PhalloBoards - An Online Community to Discuss Penile Girth Enhancement

(19.) Do girth dermal filler injections adversely impact blood pressure or increase risks of hypertension?
Dermal fillers absolutely do not affect blood pressure or increase risk of hypertension. They are strictly placed underneath the skin of the shaft and have no systemic effects whatsoever. The only rare issues are granulomas which can happen with any product and cannot be predicted or prevented. Sometimes the body's immune system can get activated which then attacks the dermal filer causing a granuloma or inflammatory nodule. Almost all of these issues are easily treated with local steroid injections.


(20.) Why are high volume silicone-oil injections into the penis regarded as the least safe or least ethical option as a girth filler by the PhalloBoards Moderation Team and many of its Sponsors? Have you ever dealt with patients who have had botched silicone injections from another Clinics come to you for revision?
FDA had issued warning in 2017 and again in 2021 against use of injectable silicone for facial or body contouring. In fact silicone has never been approved by the FDA for any dermatological condition. This "ingredient" or "product" is not very predictable in the skin and have known to spread and cause systemic side effects years later such as pneumonitis, ulcerations, migration, hyperpigmentation of the skin overlying the silicone. I have never seen a GE procedure from another clinic with a complication but I have seen it in the buttocks and lip, where the treatment of the complication required invasive procedures that left the patients with many unsightly scars.


(21.) Despite complications from correctly performed dermal injections being rare, foreign born granulomas (FBGs) are often regarded as the worst-case scenario complication. Have you experienced FBGs in your Practice? How would you go about treating this issue in the event a patient experiences signs of an FBG?
Granulomas can happen with any substance injected or implanted into the skin. By definition anything except for autologous grafting can cause a granuloma. An example would be if you suffered a viral infection such as the flu and the body mounted an immune response that decided to attack the substance that was injected. We advise avoiding any dental procedures or vaccinations 2 weeks before or after dermal filler injections to prevent this. Depending on how severe is the granuloma, I would typically inject a steroid such as triamcinolone into the granuloma and majority of the time this would resolve the issue. Not super common but I have seen a couple and indeed were mild. Sometimes if the granuloma was not even visible and we decided to leave it alone.

This is a question frequently arises in consultations: Can patients who have had a satisfying experience with HA fillers transition to polymethyl methacrylate (PMMA) for a more enduring result?
The most common scenario is : a patient tries HA and is happy with the results and now they seek a more permanent option with PMMA. Is this transition feasible? The short answer is yes.
Some doctors suggest it is problematic and want you to dissolve all your HA before proceeding with PMMA. Their concerns are as follows:
1. Risk of Complications:
They argue that the presence of HA might interfere with the PMMA integration process, potentially leading to unevenness, granulomas (inflammatory reactions), or even more severe complications due to the unpredictable interactions between the two substances.
Response:
There is no inherent reaction between HA and PMMA that would preclude their sequential use. It is important to remember that hyaluronic acid is a naturally occurring in the skin's dermal matrix. When PMMA fillers are injected into the dermal or subdermal layers where natural HA resides, they typically do not provoke adverse reactions. This is because PMMA microspheres are designed to be biocompatible and, when used correctly, should not interact negatively with HA or other dermal constituents. Injecting PMMA in areas previously treated with HA-based fillers should theoretically be as safe as injecting it into the untreated dermis, which already contains HA. The key is the technique used during the procedure:
2. Unpredictable Outcomes:
The concern is that the temporary HA filler could alter how the PMMA settles, potentially leading to asymmetry or dissatisfaction with the aesthetic outcome.
Response:
The injector must employ precision when injecting PMMA to ensure the microspheres are evenly distributed and to avoid the formation of granulomas or nodules just as they would when injecting into a penis with no HA. PMMA should be carefully injected to avoid disrupting the uniformity created by the HA fillers
4. Gradual Transition:
Some practitioners advocate for a gradual transition from HA to PMMA, allowing the HA to partially metabolize naturally over time. This approach can provide a smoother transition and reduce the risk of complications associated with immediate layering.
Response:
I fully agree with this. If you are at a size, you are happy with why not just slowly replace your HA with PMMA over time. It allows you to have more precise placement of the PMMA.

