Given the recent discussion regarding fat injection permanency, the PhalloBoards Administrator (Skeptical One) went ahead and submitted a broad question aiming to have everyone's concerns and questions addressed: "How does Rejuvall's approach differ from previous iterations of free fat transfer (FFT), what to expect (gains, recovery, potential complications, etc), and how to reconcile FFT's inconsistent past with Rejuvall's advancements?"
I was rather surprised hearing that the sentiment on the PhalloBoards is that an FFT is not a permanent girth enhancing procedure. Fat tissue that survives the transplant process is a permanent outcome. However, as I thought more about it the next day and realized why lots of people might not feel that way.
Surgically-speaking, a penile FFT is considered to be a fairly simple procedure. However, as you’ll soon discover it’s deceiving in that regard.
I regularly perform organ transplants in the hospital that are considered dangerous and overwhelming to some surgeons. I can tell you with assurance that an FFT penile procedure is far more challenging to achieve a successful transplant than most doctors and patients realize.
An FFT is a “transplant”, and like every other type of human transplant procedure, there’s a lot of places it can fail since we’re trying to move a living organism from one location to another. When a patient gets an FFT and ends up eventually “losing it all”, that simply means the transplanted tissue eventually died and was reabsorbed into the body as waste.
To succeed in this procedure, your doctor must get six points just right. Shortcomings with any aspect will affect the final outcome. . The Right Patient: Not every man is a good candidate for an efficacious FFT. A patient has to possess the right proportion of height and weight. He needs to be fairly healthy as patients addicted to potato chips and comparable junk food usually have fat that won’t transplant with success. Significant obesity usually triggers a poor outcome. Men who’ve had a previous girth enhancing procedure utilizing a permanent man-made injectable like PMMA or Silikon are not good candidates for FFT unless that material is first removed since the injected agent blocks the tiny blood vessels in the penile shaft necessary to ensure the transplanted fat cells stay alive. Likewise, men beyond the age of sixty-five will almost never get a good result – regardless of overall health – as human fat rapidly degrades to a more viscous state after a certain age. Such fat tissue simply won’t survive a transplant. Finally, this is a surgical procedure that requires mild anesthesia. If a patient has health contra’s for anesthesia, this procedure won’t be a viable option.
The Right Harvest: Improper attention to delicateness during the adipose tissue harvest is another source of failure. The fat cells must be extracted in a quantity that will provide a size increase worthy of a surgical investment AND they must be kept flourishing during that substantial withdrawal. Fat cells are rather fragile and although damaged cells can be transplanted, few will survive over the long term in such cases. Exactly “where” the tissue harvest occurs is another source for disappointing results. You can’t extract fat from just any location and expect it to succeed as there are variations in the quality of fat tissue in different parts of the human body. Likewise, some fat material has characteristics more akin to subcutaneous penile tissue compared to other more pliable fat that can leave patients with a distinguished “squishy” outer finish.
The Proper Treating of the Fat: Once harvested, the fat must be reconstituted in a manner that will make it suitable for subsequent reimplantation. We use an FDA cleared fat transplant filtration system to optimize purity, but I credit Dr. Morganstern and his many years refining these procedures with developing a novel shaping technology that optimizes the reimplantation procedure. Again, during this particular process within the treatment is yet another incidence where the fat cells can become damaged and/or die.
The Fat Injection & Placement: Finally, the harvested fat tissue gets transplanted into the penis. The most common mistake I’ve seen in this aspect of FFT is with doctors using the wrong needle for a particular patient. There’s no such thing as a “one size fits all” in any aspect of phalloplasty. Also, there’s an art form to the distribution technique that when poorly executed usually results in unevenness or lumps within the shaft several months down the line. Another common error is when the surgeon attempts to add too much fat into a singular procedure. We understand most men want the biggest possible outcome in a singular procedure but if you add too much at once, it increases the likelihood you’ll eventually end up relinquishing almost all of the transplant. One other mistake I’ve seen is where the doctor agrees to perform too many congruent procedures along with an FFT. Certain procedures are notorious for triggering excessive hematoma which prolongs any healing process. Living tissue transplants stand little chance of long-term viability if the time window for healing is overextended.
Survive the 72-hour “Tissue Vulnerability” Window: Assuming everything I just discussed was performed to perfection, the number one reason most fat tissue transplants will fail to live up to expectation is because of a 72-hour post-transplant assimilation period. For about three days after post-procedure, the transplanted cells will be unable to access any life-essential blood supply. Some of the cells will almost always die during this nutrient-starving phase. We pre-treat the penis before each procedure with a patented device that Dr. Morganstern developed that triggers endothelial cell production for healing penile trauma / Peyronie’s disease. We found this technology bridges the lack of blood flow nutrients immediately following surgery to a level that minimizes the loss of viable fat cells.
