I think the disconnect here is that you're assuming the
HA is simply "concealing" the
PMMA until the
HA disappears. That isn't what Dr.
Carney is describing.
The concern with
PMMA isn't as simple as, "this person's body reacts strongly to
PMMA, therefore it will react exactly the same way regardless of how, where, or in what amount the
PMMA is introduced."
Patient-specific immune response absolutely matters. That's one of the reasons Dr.
Carney is cautious with permanent filler in the first place. But technique, volume, distribution, tissue plane, local inflammation, and the condition of the tissue receiving the filler also matter.
There is published literature supporting that broader point.
PMMA research has found that injection technique and location can affect the development of nodules and adverse inflammatory reactions, even when the material itself is unchanged. Published penile
PMMA literature has likewise attributed irregularities and
Nodule formation at least in part to injection technique and post-injection factors.
What we are NOT claiming is that there is a published randomized clinical trial of
Rejuvall's specific
HA-first FusionThick protocol proving that
HA somehow changes the chemical composition of
PMMA or permanently prevents every possible future inflammatory reaction. There isn't, to my knowledge, a study of that exact protocol, and we shouldn't pretend otherwise.
This protocol comes from Dr.
Carney's clinical experience treating both primary enhancement patients and a significant number of patients who come to him with complications from previous filler procedures.
The purpose of the
HA foundation is also not to "hide" badly placed
PMMA. If
PMMA were simply being injected into an irregular pattern and
HA were covering those irregularities, I would agree with you that removing the
HA from the equation would eventually reveal the underlying problem.
That's not the technique.
The goal is to establish a smooth, controlled tissue contour first and then introduce permanent filler conservatively and strategically rather than attempting to create the entire desired increase with permanent material in untreated tissue all at once.
And there is an important distinction between a **mechanical lump caused by product distribution** and a **delayed inflammatory
Nodule or foreign-body granuloma**. Those are not necessarily the same biological event.
In fact, published filler literature repeatedly makes that distinction. Nodules can result from localized filler accumulation, fibrosis, injection technique, or inflammatory/granulomatous reactions.
PMMA granulomas can also appear months or even years later, which is exactly why Dr.
Carney does not consider permanent filler something that should be approached casually.
So yes, individual immune response is part of the equation. Dr.
Carney would agree with you on that point.
Where I disagree is the conclusion that immune response is therefore the *only* meaningful variable and that
PMMA must behave identically regardless of how the procedure is staged or performed. The medical literature doesn't support that conclusion either.
