TOPIC: Granuloma versus Nodule

For the educational benefit of all (including me), can someone describe the difference between a granuloma and a Nodule? I want to make sure I know what to look for.

I had 10cc’s of Ellanse injected 10 days ago and I have a pea sized lump under the skin on my shaft. I can’t see it on the surface (at least when I’m Flaccid) but I can grab it between two fingers. Hopefully it goes away but really don’t want this sucker to grow more than anything.

A Nodule will not be painful or inflamed (red, irritated, etc.). A granuloma will hurt when squeezed, be red, irritated, etc. That's the main difference.

My understanding is nodules are usually at the site of injection. They are usually temporary and painless. Granulomas are an inflammatory response caused by foreign material. They are red, inflamed, tender, grow large in size (usually), and form later that a few weeks. Granulomas can also be destructive to local healthy tissue as well.
Nodules- usually go away on their own
Granulomas- can go away on own, but usually require steroid, antibiotics, or excision when needed.

Thank you guys. So based on what your saying toothman...it’s too early for granuloma formation for me? It doesn’t hurt...not red. A little tingly but maybe it’s just me worrying. Hard to wait to see what’s going to happen

That is what I am saying. That being said, granulomas can occur with any foreign substance, HA, Ellanse, PMMA etc. I just think it’s too soon to happen.

Gainer wrote: For the educational benefit of all (including me), can someone describe the difference between a granuloma and a Nodule? I want to make sure I know what to look for.

I had 10cc’s of Ellanse injected 10 days ago and I have a pea sized lump under the skin on my shaft. I can’t see it on the surface (at least when I’m Flaccid) but I can grab it between two fingers. Hopefully it goes away but really don’t want this sucker to grow more than anything.

Hello,
I am going to address your question with soft tissue fillers in mind.
Granulomas are "active" lesions resulting from an immune reaction against a specific target.
Nodules are "inactive" bumps that don't trigger immune mechanisms and that are secondary to an excess of filler in an area.
Hence, true granulomas are characterized by:
- Late start, from a previous implant that had no symptoms
- Sudden or progressive redness, pain, sometimes itch, and tenderness in every area where the same filler exists.
- Since it is a humoral immune reaction (antibodies are delivered by the bloodstream), it will attack every area where the rejected substance is present.
- Also, the whole implanted areas harden and show the mentioned symptoms. Always at the same time, always in every site of injection.
- A true granuloma will not be selective to an isolated area in the presence of the same filler in other areas of the body, even far away from the original lesion.
- Often, they appear after another non-related immune reaction, i.e. a severe cold or any other temporary immune-depressing situation.
- They respond very positively to treatments with injectable cortisone derivatives and 5-FU, administered locally or systemically.
- They can disappear spontaneously, and typically, second flare-ups are non-common.
- Surgery is not indicated for the treatment of true granulomas
On the other hand, nodules are:
- Hard lumps or bumps that show no chronic redness or tenderness, even though they can be painful to some extent, especially through manipulation.
- They are present early after the implant of the filler
- They are isolated, or if multiple, they don't cover the whole area of the implant and if the same product is present in other areas of the body, it won't be affected.
- Nodules respond poorly to cortisone derivatives or 5FU
- They will grow to some extent and then will become dormant if they're not manipulated.
- Surgery is indicated in the Removal of nodules.
Since your question is related to PCL (Ellansé), and it is an isolated issue, I can assume that you're talking about a Nodule.
Best,
DrC

Thank you for chiming in Dr. C. My symptoms align with a Nodule. Especially the one about the Nodule going dormant when not manipulating it. Once I start feeling/massaging around in the area it starts firming up and it presents itself. It’s the oddest thing. Slight pain when I give it a firm press. Will this go away you think?

So according to Dr C a Nodule may become a problem if manipulated. This filler is placed in penis that is manipulated all the time. Hence, one can expect nodules, and nodules mean problems that require surgery.
Granulomas, are a reactive lesion that is cause by immune system response. A cold, immunization, and such can cause activation of granulomas. Granulomas MAY respond somewhat to steroid shots, however how many steroid shots. These present problems in themselves such as thinning skin. Furthermore, the causative factors, PMMA, is still present. Granulomas are destructive inflammatory lesions that grow into healthy tissue. They also need to be removed surgically, but much more aggressively. PMMA or any nonresorbable filler can and usually over time will cause these painful and concerning problems.

