TOPIC: Infections, Complications, Risks of PMMA?

Hi

Reading earlier parts of this thread, there is a discussion about PMMA migration to organs ... has there ever been a case or example of this?

If you look at the progress report site, you\'ll see my post about my situation.

After 4 months from my surgery my health has nosedived ... I know this isn\'t definitive data, however I\'m trying to gather as much data as possible.

I think part of the issue is not just the health issues, but also the inability for resolution. How do you fix yourself if you are having issues, and who can you goto? ... seems like PMMA is pretty permanently fixed ---

Anyone have any good information on why PMMA wouldn\'t migrate to other organs, or vice versa?

Dark

I think only around 3% of the beads are even small enough to migrate.

Even if some beads did migrate, which I don\'t think has ever been reported before, then what is the concern and how can it be related to your issues? Why would these beads do any harm? Macrophages transport things around the body all the time without doing any hard.

For the beads to get to the , sound like the would have to get into a vein. Cause if someone is using a needle, maybe even cannula, if it goes through a vein, and the doctor is using a withdraw injecting technique, then the moment it is being withdrawn through the vein, a small amount would get injected? Cause the thing is even the doctor can\'t guarantee this won\'t happen, cause they can\'t see what\'s happening inside. Just a theory.

phalloboards.websitetoolbox.com/post/sho...74921353&postcount=1

Interesting article / study

So basically PMMA doesn\'t seem to migrate but they are concerned with the purity of the one being produced in Brazil?

Anyways found a good article on PMMA talking about it\'s treatment in HIV patients( sorry if already been posted ) And also talks about

treatment for complications. I am now leaning more on PMMA

Second Bioplasty Congress in Mexico: PMMA for Facial and Buttock Lipoatrophy By Nelson Vergel, B.S.Ch.E., M.B.A.From Surviving HIV December 9, 2010 1 | 2 | Next > I attended the second International Congress on Bioplasty in Guadalajara last week. Here is the program in Spanish: www.bioplastia.org.mx/es/programa.php.Cosmetic and dermatology physicians from Mexico, Spain, Argentina, Brazil, and Colombia came to share experiences on the use of PMMA (polymethylacrylate) to treat HIV related facial and buttock lipoatrophy and other non HIV related physical abnormalities.Bioplasty is a technique of inyectable implantation done under local anesthesia for facial and buttock lipoatrophy and for reshaping other body parts. The product usually used is PMMA (polymethylmethacrylate microspheres) and it is usually (but not always) injected using a micro-canula (gun like device that enables faster and smooth dispersion of the product under the skin). Two brands used overseas are Metacryl and Newplastic. In the States, Artefill is the only PMMA based product approved (for cosmetic use, not lipoatrophy). It was confusing for me to find out that Bioplasty really is a brand name for the specific use of NewPlastic which was created by Dr Nagul in Brazil (he wrote a book on the procedure and trains doctors in Porto Alegre, Brazil). But Bioplastic is only one of the several PMMA options available worldwide but it seems to be spreading fast around the world. More on Bioplasty here:http://www.bioplastia.med.br/bioplasty.htm. I presented the current status of facial lipoatrophy solutions in the United States and the challenges we still face with access and the lack of an economical permanent solution to facial and buttock lipoatrophy. I presented the results of the 1500 people survey that people subscribed to my pozhealth yahoo group ( health.groups.yahoo.com/group/PozHealth/ ) helped me gather about the impact on lipodystrophy on quality of life. They were surprised that almost half of the respondents with lipoatrophy have not done anything to treat it and that 25 percent of respondents had thoughts in the past due to body changes ( bit.ly/fg4ODN ).Dr Luis Casavantes reviewed the different options available for facial and buttock lipoatrophy. Dr Gottfried Lemperle from the US reviewed management techniques for potential complications like granulomas. Dr Marcio Serra from Brazil reviewed his experiences during the past 12 years of work. He and colleges from Brazil also described their national free assistance program for people with facial lipotrophy. Physicians in Mexico want to use Brazil\'s model to provide economical access to patients in Mexico with facial wasting.The most interesting part of the conference for me was the 3 hours in which all of us got to watch 5 doctors apply PMMA (Metacryl or NewPlastic) to patients in the operating room from a giant screen. Some use a gun-like canula to inject the product and others using insulin syringes. It was great for me to see the different techniques in person. It was a true eye opener for me!I was impressed with the work on Dr Suzana Barreto from Sao Paulo, Brazil. She does a MRI on patients before she injects them with PMMA and a few months later to see how the implant behaves in people. She showed great slides on MRI results of the face and buttocks. She also compared MRIs done in patients that have had silicone injected to show how silicone migrates and shifts in tissue. I would love for her to present in the United States since I had never seen anyone who has MRI data on patients with any injectable implants.It amazes me that in the US we are so far behind of all of these countries when it comes to dealing with facial and buttock lipoatrophy in a permanent way. As I said before, the PMMA product in the US is Artefill, which is not approved for HIV lipoatrophy (only for cosmetic purposes- wrinkles, etc) and was priced horribly high for it to be cost effective for us in HIV. Luckily, its patent expires next year, which will open the door for Brazilians to bring their cheaper option to the US. I had a meeting with a few doctors to discuss how feasible it would be to do a study in the United States in 2011 so that we HIV+ patients can have access to a more cost effective permanent correction.The two options approved by the FDA (Sculptra and Radiesse) are non permanent and not cost effective for those with more advanced facial lipoatrophy. They both require yearly touch ups in most patients. Currently, Medicare pays for both but the reimbursement amounts are too low to entice doctors to use it for HIV patients. Both products have patient assistance programs that are decreasing in scope with time.The other two products that can be used in the US for facial lipoatrophy but that are not approved for that use are Silicone 1000 micro droplets and Artefill, and both are permanent. Neither gets reimbursed and there are no patient assistance programs for them. It would be interesting to see an economic analysis of the total cost for each for a facial wasting grade 2-4 in a 5 year period. I would not be surprised that permanent solutions will be cheaper in the long run for some patients.We have a lot of activist work to do to try to get something permanent approved for lipoatrophy that is not outrageously expensive and that has a good patient assistance program for those with no insurance (ADAP patients). Most people with facial lipoatrophy still have no access to treatments for that condition. Let\'s see what happens in the long run with Medicare and insurance rates for the two FDA approved options we have now. Unless something changes with a petition from the community, Medicare approval may actually hurt us more now since both companies are already reducing their patient assistance programs considerably after they assumed that Medicare would pick up a lot of the patients in their programs. If Medicare does not reimburse doctors properly, we will actually lose ground in this field. Tim Murphy from POZ is writing an article on this problem after he interviewed a few doctors who are having problems with Medicare right now.I am encouraging companies from other countries that have cheaper PMMA to start studies on facial and buttock lipoatrophy in the US soon to get ready for the time when the patent of the expensive Artefill expires next year.I will try to post some videos I took of several presentations from the conference. I am still traveling a lot and have not had much time to download and process them.