Following Prescribed Aftercare: Given the delicateness of the vulnerable cells during transplant and variations in how quickly healing occurs between one individual and another, it’s crucial to follow any prescribed aftercare program indicated by your surgeon to ensure long term success. Regardless of how capable your surgeon and how well your particular transplant procedure came out, it can fail quickly if you don’t follow recommended post-operative care.
Finally, in fairness to the skilled phalloplasty surgeons out there performing FFT, I’ve had more than one patient show up in our clinic claiming to have “lost all his previous FFT” with another doctor. However, upon close examination, we discover many of them actually retained a life-lasting portion of transplanted tissue.
How does that happen?
Following any FFT surgical procedure, there’s going to be a good bit of swelling and bruising. It takes months for all that swelling to completely subside. Some men confuse this loss of fluid – which can double the girth of the penis – with loss of fat tissue and lose sight of their pre-procedure width.
We very recently introduced a new non-surgical fat-tissue transplant procedure that will result in most patients adding about a half-inch of girth from a treatment. One of the reasons I was particularly excited to develop this new technology was so we could provide a less invasive and affordable pathway for patients to achieve that “post-surgical swollen girth” that many men adore and get depressed over losing once all healing is complete. It’s worth mentioning that this new procedure is NOT well suited as an initial procedure for men already over seven inches as we’re restricted in the amount of transplant tissue we can successfully collect from this pathway.
Another FFT complaint we sometimes encounter is patients were left with palpable fat “bumps or nodules” in their penis in the months or years following surgery. It seems some of you are aware that our clinic is able to redeploy the same technology we use to break up fibrosis and plaque in the penis that’s commonly associated with Peyronie’s disease to resolve these nodules since we’ve had a number of patients visit from around the globe for such repairs who indicated they heard about us on the PhalloBoards. However, I want to be clear that 98% of such nodules associated with an FFT are not from “fat tissue”. Rather, they’re pockets of excess edema which became trapped during the post-surgical healing process.
Most FFT surgeons recommend massaging the transplanted tissue for a period of time following your procedure to help reduce the likelihood of this unsightly outcome.
Information Provded by Dr. Carney. For more information or to request an appointment: https://www.phalloboards.info/directory/75-dr--carney.html
"Do you know if it will be a horizontal cut or a VY log cut? I been thinking about lig cut for quite some time now but I can’t make up my mind because I am kind of worried about the angle drop. I searched online to see if there will be any before and after pics but can’t find none. Also do you know how much are they charging? If it is appropriate to ask such question here in the forum. I would greatly appreciate your response. Thank you."
I’m going to provide a very lengthy response to your question in order to help you and others make the best possible decision for yourself in this regard.
Let’s start with the ligaments themselves. Every guy has a different number, size, tautness and exact location of their suspensory ligaments. They were designed into men during a time of evolution when sex between human beings was often a very violent process. Keep in mind: we might like using our sexual organs for fun, but their sole purpose physiologically is the procreation of our species. Many, many, many years ago we needed a lot of structural support at the base of the penis in order to consummate sex. If we had sex like that nowadays we would probably be charged with a crime.
What you “see” of your penis is where the organ becomes visible from underneath the pelvic bone. Your penis organ actually starts near the anus. The suspensory ligaments are connected to the base of the penis from the pelvic bone.
There are actually four aspects to optimal penile lengthening. One, is the cutting of the ligaments at the base of the penis. The second is the release of the deep ligament. The third is repositioning as much of the penis organ that’s situated on the inside to an outward location as is safely possible. And finally, there’s stretching.
It might be helpful to envision the suspensory ligaments at the base of the penis like the base roots you see around a tree in your front yard and the deep ligament as the tap root of that same tree.
I bring this up because we see lots of patients who had a previous ligament release performed and complained they actually “lost” length. How could that happen? It happens because of patients seeking a minimized scar in achieving penile length.
If we only cut the top suspensory ligaments (like the roots around the base of our imaginary tree) – the deep ligament (the tap root) will still hinder the penis from successful stretching. We found this most common for patients who had a ligament release performed through the scrotum to make it a “scar-less” procedure. Patients who had such procedures and are almost always unhappy with their length outcome are sometimes informed it’s likely “the ligament reattached”. However, we’ve discovered that wasn’t the case when we performed a subsequent lengthening surgery. The reason was rooted in the fact the deep ligament held fast and internal scar tissue underneath the skin from the procedure triggered new tautness and a reduction of penile length.
While a VY-plasty is suitable for some patients, we found that we get the most optimal lengthening results via a 2-3-inch singular incision running straight up from the base of the penis at the pelvic bone. This opening allows optimal access the suspensory ligaments, the deep ligament and repositioning of the penis, as able.