5. Time Interval: It's sometimes advised to allow sometime between the HA filler dissipation and the PMMA injections. This gap can help the practitioner assess the natural anatomy of the penis without the influence of the HA filler.
Response:
This not necessary if the original HA filler was well placed and has been well integrated into the tissue. This might be desired however if the original HA was poorly placed.

Why Not Dissolve the Existing HA?
Dissolving HA is not cheap, hyaluronidase is expensive, and a significant amount is needed for full reversal. Why incur this expense if it is not needed. Also why reverse the gains that you have already paid for? Dissolving the existing HA just seems like an unnecessary expense.

Conclusion
From a biochemical standpoint, there's no reason to expect that PMMA cannot be safely injected into areas where HA fillers have been previously placed.
Through my clinical experience, I have found that both hyaluronic acid (HA) and polymethylmethacrylate (PMMA) fillers can be safely employed for penile augmentation, whether they are used together or in a sequential approach, to meet the preferences and objectives of my patients.

getmoregirth.com/blog/

Damo85 wrote: That’s so interesting. The penis fill and erect filll sites are super similar so it really makes sense what you are saying. I would like to go for PMMA after HA but I think androfill is the only place that does it. Moorgate and Greta won’t.

I remember when Moorgate tried to use Ellanse perhaps 3-4 years ago and published some bad results (which they thought were good results I presume) in an Ellanse Before and After section of their website
I speculate that perhaps they had a really bad case or two and stopped using the product - which can certainly happen with Ellanse, indeed we have had a bad case in London, and Dr Kimilu in Manchester had a pretty poor outcome once using Ellanse and stopped using the product after that.

The fact that Dr Greta refuses to inject it, even under the umbrella of Androfill, should remind people that the risks are real.
Doctors are refusing money essentially because they are worried about the risks.

That said, when Ellanse goes well (which is most of the time), the patients don't seem to ever return to HA.
They say it is firmer and harder, on the downside they more frequently notice nodules and there is no a lot we can do besides minor surgery to address issues with the product.
Veterans of the PB forum will recall that for years Dr Horn refused to inject Ellanse before becoming comfortable with the product and risks.

It is sensible to use an inexpensive HA filler first, even a small procedure, to 1) practice moulding and gain familiarity with the aftercare process, and 2) determine with something reversible whether you are a good candidate anatomically speaking, for dermal fillers in the penis generally (some are not due to various issues).

Sorry I’m late to the game. I’m traveling out of the country and I’ve been off the grid since last week. Back to work today.

You have a condition in which your phimotic ring (the same band of tissue that causes phimosis) is creating constriction. It’s actually phimosis in a circumcised patient that is now presenting since your penis is larger. See a photo here. This patient doesn’t have dermal filler but he has a tight band like you do. Ignore the procedure in this page that talks about how to correct it. You don’t need that.

en.m.wikipedia.org/wiki/Preputioplasty

I can clearly see the tissue boarders in the center of the shaft of your penis. Basically this constriction band is tight and your penis is getting larger around it and it’s causing dermal filler to be pushed forward and back. In my clinic I use a neurotoxin such as Botox or dysport to relax these bands and they disappear for 9-12 months.

The sleeve may be causing sensitivity because of an allergy. I would like to discuss with you on the phone. I’m going to direct message you and try to get your phone number in privacy and call you about the sensitivity.

But the curve in the flaccid penis you see is from the constriction band. My guess is it relaxes when you are warm or stimulate and looks better.

It just presents an extra challenge to your procedure but it can be addressed.

Here are 3 examples of patients that have it. One of which I included the after photo after I injected him with neurotoxin to relax it.

