TOPIC: Small hard bump at entry point

I'm approximately 7 weeks post Linnea procedure. One of the entry points developed a small raised bump. This is my third round and Ive never encountered this.It's the size of a small pimple and very noticable. Is anyone familiar with this and how to treat it?

Chat GPT is leaning towards a tiny epidermoid (inclusion) cyst or a small trapped keratin plug ?

It sounds like an entry-point nodule (when filler and fluids weren't properly expelled during the massage process post-op) but 7 weeks out is a little unusual, but not necessarily alarming or impossible.

The Epidermoid cyst and keratin plug are not out of the question, but even then I don't believe they present anything immediately concerning (in fact I used ChatGPT to refresh myself on those skin/injection anomalies since most aesthetic bumps discussed here are typically superficial nodules as a result of fluid/filler accumulation, or granulomas, and rarely anything in between).

Depending on the diagnosis and the significance/size of the bump, treatments include punch-excisions (and similar techniques), or even the passage of time (some bumps resolve on their own).

If you find it too problematic aesthetically to wait, you can have it examined and removed locally, I doubt you'd want to travel International for a 5-minute process that doesn't involve a deep expertise in penis enlargement, but if they happen to be familiar that's always a plus (in fact, I'd recommend a Dermatologist, @Dr_Sullivan is an option if you are close to Florida).

If you intended on going back to Avanti Derma for general-touchups (and/or more girth), then maybe it's worthwhile waiting at least that much time if you can. Otherwise you have options, so you can take comfort in that.

With a entry-point nodule, I can't say for certain when it would be deemed "late onset," (6 weeks? 6 months?) which would make it peculiar to me (because typically they tend to be noticeable early on). Due to its appearance now, I would mostly monitor if & how it changes -- specifically if it gets bigger in size, reddens, warmness, becomes tender or painful, or begins to open and/or puss. If it remains as is (as I expect it to), I suspect it's related to one of the culprits we've discussed here (entry-point nodule, epidermoid cyst, or keratin plug), and fortunately given the size and location of this bump, sounds very manageable.

If you have pictures that could help.

It actually began to develop around the second week. This particular entry point was stubborn and would open randomly. I would say it closed for good around the fourth week. It is pink, not tender to the touch, very sub surface, somewhat elongated like a grain of rice now that I examine it more. I'm in RI so I do not plan on visiting Avanti until I determine whether or not I want a final polishing up. I would prefer to have it taken care of sooner than later but I'm willing to wait another couple months to see if it flattens out. It's most noticable Flaccid, with an Erection it kind of blends with the other tissue. My concern is that it very noticable and would probably be mistaken for an STD if seen Flaccid.

I'm definitely leaning heavy into the entry-point Nodule theory with the current photo, especially now with more context to both time and the size (and location) of the bump; regardless of my theory (it holds no diagnostic authority), from experience I can tell you that as long as it doesn't worsen (the things I mentioned to monitor in my prior reply), your willingness to wait a couple weeks might not be a bad idea.

I'll be frank, at about 7 weeks post-op, I'm not sure any additional "massaging" of that Nodule will help diminish it (in fact it could be abrasive and have the opposite effect), but you should check with Avanti Derma to see if there are any topical remedies worth considering in the interim (probably won't be anything that gets rid of it, but may be able to reduce its "footprint").

On the matter of waiting a couple of months, this could help determine: [1] if time alone seems to work in your favor and it begins to diminish on its own; [2] if it's a real concern, because in that time you'll absolutely exhibit signs if this was anything more than a benign artifact from the injection process; or [3] whether you pursue the Avanti polishing route -or- to have it addressed locally (assuming it remains mostly as is).

A Nodule would be caused by an accumulation of PMMA microspheres or is that a broad term for various anomalies?

Im split between it being a PMMA Nodule or keratin pearl. Im leaning more towards Keratin pearl because I expressed a very very small amount of white paste like material from it a few weeks back. It appeared to have a very small white center also. I have since stopped manipulating it by squeezing.

Avanti is generalizing it as a minor irregularly remaining through the healing process. They mention the bump may continue to improve while the tissue heals and settles over time. They also mention the possibility of steroid injection if the irregularly does not improve after approximately 6 months.

And I appreciate the support you have provided to me on this SK1

Here is my take on this. The term "Nodule" is generally descriptive rather than diagnostic. It simply refers to a localized palpable area of tissue and can have a variety of underlying causes depending on the timing, location, clinical presentation, and material used.

In the setting of PMMA, a true PMMA-related Nodule may result from a localized concentration of microspheres, collagen deposition, inflammation, fibrosis, or a combination of factors. However, not every small palpable irregularity should automatically be assumed to be a PMMA Nodule.

Based on your description of a superficial, non-tender, stable lesion located at an entry point, other possibilities such as scar tissue, a healing irregularity, epidermal inclusion cyst, keratinous debris, or a localized tissue reaction would also remain within the differential.

The fact that it appears stable and not progressively enlarging is reassuring. In my experience, many minor entry-point irregularities continue to improve as tissue remodeling occurs over several months. Continued observation and serial photographs are often more informative than frequent manipulation of the area.

Ultimately, clinical examination is far more valuable than photographs alone, but I would be cautious about labeling it a PMMA Nodule without additional supporting findings. If the provider kept releasing product when exiting the cannula entry point than this would be considered a PMMA Nodule. Again in my experience, many minor entry-point irregularities continue to improve as tissue remodeling occurs over several months.

Thanks Tanner, I appreciate the explanation. It sounds like there are several possibilities and that "Nodule" itself doesn't necessarily imply a PMMA-related issue.

Given that it's stable and asymptomatic, I think I'll continue to leave it alone and give the tissue more time to remodel before deciding whether anything further needs to be done.