The use of PMMA for medical uses dates to 1936 in as a bone cement. PMMA has presented a good degree of bio-compatibility and as a result it has been extensively used as a soft tissue filler, bone cement, component of denture materials and tooth bond, housing for pacemakers and intra-ocular and contact lenses. The material itself was chemically synthesized in 1904.Dr. Gottfried Lemperle developed the concept of using PMMA micro-spheres for tissue augmentation in Germany in 1989. PMMA has been available in Germany since as sub-dermal injections used to reduce wrinkles, scars and for certain larger soft tissue deficits. PMMA as a tissue filler was first introduced to Europe in 1991 as Arteplast and marketed as a non absorbable injected material. It was composed of microspheres suspended in a gelatin solution. It was observed that the gelatin material was reabsorbed and replaced by native collagen. Not fully recognized at the time was that PMMA itself was stimulating the deposition of new healthy collagen around the individual microspheres without causing fibrotic reactions seen in the implant of foreign materials such as siloxane. Arteplast has since been superseded by newer generations of PMMA of greater consistency in granule size and surface smoothness. Dr Lemperle said: \"because of the extensive fibrous network associated with PMMA related granulomas, intralesional corticosteroid injections are considered the best treatment. We saw an Arteplast' granuloma develop as late as 10 years after injection, which responded well to high doses of local steroids and a pulse light therapy. After sieving and washing, the second generation Artecoll in Europe caused a significant lower number of foreign body granuloma.\" There are several PMMA injectable products available. Among the approved and registered PMMA based products are Artecoll and Artesense', manufactured in Holland and approved in Mexico and Canada since 1998. Both are formulated with 20% PMMA in a vehicle composed of 79.7% bovine collagen and 0.3% lidocaine. Metracryl and BioPlastic are two other PMMA products widely used in Mexico, Brazil, Argentina and Europe.Published safety and efficacy studies of PMMA in the United States done for FDA review dealt with PMMA use for the cosmetic correction of nasolabial deficits and concluded that \"PMMA is the first soft tissue filler that demonstrates continued improvement and persistence of correction over a 5-year period post-treatment.\" PMMA is now manufactured in the United States and was approved by the FDA in October 2006; marketed as ArteFill' (a new formulation of Artecoll), a compound of 20% PMMA in 80% bovine collagen and a small amount of lidocaine.However, Artefill is extremely expensive for facial or buttock lipoatrophy correction. ArteFill' costs medical providers $720.00 per ml prepackaged in a box containing 4 syringes of 0.8 ml of product. The professional services of the provider are often sold to the patient for double the cost of the product, thus making it impractical as a corrective for large volume tissue loss. Calculations for the cost-of-treatment climbs astronomically since quite common in the faces or buttocks of people with HIV tissue loss are deficits which can require from 30 ml to 400 ml of filler to correct. A severely atrophied buttock requiring 300 to 400 ml of ArteFill' would cost in the range of $200,000 to $300,000.Dr Lemperle has shown that the reported complication appearing in clinical trial results of Arte-Fill has been a small number of tiny palpable nodules. The clinical experience suggests that nodules tend to develop in thin skin areas or when the product is dermally injected in a too superficial manner. These nodules often respond to treatment with Kenalog 40, a cortico-steroid and in many cases also spontaneously remiss. ArteFill' was developed and purified over several generations from the original Arteplast, the appearance of granuloma have decreased dramatically after the micro sphere surface was cleaned up of any imperfections that may have caused macrophages to attack them as foreign objects.Dr. Luis Casavantes said that based on his experience in the past 5 years of experience with NewPlastic, a PMMA product produced in Brazil and widely used in Mexico and worldwide, does not appear to produce either palpable nodules or true foreign body granuloma, when grafted underneath the muscle fascia. NewPlastic seems to be a lot cheaper than Artefill. A moderate to severe facial lipoatrophy correction would cost from 2500 to 3500 depending on the volume needed. Buttocks require a lot more volume, with costs running from $4000 to $8000 depending on the severity of wasting. Of course, no one knows how much this product would cost in the US if it gets studied and approved here.