It’s important to understand that the penis doesn’t just “jump forward” following a release of the ligaments – they’re not that tight on 99% of patients. That’s why the penile repositioning is so important for most patients – along with the fact it inhibits the likelihood of ligament reattachment. It leaves a scar akin to a hernia operation which is what most single male patients use to describe where they got it in the future.
The degree of work with stretching on the part of the patient following surgery is often under-amplified by some doctors but a crucial aspect of increased penile length. It starts 2-3 weeks after your procedure with a traction device that causes mild tension on the organ while it’s still healing from surgery. At this juncture, we want to inhibit any post-surgical retraction of the penis and loss of any of the hard-earned gains you enjoyed post-surgical. Tissue will naturally retract following any procedure and you want to make sure your penis doesn’t get involved in that process through mild traction. A couple of months later after things are completely healed, you’ll want to evolve to using weights to stretch the penis organ. Results from stretching are no longer inhibited by the strong ligaments you had cut for length. This program will trigger the cells to slightly tear and grow back larger over time – in a process similar to building muscle mass to your biceps. Alas, it’s time consuming. You need to stretch for two hours daily for six months after the procedure to achieve best results.
The fear of a significant change in erect angle while standing up is most often promulgated by doctors who don’t perform penile lengthening procedures. The angle changes 5-20 degree’s depending upon your present angle when standing up straight. It drops more on a percentage basis if your engorgement points near straight upward and less if you’re presently situated me straight ahead. Most men are prone on a bed when erect and never notice that difference.
A bigger consideration for some if the subsequent “looseness” at the base of the shaft following a ligament release. While most sexual positions are still fine in this state, the force of a partner coming down at an angle as with “cowgirl and reverse cowgirl” are challenging without putting your fingers at the base of the penis to add support. Thus, if “rodeo” sex is your favorite pastime, you need to think long and hard before considering a penile lengthening procedure.
Thus, in summary:
You must have a ligament release in order to achieve real and lasting increase in penile length.
Only cutting the top ligaments to reduce scaring reduces the likelihood your lengthening will succeed. You need the deep ligament cut as well.
The post-surgical erect angle isn’t usually a big deal. The subsequent “looseness” at the base of the penis during rigorous sex is a more important consideration for some patients.
Stretching is required to achieve optimal results. If you’re not able or willing to invest the time in post-surgical stretching, it’s probably not worth your time and money to invest in a lengthening procedure.
We presently charge $9,800 for our optimal lengthening procedure that includes release of top and deep ligaments plus penile repositioning, anesthesia and supporting stretching devices.
Know that’s a lot of information but I hope it helps you make the best decision for your particular case.
Do you believe there is any validity to the claim that penis enlargement devices (example: pumps, hangers, etc.) and penis enlargement exercises (example: jelqing, stretching, etc.) can increase the size of the penis?
There is no objective evidence that these methods do very much good. I am aware that they are very popular and that men would like to avoid surgery, but these devices do not have a great track record for most men. One exception is the use of a stretching device for penile curvatures. This does sometimes work and is worth a try, especially for mild curvatures that are not associated with a thick Peyronnie's plaque.
Do you believe there is any validity to the claim that supplements (example: male enhancement pills, topical creams, etc.) can work in increasing the size of the penis? If they are indeed scams, how have they been able to remain prevalent?
Supplements provide no long term benefit. Yohimbine, which is one type of supplement, can provide some short term benefit, but does not create a permanent change. Of greater importance regarding supplements is that they are not regulated by any agency in the US. Therefore, the makers of supplements can make any claims they want with little or no downside. An interesting study performed at the Children's Hospital of Philadelphia examined the content of supplements and found that many of them had little or none of the product claimed to be present. This included some vitamin supplements. I actively encourage my patients to stop taking supplements before surgery since they can create problems such as bleeding after surgery.
(8c) Do you see any benefit in employing the use of growth factors (like Platelet Rich Plasma treatment) to achieve size? Also, do you believe there is any merit to the idea of PRP-therapies improving the result of a penis enlargement procedure?
This is a hotly debated topic. Like the other topics in this thread, there is little evidence to support the use of PRP. I am aware of anecdotal evidence for PRP, especially with hair restoration. As for its use in penis enlargement, there is, at present, no evidence that supports its use.
Information Provided by Dr. Solomon. To learn more or request a consultation:https://www.phalloboards.info/directory/77-mark-p-solomon-md.html
PhalloBoards member "Chester" asks:
"Hi Doctor, before I ask my question, I'm happy to report that the procedure has been a huge success. Thank you for your great work! My question has to do with the impact a filler in your penis has on blood pressure. There is only so much size and mass in the penis, and if you're adding filler volume, one stands to reason that there will be added pressure on the veins in the penis. I'm curious about your thoughts regarding long-term impact this has on blood pressure. I ask because, as we age, blood pressure tends to go up, and I think this topic is important yet rarely addressed. Personally I'm in my forties and there's a history of hypertension in my family, along with being pre-hypertensive."