I second Avanti Derma's take on Ellanse. Many recipients of the filler are reporting much longer retention than originally projected by the manufacturer, which is actually great news for penis enlargement patients. Of course, Hyaluronic Acid (HA) is a good starting point and it isn't unusual for some Clinics trial HA first to see how well your penis acclimates to fillers in general. You may also find you like HA and stick with it, especially given its healthy safety profile if you come across a version/brand with better overall retention.

Truthfully I'm not sure what brand of HA Moorgate uses, and depending on the nature of its cross-linking & quality, may not be the most ideal iteration of HA for penis enlargement (pure speculation on my part if you've seen such a dramatic loss in a month's time @Kara101349 ). Typically you don't start looking at topping off any reductions until about a year (give-or-take a few months) post-op, so either you're a rare outlier (someone who breaks down foreign bodies rapidly on the extreme end), or the quality of the HA isn't ideal for penile application. This is open speculation on my part because I have no knowledge of what brand of HA is being employed, how/where it's being sourced, etc.

Fat transfer is an option as well, but I cannot vouch for the efficacy or quality of Moorgate's FFT work, I've only heard/seen their dermal filler results.

If you wish to remain in Europe, Androfill of U.K. or Dr. Horn's own Independent Clinic in Brussels, Belgium can provide HA, and Ellanse is available in the U.K. (I am awaiting on word about Ellanse's availability in Belgium). The only other options for Ellanse that are trustworthy are the aforementioned Avanti Derma in North America, as well as a Clinic or two in Australia, but I haven't been in touch with the Aussies in a bit so don't know the current status there.

@Guy123 I moved your post to its own topic so that can get the appropriate advice.

Also, by "bubbles" I assume you mean nodules perhaps? Without photos it will be a bit challenging to provide the best advice, so that would be helpful.

It isn't unusual to see minor aesthetic irregularities from dermal filler injections (especially after the first round), and typically requires a subsequent round or two to achieve your final size & aesthetic goals. At least this is true in general.

While PhalloFILL Miami is not a Sponsor here, their Primary Branch (the ones that developed their proprietary method) @PhalloFILL Dallas might be able to chime in.

Moses wrote: I have gotten dermal filler while uncircumcised. I can’t just go for multiple smaller sessions because I live far away from my closest clinic that offers it. I think that would be the best solution if possible because I have gone in twice and gotten max 4 units per session. The doctor will not do more then that where I went. If I could afford it and take the time off work, I would have gone down and got maybe 4 sessions of 4 units in maybe a 2-3 month time span.

I have definitely enjoyed the extra girth, but the issue I had was the doctor focusing on aesthetics. Of course when I’m flaccid, it’s harder too see the areas that are useful in sex for extra girth. My injections look to be placed good when flaccid, but it pulls down to the base during intercourse. My last visit I explained this and told the doctor I would like to get it higher up towards the glands as possible. My goal wasn’t aesthetics but function. Of course it looks okay, but pushing into a vagina, it will bunch up and not even go in sometimes. I have gotten past this by putting on a condom to kind of help hold the skin higher.

I went almost a year between those two sessions. And have about 2 units left in the package that I got. Currently I am doing some high weight extending on the ligs to kinda grow into the skin hopefully. I guess I’m hanging with an higher tension extender. I wish I could get at least 6 units at once, and that can help alleviate this issue. I think if the injections were higher towards the glands, it would stay and be useful without the use of a condom.

Best thing I can do now, is just try and get back and continue building up to the glands 4 units at a time. At this rate it will take 2 more visits. And maybe another to fill in gaps that I kinda have from previous. Not bad gaps, just the filler settling a little uneven. Which you can’t tell until it bunches up. It’s currently mostly at mid shaft, on the left side it’s higher leaving an untreated section lower. On the right side it’s lower towards the base leaving less towards the glands.

I also didn’t think I had a lot of excess foreskin because it always looked fine before when erect. Naturally pulled away from the glands and looked almost uncircumcised. When I got filler, it does feel like I have a lot of skin now. It still pulls back off the glands, but it also does move a lot too. I have seen some good results in these forums. So I’m guessing it can be done good.