www.thebodypro.com/content/art59874.html?getPage=1

FBG\'s formation after pmma injection usually occur after few weeks usually between 6 months - 5 years sometimes painful with a red color.

They are usually diagnosed histologically as \" a massive giant cell formation around pmma beads \".

If you remember I have mentioned before in regard of the treatment of FBG\'s beside other treatments e.g. using intra-lesional steroid injection \"Kenalog\" the other Drug which I have mentioned it before an oral drug called \"Allopurinol\" I have posted a paper about that long time ago, it was from Germany 2003, now there is another paper from Brazil 2012 and they have also successfully treated FBG with Allopurinol, I think this will add more options for the treatment of FBG before going for the decision of surgical excision (So does that make it more easy for us in regard the treatment of FBG after pmma injection if they did really occur ??) :-

Germany 2003 :-

archderm.jamanetwork.com/article.aspx?articleid=479114

Brazil 2012 :-

www.hindawi.com/crim/dm/2012/945205/

I am sure Dr.C. read these articles.

Thanks Smartman

Note that it seems that the people involved in the study who benefited from Allopurinol had follow-up surgical procedures to remove the PMMA ... so I\'m not sure if they are positioning Allopurinol as a treatment.

Also, how are you sure Dr C knows about these reports? ... did you talk to him about them?

Thanks!
Dark

Hello forum, Ive been a lurker on these forums since PMMA first became the topic of interest. Sorry about the name, it was made on the spot (its a cheeseburger for those who are wondering) Ive read pretty much the entire forum and followed many stories and I thought I may share somethings that I\'ve been told. First off i\'m by no means any expert on medicine, I just matriculated to med school so i have limited knowledge. However, I have several doctors in my family and have had the opportunity to speak with some of them, specifically my father who\'s been an Orthopedic Surgeon for 20 years. After watching him perform a total knee replacement surgery I asked him about the biocompatibility of PMMA and if he had seen any adverse reactions to the cement. Also im sure this has already been cleared up but orthopods mix the PMMA with another substance that makes it extremely hard. This process happens in about 5 minutes and it gets extremely hot during the reaction so I dont believe that hardening is as much of a problem as some may think. Anyways he told me that PMMA is very compatible with human tissue and it has been used in orthopedics for decades. He then went on to mention that he had never seen any MAJOR complications via immunoreponse from the body. HOWEVER, he said after about 15 or 20 years when the material begins to break down it can get pretty \"ugly\". Now this concerned me at first but then I got to thinking on what he may have ment, and from what I know the entire implant breaks down after 15 or 20 years because of mechanical wear. THis is why orthopods generally refrain from doing them on anyone younger than 60 because they have to be replaced with a new implant and new PMMA. Perhaps its the bodies response to all the components of the implant breaking down.