I’m happy to hear you’re pleased with your outcome Chester.
When girth is added to the penis via any sort of injectable or FFT, that enhancement occurs by adding the bulking agent into to the subcutaneous tissue “surrounding” the vascularized penile organ. The incredibly small capillaries located within the subcutaneous tissue are not affected by total body blood pressure – they are simply too minuscule and remote to be impacted. If you added additional girth augmentation later, our limitation is the degree of stretch within that subcutaneous tissue – not the penis organ. Human tissue is very stretchable with time. You just can’t force stretch it without risks.
Your erection process to attain a full engorgement is an automated sealing process within the organ. If you provided increased blood force it won’t change the amount of blood provided to the penis as it locks itself closed once a full dose of blood is in place for optimal penetration size. Alas, high blood pressure tends to cause an opposite effect on men and their erections as veins in the body can and will harden from high blood pressure, resulting in erectile dysfunction symptoms from insufficient arterial blood flow. Remember, your penis is located on the very edge of your body. That means it gets lower priority of blood flow when resources are limited – as with patients exhibiting cold hands and feet.
Finally, some blood pressure medicines are notorious for triggering significant ED issues as they medicate the same sort of situation I just described. The hypertension drug we recommend patients not use for their blood pressure condition relative to penile performance is Propranolol. We’ve discovered it not only causes ED but also triggers penile fibrosis: the building block of Peyronie’s disease.
Information Provided By Dr. Carney. To learn more or schedule an appointment: https://www.phalloboards.info/directory/75-dr--carney.html
Dr. Solomon, do you believe attitudes toward male elective medicine (namely penis enlargement) will ever become as socially accepted or mainstream as the common "nose" or "breast" job? If so, how long do you predict this shift in attitude will take? If not, what are some reasons potentially holding it back from normalization (e.g. stigmas)?
I think that attitudes are definitely changing. I recently was asked to publish a paper in the journal Plastic and Reconstructive Surgery on this topic. In addition, I presented at our annual meeting and, as a reviewer for the Journal, I am seeing articles presented for publication almost monthly on the topic of penis enlargement surgery. Awareness of the topic is increasing, so it is likely that it will become more acceptable with time.
Dr. Solomon, concerning costs (*3 Part Question):
how can I go about acquiring the costs for any given procedure?
My office gives a range of costs to patients who inquire on the phone. We do not provide costs by email. However, the only way to get an actual cost for surgery is after an evaluation by me. This is due to the fact that procedures are individualized for each patient. In many cases, patients ask about one procedure, but after an exam, they need something different, which may be less expensive than their original request. For example, men often inquire about getting both length and girth, but after an exam, they may only benefit from one of those procedures, so the cost is less.
are there any procedures my insurance will accept?
There are several parts to this answer. First, medical insurance covers procedures that are defined as "medically necessary." Procedures for penis enlargement are cosmetic in nature (like breast enlargement). Cosmetic surgery is not generally covered by insurance. Your individual policy may have some exception to that rule, but only you can determine that by asking your insurance company or reading your insurance policy. Surgery for revision after failed cosmetic surgery is also not generally covered by insurance. Most insurance plans will not cover cosmetic surgery or complications from cosmetic surgery. Again, the best way to determine your coverage is to review your policy or call your carrier. Even if you have coverage, you will need to find a surgeon who participates with your insurance carrier. Otherwise, the surgeon is considered "out of network", which means you will be responsible for the costs of surgery and you can ask your insurance to reimburse you according to your plan. Most times, they will reimburse only a portion of the costs in that situation.
is financing available? This was mentioned on your website, but I'd like to know more.
My practice works with several outside entities that provide financing for surgery. You need to apply to them directly to determine if you qualify. The two that we work with most often are CareCredit and United Medical Credit. They each have their own rules about financing and they make their decisions independent of my medical decisions.
Dr. Solomon, the Moderation Team would like to know if your Clinic has any exciting new plans, procedures, devices, locations, publications, and/or promotions for the new year (2021) & beyond?
I publish articles on penis surgery in the plastic surgery literature from time to time. These are designed for a medical audience and are not usually available to nonmedical people. You can access them by going to PubMed. I am always evaluating new methods for surgery, but will only discuss them once I have implemented them and have follow up data.
Information Provided by Dr. Solomon. If you have questions or would like to schedule an appointment:https://www.phalloboards.info/directory/77-mark-p-solomon-md.html