TOPIC: Glans enlargement options

Dr. C -

There have been some questions about what can and can't (should or shouldn't) be used in the glans for enlargement. For example, what are your opinions on Ellanse and why it should or should not be used for glans enlargement?

Hello briceb, thank you for bringing up this common, yet poorly understood topic.
Here are some important facts about the glans:
- The glans is the distal end of the Corpus Spongiosum. A sponge-like tissue whose main function is to participate in the erectile process when it is filled with blood during the arousal.
- It is covered by the lamina propria, a thin layer of connective tissue that is found in many tissues like the digestive tract and others.
- Starting from the surface, we see the epithelial cells (epithelium), then the lamina propria, which in real life is of around ⅛ of an Inch, then the Corpus Spongiosum directly connected to the vascular system. For obvious reasons, no fillers should be deposited there.
- Enhancing the thin lamina propria with soft tissue fillers is very tricky because of the risk of creating tissue Necrosis and/or injecting the soft tissue filler into the Corpus Spongiosum, which is comparable to injecting it into a vein. In real life... how much can you augment a ⅛ Inch membrane before destroying it?
- In a few words, we can create Necrosis if we go too superficial.
- If we go deep, we will inject directly into the bloodstream, and we can create thrombosis and/or clog the spongy cavities of the glans.
For the reasons listed above,
1) We always use Hyaluronic Acid because the product is somehow safe if we go into the bloodstream (it dilutes), and the risk of thrombosis is low.
2) We use low volume because the thickness of the lamina doesn’t allow for considerable amounts.
3) I’m talking about 1cc. of HA, average, the results are mediocre, and they last probably a couple of months.
Using any of the microsphere-based bio stimulators like PMMA (Linnea), PCL (Ellanse), or CaHA (Radiesse) risk the added issue of promoting collagen formation and potentially worsening the risks mentioned before.
Please see the attached illustration that shows the lamina propria (LP), the epithelium (E), and Corpus Spongiosum (CS).

The photos and description in this patent may be helpful:
patents.google.com/patent/US20130066148A1/en

wonder if anyone has ever contacted this doctor: cranects.com/glans-implant/

It is certainly harder to satisfactorily enhance the glans. When I inject the rim(corona) of the glans I am happy to inject 4ml of HA. Putting in too much or something too stiff/hard can cause the compressive vascular compromise as mentioned by A_D above. Reklaw, if I remember correctly, had problems when a stiff particulate filler was injected into the glans causing ulcers leading to punched out depressed scars.
There was a doctor who did ligament division and dermal-fat grafts who used to inject 10ml of permanent Aquamid filler deep into the glans. It has been taken up by another doctor in Sydney now. How it does not cause huge problems, block the urethra I dont know.
The Koreans published a study getting great longevity like 2 yrs from HA - I will try and remember to pull up the study. But that has not been our experience.

Dr_Oates wrote: There was a doctor who did ligament division and dermal-fat grafts who used to inject 10ml of permanent Aquamid filler deep into the glans. It has been taken up by another doctor in Sydney now. How it does not cause huge problems, block the urethra I dont know.

I'd be very curious to track this practitioner down. Also, would be curious about the approach @morgansternrejuvall uses as they have an expensive glans option, and the photos look good.

Dr_Oates wrote: The Koreans published a study getting great longevity like 2 yrs from HA - I will try and remember to pull up the study. But that has not been our experience.

I read one study from a research hospital in Korea: It was for PE.
Placement and volume in the PE case may also be different.
Here's another Korea Study
www.ncbi.nlm.nih.gov/pmc/articles/PMC6302150/

I am very impressed by the case study of this Urologist:
www.urologicalcare.com/contents/penile-i...ns/penile-glans-size
There is an excellent breakdown of details with photographs.

These treatments, with the photos above, were for guys with implanted Erection pumps which do not expand the glans. What we do is similar and we get the same sort of result - especially immediately. It is a week or 2 later they don't look as big as it was initially.

This is a great point to remember, that I neglected to recall that post procedure swelling and pre-absorption there may be much more dramatic results.
In your clinical experience, what is the minimum time and frequency of touch ups
Is there any stretching of the tissue possible to enable more accommodation of filler?
Does pumping stretch the tissue creating more space for filler?

hadhatter wrote: This is a great point to remember, that I neglected to recall that post procedure swelling and pre-absorption there may be much more dramatic results.
In your clinical experience, what is the minimum time and frequency of touch ups
Is there any stretching of the tissue possible to enable more accommodation of filler?
Does pumping stretch the tissue creating more space for filler?

hadhatter,

minimum if 2 weeks preferred, although have don it occasionally with less for international travellers. swelling is the short term issue. We dont really know if pumping/stretching works that way. Keeping things straight with them helps.

Hello @briceb ,
The only product that I would use for glans enhancement is hyaluronic acid because it is a substance that naturally exists in our bodies.
HA is a soluble, reversible gel that protects, to some extent, patients from potential accidents such as spongiousum body collapse and pressure-related necrosis of the mucous membrane/epithelium.
What worries me the most is the thickness of the glans epithelium. It is very thin (around 2mm) and easy to penetrate with a needle, ending up in the spongiosum body's depth and depositing the product right into the bloodstream; micro-cannulas don't work here.
Of course, the following statement only exists in my imagination: if some HA enters the bloodstream, it is possible that by the time that it ends up in the micro-vascularity of the lungs, it has been somehow dissolved or diluted.
On the other hand, if any of the microsphere-based products (Ellansé, Radiesse or Linnea) are accidentally injected into the corpus spongiosum, we know for sure that they won't be dissolved and will create a small (hopefully) pulmonary embolism.
For everybody's disappointment, the glans is not an area that has the ideal anatomical structures for the implantation of a soft tissue filler, much less to receive any type of prosthetic implants.
The best you can hope for is a mediocre and temporary result with the use of HA, the safest product for the area.
DrC

Avanti_Derma wrote: Hello @briceb ,
The only product that I would use for glans enhancement is hyaluronic acid because it is a substance that naturally exists in our bodies.
HA is a soluble, reversible gel that protects, to some extent, patients from potential accidents such as spongiousum body collapse and pressure-related necrosis of the mucous membrane/epithelium.
What worries me the most is the thickness of the glans epithelium. It is very thin (around 2mm) and easy to penetrate with a needle, ending up in the spongiosum body's depth and depositing the product right into the bloodstream; micro-cannulas don't work here.
Of course, the following statement only exists in my imagination: if some HA enters the bloodstream, it is possible that by the time that it ends up in the micro-vascularity of the lungs, it has been somehow dissolved or diluted.
On the other hand, if any of the microsphere-based products (Ellansé, Radiesse or Linnea) are accidentally injected into the corpus spongiosum, we know for sure that they won't be dissolved and will create a small (hopefully) pulmonary embolism.
For everybody's disappointment, the glans is not an area that has the ideal anatomical structures for the implantation of a soft tissue filler, much less to receive any type of prosthetic implants.
The best you can hope for is a mediocre and temporary result with the use of HA, the safest product for the area.
DrC

Hi Dr C!

As I said we have been injecting 4 ml HA and doing multiple sessions for the glans. But it is NOT safe in the blood stream. It can result in a syndrome like Fat Emboli Syndrome and there have been a number of deaths - primarily with intravaginal injections.

Thank you for the input, Dr. Oates,
I fully agree. No foreign or autologous material is good when injected into the bloodstream. I meant "to some extent," but we know that mechanical complications after soft tissue fillers are basically the same, independently of the product used.