Sorry this post was so long and I hope it was helpful and not redundant
Champwitcheese

@Champcheese

Thanks for this information. PMMA is used in a wide array of medical fields (not exclusively orthopedics). Heck, my first pair of contact lenses were made from it. It is inert, sterile and very much biocompatible. Your concern of \"mechanical wear\" is irrelevant with regard to utilizing PMMA in the penis. There is no pressure on the implant (apart from sex/masturbation) as there would be in orthopedics. Joints, bone cement, pins and compound movements put a great deal of stress on the body and the ligaments/tendons/tissues involved. This is why PMMA has been utilized as a filler in the face and other areas for decades without any \"mechanical wear\" being evident. As you stated, PMMA in orthopedics is mixed to make it very hard. Harder= more fragile/susceptible to fracture especially under the stress of muscles, bones, etc. Unfortunately, this comparison of polymethylmethacrylate as it is used in orthopedics is not an \"apples-to-apples\" comparison as it is used in penile bioplasty. I\'m confident smartman could add to this post.

Hello I have a small penis. I have always wanted to make it \"normal\". The PMMA looks good, however I printed out the material from Dr Casavantes website and brought it to my Dermatologist to get his feedback. I have known the guy for 12 yrs and trust his advice.

He looked over the info and said I must be crazy. Not only is there a chance I will have a bad reaction to the PMMA, but HE WILL REFUSE TO HELP ME if I end up with a complication. He was really very irate I would consider traveling to Mexico for what he called \"Physician assisted genital mutilation\".

So I am starting to do more research and now I think this is not such a good idea. Also several members mentioned that Dr C may be using a bootleg PMMA that may lead to complications later in life. Also the links big ben posted about Dr C having harmed people with bio-alcamed injections, and Dr lemperle getting arrested for scaring a ladies face really makes me ask, can these people be trusted ? is there a better solution out there ? Will my penis always be the smallest ?

If this does not work out I will likely have to ask my physician about Dr Reed\'s Girth procedure, but I am worried he will say no again. help I am desperate.

Snoopy -- this is the reaction I\'m getting from the number of doctor\'s I\'ve gone to.

They consider me crazy for having this PMMA procedure done... it only intensifies my fear.

I mean the Urologist didn\'t so much think I was crazy, but I could tell when he looked at the PMMA materials I printed out for him, he read them, and was shaking his head...

Live and learn I guess....

With the complications I\'m dealing with, I plan to post a continual progress report as I deal with my FBG like symptoms

Dark

I have other health issues, but my doctors are caring. I was very shocked by how upset the doctor became when I showed him the papers.

My biggest fear would be to have a damaged penis that nobody is willing to work on. I have been to the ER and I know that is not where I want to end up for penile complications. surely there must be a reason why my doctor is so against this.

Thank you very much for posting your story and I hope you get better soon.

Snoopy wrote: If this does not work out I will likely have to ask my physician about Dr Reed\'s Girth procedure, but I am worried he will say no again. help I am desperate.

The reason any of us even considered PMMA is because of the appalling record of the procedures available in the US and Europe.

I think we are all aware of how crazy going to Mexico for a permanent filler sounds, but it\'s the result of pure desperation and frustration.

The truth is, generally speaking, penis enlargement is a bad idea. That isn\'t just my opinion, if you do your research you\'ll see it\'s a fact. Then history of these procedures and devastation they\'ve caused is literally unbelievable. For years people have tried fat injections, Dermal Grafts, allografts and recently solid silicone implants. The results have been dreadful. Hence some guys are prepared to pioneer PMMA, with the theory that there is a lower chance of the filler reacting badly, than there is of damaging your penis via one of the current surgical procedures available in the US.

To be fair, so far the complication or dissatisfaction rate with PMMA is way lower than anything we\'ve seen before. That isn\'t to say it\'s a good or safe option, just that to date it\'s done far less damage the procedures available in America.

The notion that Dr. C is using bootleg PMMA is the silliest kind of silly. Why would a renowned bioplastician who associated with a \"PMMA Congress\" and consults with the likes of Professor Lemperle and other bioplasticians around the world, when all he\'s using is Chinese-made PMMA? Unless the Tijuana stigma is being carried way too far, there is zero evidence that the material being provided at the doctor\'s office is anything less than authentic.

Having a successful penis result I understand your admiration of Dr C. But I also believe the people you trust most in your life are the ones that can burn you the worst.

It has been mentioned that this doctor does not show the patient the PMMA packaging, I am not comfortable with that one bit.

And According to the article big ben posted dr lemperle was arrested for hurting a lady and practicing without a medical license. Is this the guy I want to ask for help if the PMMA turns out to be bad, Hell NO !

If you have PMMA and it worked out well, great. But we all have different ideas about what is safe and what is untrustworthy.