TOPIC: Question on Bellafill timeline

PmmaFan wrote: Yes mine was many years ago. Maybe the technique changed.

@Skeptical_One
What is PRP for a technique? Its like shockwave therapy?

PRP stands for platelet rich plasma and there are a lot of different uses for it (example: aging athletes will use it in areas like of their body that are more prone to injury). It's made from your own blood and there is a bunch of different information about it on the web -- I implore you to Google it as there is an abundance of knowledge regarding its many uses and legitimacy.

It should be noted that PRP alone does not increase penis size, however there are some who believe it can improve erection quality, and in the case of penis enlargement, aid in the recovery of whatever procedure or protocol you employ. Also, because it's extracted from your own blood, it's very safe all things considered, and I'm of the camp that believes "what harm can it do if added to my PE procedure or protocol (especially if the costs are negligible) in the grand scheme of things?"

Dr_Sullivan wrote: The approach to managing lumps or irregularities after Bellafill (PMMA) injections depends on their cause:

1. Uneven Placement, Pressure Areas, or Uneven Collagen Formation: If the lumps or irregularities result from factors like uneven placement of the filler, pressure areas created post-procedure, or irregular formation of collagen, it's advisable to wait approximately three months before taking action. This time allows for the natural settling of the filler and the body's adjustment, which can resolve many of these issues.

2. Granulomas Formation: If the lumps appear to be granulomas (inflammatory reactions that can form around foreign bodies like fillers), it's important to address this as soon as possible. Granulomas can be a more serious complication and require prompt attention.

Treatment approaches vary based on the scenario:
- For issues related to placement, pressure, or collagen, the treatment might involve injecting more filler to even out the area.
- For granulomas, the recommended treatment is usually intralesional, involving direct treatment of the granulomas themselves.

Is it easy to differentiate between the two - lumps and granulomas?

Girther wrote:

Dr_Sullivan wrote: The approach to managing lumps or irregularities after Bellafill (PMMA) injections depends on their cause:

1. Uneven Placement, Pressure Areas, or Uneven Collagen Formation: If the lumps or irregularities result from factors like uneven placement of the filler, pressure areas created post-procedure, or irregular formation of collagen, it's advisable to wait approximately three months before taking action. This time allows for the natural settling of the filler and the body's adjustment, which can resolve many of these issues.

2. Granulomas Formation: If the lumps appear to be granulomas (inflammatory reactions that can form around foreign bodies like fillers), it's important to address this as soon as possible. Granulomas can be a more serious complication and require prompt attention.

Treatment approaches vary based on the scenario:
- For issues related to placement, pressure, or collagen, the treatment might involve injecting more filler to even out the area.
- For granulomas, the recommended treatment is usually intralesional, involving direct treatment of the granulomas themselves.

Is it easy to differentiate between the two - lumps and granulomas?

Very, especially for a Physician. One (i.e. lump or large Nodule) is an aesthetic irregularity (clumping of filler and associated bodily fluids/tissue due to any number of reasons), and the other (granuloma) is an actual immune response that may require medical intervention well beyond "breaking up the Nodule/lump."

That said, both lumps and granulomas don't appear to present any major issues with respect to penile function & health as far as I've seen (assuming of course, these issues are being addressed by a Health Care Professional, especially those with insight into these potential complications, like Dr. Sullivan).

Usually it is fairly easy. Granulomas are firmer and well defined.

Hello @Dr_Sullivan , I have had approximately 42ml of HA, (10ML of Voluma and 32ml of Restylane Lyft) over an 8 month period. My last procedure was April of last year and I had about 10ml. Is hasn't degraded all the way, I would say about 75% left but I need to get it touched up. Could I continue with Bellafill at this point instead of HA? If so, how would the degradation of the existing HA impact the formation of the Bellafill and would I be prone to more irregularities?

Would love to hear your thoughts on this as I am in a similar situation

This is a question frequently arises in consultations: Can patients who have had a satisfying experience with HA fillers transition to polymethyl methacrylate (PMMA) for a more enduring result?
The most common scenario is : a patient tries HA and is happy with the results and now they seek a more permanent option with PMMA. Is this transition feasible? The short answer is yes.
Some doctors suggest it is problematic and want you to dissolve all your HA before proceeding with PMMA. Their concerns are as follows:
1. Risk of Complications:
They argue that the presence of HA might interfere with the PMMA integration process, potentially leading to unevenness, granulomas (inflammatory reactions), or even more severe complications due to the unpredictable interactions between the two substances.
Response:
There is no inherent reaction between HA and PMMA that would preclude their sequential use. It is important to remember that hyaluronic acid is a naturally occurring in the skin's dermal matrix. When PMMA fillers are injected into the dermal or subdermal layers where natural HA resides, they typically do not provoke adverse reactions. This is because PMMA microspheres are designed to be biocompatible and, when used correctly, should not interact negatively with HA or other dermal constituents. Injecting PMMA in areas previously treated with HA-based fillers should theoretically be as safe as injecting it into the untreated dermis, which already contains HA. The key is the technique used during the procedure:
2. Unpredictable Outcomes:
The concern is that the temporary HA filler could alter how the PMMA settles, potentially leading to asymmetry or dissatisfaction with the aesthetic outcome.
Response:
The injector must employ precision when injecting PMMA to ensure the microspheres are evenly distributed and to avoid the formation of granulomas or nodules just as they would when injecting into a penis with no HA. PMMA should be carefully injected to avoid disrupting the uniformity created by the HA fillers
4. Gradual Transition:
Some practitioners advocate for a gradual transition from HA to PMMA, allowing the HA to partially metabolize naturally over time. This approach can provide a smoother transition and reduce the risk of complications associated with immediate layering.
Response:
I fully agree with this. If you are at a size, you are happy with why not just slowly replace your HA with PMMA over time. It allows you to have more precise placement of the PMMA.

5. Time Interval: It's sometimes advised to allow sometime between the HA filler dissipation and the PMMA injections. This gap can help the practitioner assess the natural anatomy of the penis without the influence of the HA filler.
Response:
This not necessary if the original HA filler was well placed and has been well integrated into the tissue. This might be desired however if the original HA was poorly placed.

Why Not Dissolve the Existing HA?
Dissolving HA is not cheap, hyaluronidase is expensive, and a significant amount is needed for full reversal. Why incur this expense if it is not needed. Also why reverse the gains that you have already paid for? Dissolving the existing HA just seems like an unnecessary expense.

Conclusion
From a biochemical standpoint, there's no reason to expect that PMMA cannot be safely injected into areas where HA fillers have been previously placed.
Through my clinical experience, I have found that both hyaluronic acid (HA) and polymethylmethacrylate (PMMA) fillers can be safely employed for penile augmentation, whether they are used together or in a sequential approach, to meet the preferences and objectives of my patients.

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