Skeptical_One wrote: @Dr_JChang
and @Dr_Goldstein
of Pollock Clinics, I had a question a lot of our forum readers may want to know more about.
A topic that has been relatively active in the past few months is how fillers sometimes bunch up (or down) when injected into uncircumcised men. This seems to happen regardless of how experienced or skilled the practitioner is, and it also seems to happen regardless of filler type. It has now been coined the accordion effect because the penis can take on that appearance in severe instances.
Now it doesn't happen 100% of the time, but even the most seasoned injectors prefer having either provided a warning to their patient prior to a procedure, or some even have their patients sign a waiver. I even know of one Clinic who may not do any unless the person considers adult circumcision first.
Since your Clinic has a notable specialization in adult circumcision, I thought it would be a great opportunity for you to share your ideas/thoughts/knowledge on:
(1) Why the accordion effect happens to uncut men. As in, what anatomical/dermal obstacle is being presented to the fillers?
Thanks for the questions. I see that this has been addressed many times in this forum already but in general this "accordion effect" occurs in uncut men due to clumping of the filler towards the base of the penis as the foreskin is pulled back. I suspect that this is a result of the filler and the superficial fascia/skin moving as a unit in tandem as opposed to the skin sliding over the filler layer. In uncircumcised men, the foreskin would normally slide over the deep fascial layer. In other words, filler shifting occurs due to the hypermobility of the skin when uncut, especially when there is a lot of foreskin. The men who have less foreskin who looked partially circumcised have less of this effect, which makes sense. In circumcised penises, the overlying skin is stable which means the filler stays relatively in place. I have seen a lot of men with phimosis as well which is when the foreskin is tight and cannot be rolled back. In fact, they maintain their foreskin covering their glans all the time. In these cases, since the man is already used to not rolling the skin back, filler shifting is not an issue.
Skeptical_One wrote: (2) Are there considerations an injector can take to reduce or eliminate this problem?
Given that filler shifting can occur in an uncircumcised man, the less filler volume there, the less of the "accordion effect" there will be. We generally do not recommend more than 8-10cc of filler for uncut men to see how things look after a period of stabilization as every penis can take on different interactions. If filler shifting is minimal, then more filler can be added, especially towards the base of the penis. Some injectors believe they can reduce the "accordion effect" by creating a taper with the base being wider but I find that with large volumes it doesn't make a difference.
Skeptical_One wrote: (3) Are there means to correct this if an uncut individual experiences the accordion effect after injections.
In men who have some degree of shrinkage, we can use Botox to try to relax the penis and reduce filler clumping at the base. But in general, other than being conservative and careful in applying the filler or getting a circumcision after the filler is administered, I'm not aware of any corrective measures.
Skeptical_One wrote: (4) Do you believe circumcision is mandatory for uncut men, or do you believe Pollock Clinics have the requisite background to work with these patients?
It's not mandatory - but its important to men to understand the need to be conservative with filler application, the risk of "accordion effect", and the risk of worsening phimosis if there is some tightness in the foreskin made worse with filler migration into the foreskin.