What you're describing here is exactly the "accordion effect."
The penis looks good in relaxation, but during erection, you can pull the complex skin/implant that bunches up at the base of the penis, and in some cases, it even interferes with penetration.
Repeated small amounts of fillers are not the solution because you eventually add up enough to develop the annoying accordion effect.
The best approach is the circumcision (low and tight) performed in advance of the phalloplasty procedure. I recommend our patients wait 6 weeks after the circumcision scar heals completely (stitches out, no openings, total wound closure).
Grower or not, you can get a good circumcision from the right surgeon.
DrC @ Avanti Derma

Yes. We use Revanesse Versa+ hyaluronic acid. They are 1.2 ml syringes rather than the standard 1.0 ml so you get 20% more dermal filler. It also has the best g prime, flexibility, and best safety record with the FDA.

All the best,
William

I have gotten dermal filler while uncircumcised. I can’t just go for multiple smaller sessions because I live far away from my closest clinic that offers it. I think that would be the best solution if possible because I have gone in twice and gotten max 4 units per session. The doctor will not do more then that where I went. If I could afford it and take the time off work, I would have gone down and got maybe 4 sessions of 4 units in maybe a 2-3 month time span.

I have definitely enjoyed the extra girth, but the issue I had was the doctor focusing on aesthetics. Of course when I’m flaccid, it’s harder too see the areas that are useful in sex for extra girth. My injections look to be placed good when flaccid, but it pulls down to the base during intercourse. My last visit I explained this and told the doctor I would like to get it higher up towards the glands as possible. My goal wasn’t aesthetics but function. Of course it looks okay, but pushing into a vagina, it will bunch up and not even go in sometimes. I have gotten past this by putting on a condom to kind of help hold the skin higher.

I went almost a year between those two sessions. And have about 2 units left in the package that I got. Currently I am doing some high weight extending on the ligs to kinda grow into the skin hopefully. I guess I’m hanging with an higher tension extender. I wish I could get at least 6 units at once, and that can help alleviate this issue. I think if the injections were higher towards the glands, it would stay and be useful without the use of a condom.

Best thing I can do now, is just try and get back and continue building up to the glands 4 units at a time. At this rate it will take 2 more visits. And maybe another to fill in gaps that I kinda have from previous. Not bad gaps, just the filler settling a little uneven. Which you can’t tell until it bunches up. It’s currently mostly at mid shaft, on the left side it’s higher leaving an untreated section lower. On the right side it’s lower towards the base leaving less towards the glands.

I also didn’t think I had a lot of excess foreskin because it always looked fine before when erect. Naturally pulled away from the glands and looked almost uncircumcised. When I got filler, it does feel like I have a lot of skin now. It still pulls back off the glands, but it also does move a lot too. I have seen some good results in these forums. So I’m guessing it can be done good.

I'm confused. Isn't everyone's erect length much longer than their unstretched flaccid length? Unless he meant you are a big-time grower (like I am) where the contrast in size between limp & hard is so dramatic, I'm still not sure why that would disqualify you from circumcision. You should reach out to their office and ask for a more medical explanation on why this would pose a problem, especially given the potential obstacles created by getting dermal filler enhancement on an uncircumcised penis.

And I'll note as I've done many times before, being uncut (a.k.a. uncircumcised) doesn't necessarily disqualify you as a candidate for girth enhancement, but it does mean you are at higher odds of aesthetic irregularity than cut (a.k.a. circumcised men). I'm very confidence in this assertion because some of the highest volume penile injectors have all stated this as a matter of fact and not speculation. Sure, as an uncut guy you can end up with a satisfactory result, but if I were in the shoes of an uncut guy, I'd weigh which was more important: foreskin, or the trade-off for girth.