Look, I had 10 cc of Bellafill placed by a US doctor in 2018. I have been on the brink of ultimate helplessness and despair since. Nodules, granulomas, Removal surgery, swelling, pain. I am convinced particulate matter, PMMA, should not be present in a sliding moveable plane. Anyone who wants it or believes the wonderful stories of success beware. Look through the archives. Most everyone who had it placed has had issues of some sort. Asymmetry, pain, nodules. At least 5 members have had Removal surgery with different levels of success. Some, have needed all of their penis skin removed grafted with inferior immobile skin. Please, only chose HA if you plane on any type of filler. Yes it’s temporary, but.......it’s only temporary. I have a million dollars and I would give my million dollars away to have my old penis back.

This is worrisome

I guess I had granulomas that were reduced on my second round using corticosteroid injections . Not eliminated . I also experienced product lumps . These were also Reduced by the addition of a small amount of additional product. Still have some divots and will have a 3rd round .

It’s pretty much a given you will have 2-4 rounds just to smooth out irregularities . If you expect this , I believe most would say it’s great . However there are the horror stories as toothman points out . What percentage ? My guess is 1-5 percent .

@Toothman

Nodules are literally the most benign, non-consequential "complication" there is in Phalloplasty. It's purely aesthetic and the only "pain" associated with them is the friction that arises from more pronounced nodules and your skin & clothing.

And I think you have it misunderstood --> nodules are generally present shortly after the procedure. If they come about (which isn't uncommon) they are rather easy to address (non-surgically), I'd know, I've had mine corrected over the years (may take a couple of touch-up sessions, but it comes with the territory, everyone should know this going in). New nodules don't arise because of manipulation, masturbation, or sex. As a matter of fact, if you have a Nodule-free procedure and are a year out post-op, you're smooth sailing. If you have nodules and have them corrected, and go a year without any new nodules, you're smooth sailing.

Granulomas, however can come at a later time as pointed out by Dr. Casavantes. As previously explained, they can be treated, can reverse on its own, and can be removed if necessary. Relatively speaking, even these complications pale in comparison to complications found in other procedure-types. What should be noted is that no procedure is without risk, and if anybody thinks that getting PMMA or Ellanse will be 100% complication free, I'm afraid they wont make a good candidate for Phalloplasty.

Women get nose, boob, and butt jobs, and they all have varying degree of complication rates. No one closed that industry down because of it. Since no procedure is without risk, you have to weigh the pros & cons, and determine whether the risk is worth the reward. Furthermore, and more importantly, is to determine if the complication rate is poor, so-so, or acceptable. If we take all authentic patient reports, dermal fillers score an "acceptable" complication rate, and maybe "so-so" if you take minor complications (e.g. nodules) into account.

The notion that 5 men have reported Removal is, in my opinion, a remarkably low rate considering the hundred+ reports of successful outcomes. Granted, success is subjective and obviously some results may be more desirable than others, but I'm generally implying "free of major complication," and that's saying a lot in this industry. Yes, just like you recommended readers doing --> please go back and review 2018's, 2017's, 2016's, and so on.

These proclamations that a procedure is unsafe because it didn't work for you is irresponsible. I oppose rigid implants, multi-layered dermal matrices, scaffolding, and silicone oil for the obvious reasons (highly risky, obsolete, etc). The sheer success rate of dermal fillers when employed by an experienced practitioner is unparalleled, and the contents on PB 2.0 and PB 3.0 are living, real-time proof.

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Ok then anyone who wants PMMA get it done.

Toothman wrote: Ok then anyone who wants PMMA get it done.

Except I hope that isn't the attitude of those who "want" to pursue penile augmentation. If you want PMMA (or any other viable procedure), start with some questions I've seen associated with the decision making process. These are just some in the form of a YES-or-NO checklist (honest answers will get the best results):

