opinion will also weigh heavily on my decision.

I\'ll also consult their office on their opinion of 20% in general. Keep in mind, they have made tweaks when things have been problematic in the past (i.e. discontinuing neck entry). Seeings how they still use 20%, they must have reason to believe the success rate is more than acceptable in their eyes. I\'ll have to see what they say about it, and I\'ll share it with the forum when I learn more.

I think Dr C\'s office realized that most people were complaining about 10% not showing consistently good gains so they went with 20%. The same with the neck entry points, they had problems and now they normally do not do it but it is still an option under certain conditions.

That\'s what is good about his operations, they listen to customers and try to improve. They still make some mistakes, but at least they try to fix them and improve their procedure.

@Mustang,

i agree with you that is what good about Dr.C.\'s office they follow the results of their patients and modify and improve their techniques .

But sure it will take time to perfect their results (not to forget to expect an excellent result with PMMA beads in a dynamic organ is not an easy thing).

@Sizemic,

You have really great result with 4 rds with two different conc. as far as I remember :-(20%(22cc.s),10%(17cc.s),10%(12cc.s)+20%(18cc.\'s))

and I think you did massaging post-injection but about wrapping I am not sure?? It will be nice if you can remember your post-injection strategy.

Could it be the reason that you have great result because your penis doesn\'t turtle much (as a shower) so you have always a long Flaccid and your dartos muscle is not hyperactive so it doesn\'t affect the PMMA beads underneath them and the reason I have mentioned this because I read somewhere that some doctors who use Artefill in the face in US they found a better aesthetic result if the patient had botox in the same area before using Artefill, and they are collecting some data for publication.

So can botox injection in the penis help in reducing unpleasant aesthetic results (like in the face) (esp. with higher PMMA conc.) by preventing dartos muscle continuous contraction to avoid disturbing the continuity of the PMMA micro-strands.


Btw Wade had mentioned to you it was in your thread page 26 post no.381:-

Wade warned that because there was already so much material there, that the new PMMA might have trouble settling and sticking. He said the more product that you have there (old material) the new PMMA can collect and lump so extended massaging was very important. He even said that years ago they had patients doing many small sessions over the course of a long period of time. And the more sessions they had the more common it was for them to develop lumps and bumps do to the material.

Hi Guys,

Sorry to keep you waiting, these are some pictures. I remind you here that what can be seen isn\'t 100% representative of what its condition is. My camera is a very old low end point and shoot and even without that, it is hard to photograph surface distortions. Finally, the biggest issue I am having is the very unnatural feel of my unit when at rest, give that one can easily detect lumps and hollows which are instantly evident to the touch, unless it is a shy surface caress.


The first photo is the morning after session 2. My current temporary conclusion is that my body reacted adversely to 20% Metacryl and that this was impossible for Dr C to predict in advance. I also think that this caused a huge amount of irregular swelling which was not at all even, but very lopsided. I would expect that this also caused the PMMA to lump together while hardening? In any case, I added a final picture taken today in semi-Flaccid condition to show that all is not bad; as long as it is gorged it remains very presentable. FYI that is a shadow from an olive tree and not a dark spot on the shaft.


Cheers,


HUNK CHUNK
PS. Photos are too large and I will have to post them later, as I get an error message! \"An error occured. Error. Storage limit exceeded.