I know for some guys, getting circumcised is controversial and I'm in no way saying you MUST get this done, only that you ought to accept you are not going to be an ideal candidate for filler injections, and your most optimal alternative route would be to go for Hyaluronic Acid (HA) due to its reversible & temporary nature, and to do so in small volumes, building girth up incrementally.

otis wrote: Correct me if I'm wrong, but we don't currently know if the reason for Ellanse's longer than advertised duration is that the collagen is sticking around after the spheres have absorbed or if the spheres themselves are taking longer to absorb than anticipated. Maybe you could tell with some sort of scan?

There are different types of collagen produced by the body, and probably fibrosis in the process of injecting these dermal fillers in large volumes, it is most likely (from what I've gathered thus far) just the longer half-life of this type of collagen and fibrosis that provides its longevity. I believe the PCL microspheres do absorb in the time projected by the manufacturer (hence their confidence in originally issuing 1, 2, 3, and 4 year versions), but I suppose it's plausible that these microspheres may take longer to absorb/breakdown for some more than others. Suffice it to say, there is every reason to believe the PCL will eventually go.

Viable options still in discussion, in a nutshell:


Non-Surgical (Injectable Dermal Fillers):

• Hyaluronic Acid (HA)
• PMMA
• Ellanse (not available in the U.S.)
• Radiesse
• Renuva

Surgical:

• Fat Injections (FFT)
• Dermal Grafts (e.g. Alloderm, Surgimend)
• Ligamentolysis (lengthening surgery)

Protocols (neither surgery or filler injections; primarily relies on a prescribed enlargement routine and possible supplementation over a period of time:

• P-Long
• A soon-to-be-announced Rejuvall Protocol

Also worthy of note* -- rigid silicone implants for the purposes of augmentation are still just as bad as they were in 2011, and large volumes of silicone oil as dermal filler injections are arguably just as bad -- avoid both!

Check out the Phallo-Guide for a refresher, then hit up the Physician Directory to see which vetted & screened Practitioners are in your area who may provide the kind of services you are looking for.

And of course, there is a lot to catch up on, so find an hour(or more) every week and brush up on the last couple years of discussion and progress reporting. Good luck!

Skeptical_One wrote: Hyaluronic Acid (HA) and silicone are on the literal opposite ends of the spectrum; HA has arguably the best safety profile among dermal fillers whereas silicone oil has arguably the worst. I wouldn't write off HA in the hands of a quality injector (the Dallas PhalloFILL location has put out a lot of great work and satisfied patients --> click the Review Tab in addition to comments made around this forum about their Team).

Indeed, I think my wording may have been off? HA i absolutely will touch, and have (and have some bits still remaining in my junk still from a long while back). If I were down for more HA I'd be at Dr Clavell's office tomorrow, cash in hand.
What i will absolutely NOT touch (in large part thanks to reading here) is silicone, and if a doctor offers it he doesn't know dicks, and as such, I'll write them off entirely.

I just don't want to do HA any more - nothing against the outcome, but I'm ready for PMMA.It's just a whole ordeal getting scheduling sorted to get to TJ or Ohio or Florida, whereas a 4 hour drive is no biggie.

itgoesthud wrote: a 10ml syringe is massive as well - any info on who the doc is? I googled extensively for PMMA docs in Texas because I hate flying, but everyone I've seen is either HA, or silicone, which i aint touching.

Hyaluronic Acid (HA) and silicone are on the literal opposite ends of the spectrum; HA has arguably the best safety profile among dermal fillers whereas silicone oil has arguably the worst. I wouldn't write off HA in the hands of a quality injector (the Dallas PhalloFILL location has put out a lot of great work and satisfied patients --> click the Review Tab in addition to comments made around this forum about their Team).

Metacrill was the PMMA Brand that was distributed in Europe, but if memory serves me correctly, it is no longer being manufactured. This actually might imply that there is no medical-grade PMMA dermal filler in Europe at present time (I cannot confirm 100% as this is being typed).

This would make Ellanse the superior option. For those who don't wish to fly to the U.K., Dr. Horn has a Brussels location. Ellanse has been shown to last much longer than originally projected (2-4 years) and is very similar to PMMA in the way it builds girth (through collagen creation).