1. Has my size been a long-term point of insecurity? (Note*- I'm convinced more than ever that size is highly overrated and genuine size queens represent a fraction of the population. Things you can't change through traditional means like height and endowment should not be ridiculed or regarded as less masculine. Instead, see your penis enlargement endeavors as a means to conquer your sexual ambitions by expanding your pool of candidates, much like a good career, education, looks, fitness, or sense of humor would do.)
2. Am I generally free of any symptoms (or diagnoses) of mental illness, regardless of its short-term or chronic status? Due to the obscurity of un-diagnosed psychological ailments, we can also rephrase this question to ask: Am I generally regarded as well-adjusted by my peers, family, and friends?
3. Am I statistically regarded as under-average in either length, Girth, or both? (based on the most credible data available, not internet myths)
4. Have I spent a combined minimum of 24 (total) hours researching PhalloBoards and can describe most of the following options: PMMA, Ellanse, Radiesse, Hyaluronic Acid, Silikon1000 via micro-droplet, Silicone oil/gel, rigid silicone implants, inflatable implants, free fat transfer, Dermal Grafts, and PLGA scaffolds?
5. Can I name at least 2 practitioners of penis enlargement off the top of my head who are also PhalloBoard Sponsors (as of the date of this posting)?
6. Am I aware that even the best of procedures and the best of doctors can still result in complications, regardless of how infrequent those complications may occur?
7. Am I aware that my own anatomy & physiology plays a significant role in my overall outcome. In other words, the realization that a Doctor could (hypothetically) perform an identical procedure on two different men and get two different results.
8. Am I in a place in life to comfortably take on the necessity of cost & travel over the course of a year (or two) to undergo Phalloplasty? This applies to unexpected costs & travel due to unforeseen revisions, irregularities, or complications.
9. Do I enjoy an active single-life and casual sex is something I frequent, or would like to frequent more?
10. (Applies to those with a significant other): My life with my significant other is both happy & stable. That said, am I seeking medical Male Enhancement to spice up intimacy in the bedroom, and not for the purposes of salvaging a marriage (or a long-term relationship)?

If you said YES to at least 6 of these questions, you're probably a solid candidate. If you said YES to 8 or more, then I'd have to agree with your quote above.

This isn't a scientific test (obviously) and is just a list of factors I've witnessed playing a crucial role in the decision making process. Point is, if you're gonna get work done, be in the right place in your life. If & when you decide to get work done, seek out the best in the field... too many no-name practitioners think this stuff is as easy as A-B-C but it never ceases to amaze me the poor results they churn out.


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I still see a lot of controversy and confusion between granulomas and nodules; you guys may have noticed that I use the term "true granuloma" often because most so-called granulomas are no granulomas.
There are also chronic granulomas and acute granulomas, and the discussion will get more and more intricate as we dig.
One of the topics that I really love is "the ideal filler", because it doesn't exist and I firmly believe that it will never do. So, if in doubt, simply don't do the procedure. Complications are extremely low, but they're around.
Granulomas may occur after any filler, being it HA, PCL, CaHA or PMMA, but of course, the longer-lasting the product, the more complicated the issue.
After all these years and thousands of patients treated with all kinds of fillers in literally every imaginable part of the body, I have seen two cases of (again) true granuloma in the face, and one in the penis. The two facial instances were acute and they healed after one session of systemic prednisone (7 days, decreasing dose). The only one in a penis is a chronic granuloma secondary to silicone injections and the approach has been surgical.
On the other hand, I see nodules in a daily basis. They are big, small, unnoticeable, visible, asymptomatic or painful... you name, but there is no immune reaction involved. If I say that they're sensitive to manipulation I refer to patients that over massage or keep messing with them in different ways.
All of us wish that complications never occurred but they're present in every aspect of our lives; everything that goes wrong, especially elective procedures, creates a strong feeling of remorse and desire for reversal, and this is not specific to Phalloplasty, or surgery, or elective medical treatments; it happens after every bad decision that we make in life.
You guys are young and most of you never saw the horror stories associated with surgical Phalloplasty. Patients have had their penis destroyed after their own FTTs.
I understand that one bad result is one too many, and it is the reason why I always recommend moderation and never push any patient to go through a cosmetic/elective treatment. One common occurrence in my office is my denial to work on insecure, non-educated patients.
@Skeptical One has mentioned some very interesting things, and I am going to go in detail over one specific one: The Small Penis Syndrome, possibly the only condition that has a medical indication for nonsurgical Phalloplasty.
If the individual is socially handicapped or has psychological issues because he thinks that his penis is small, the only way to give him a positive result is not by sending him to the shrink... you've got it... is by giving him a bigger penis.
I am truly sorry for any patient that has complications after any procedure and under any circumstance, and yes... nonsurgical Phalloplasty (as non-invasive and benign as it sounds) has pros and cons.
We have advanced a lot, though. Surgical Phalloplasty had a complication rate that neared 100%; the complication rate of nonsurgical Phalloplasty is below the average complication rate of facelifts and other common procedures that are considered safe.