TOPIC: Flaccid length too short for fillers?

First off I apologize for the sensationalist title.

I'm set on getting Phalloplasty performed in 9-12 months. Currently leaning towards Proud Urology in Seoul or Rupeka in Ohio. I want to make sure I get good results, but I am notoriously lazy. Too lazy to do manual PE exercises. And yes I understand the irony of being not lazy enough to fly across the world to get PE surgery performed vs jelq in bed for half an hour each night. Here's a breakdown of good and bad things I got going for me (there's more bad than good LOL).

Erect: 5.5" length 4.75" Girth

Good things about me/my Dick

• Circumcised
• uniform Girth through shaft
• Money is not an issue
• Mid-30s
• no medications
• Willing to take post-treatment healing seriously
• Obsessive researcher

Bad things about me/my Dick

• Flaccid length all over the place/incredible retraction. Anywhere from 1" to 3.5" at any given moment
• Too lazy to do PE exercises
• 'High and tight' Balls. While it does jut my package out farther, it makes a number of PE equipment or even Cock rings difficult to use
• Premature Ejaculation (one reason I'm leaning towards Proud Urology)
• Trouble maintaining erections (a concern I have with some healing processes, although I am interested in getting on say, low dose Cialis)
• Glans size normal/below avg compared to current Girth (not overly concerned over aesthetics but thought I'd mention it)
• Semi-strenuous job that involves carrying heavy things
• Drink alcohol (willing to take a break for a few months before+after procedure)
• Smoke cigars (willing to take a break for a few months before+after procedure)
• Overweight

Dang that list went on longer than I thought....What should I do in the next 9-12 months? Any recommendations on Phalloplasty that would be a good fit? Procedures to avoid due to my circumstances?

Hey,

from what you have written, I do not see a contra-indication for dermal fillers (HA). When the penis is retracted, it might be more difficult to inject the filler uniformly. However, it has to be moulded afterwards when Erect anyways. I would consider an easy to mould filler like Juvederm Voluma and taking some PDE5-inhibitor after the injection to be able to achieve an Erection.

Since you are overweight, getting rid of some excessive pounds will also reduce the fat pat and thus make the penis more visible.

Restricting tobacco will improve vascularisation and Erection strength and duration.

I would make these life style changes first and then try out a smaller volume like 8ml of an easy to mould filler. The filler would then also prevent retraction to a certain extent.

I think both options are great for your endeavors, but may I ask how you ended up with two options on the opposite sides of the globe?

My guess is you travel a lot?

Either way, if your Erect Length is 5.5", they'll be able to stretch your flaccid and it won't be an issue for any seasoned practitioner. Good luck!

Simple. I live close enough to Ohio, and Rupeka sounds like one of the very best for the PMMA route.

What brought South Korea to my attention is their premature ejaculation treatment, and seemingly less active healing protocol (I am lazy, after all). Someone on this forums did suggest 2 weeks of staying local to the clinic for daily checkups, which would be an issue for me.

I did see the before/after's at Proud Urology, with a BUNCH of Koreans with far more retraction than myself, and came away very impressed. The suspensory ligament cut I'd probably skip...but I believe someone mentioned being able to use their fatpad lipo for their fat graft, with less chance of rejection. I'm a big fan of putting that fatpad to use.

Side note, not Phalloplasty specific: from what I've read there seems to be a risk of removing fat cells from the body and NOT re-injecting them someplace else. Why? Because your weight re-distributes itself among your existing fat cells. Which means your visceral fat (the fat cells around vital organs) gets larger to compensate for the overall loss.

EinMax wrote: Simple. I live close enough to Ohio, and Rupeka sounds like one of the very best for the PMMA route.

What brought South Korea to my attention is their premature ejaculation treatment, and seemingly less active healing protocol (I am lazy, after all). Someone on this forums did suggest 2 weeks of staying local to the clinic for daily checkups, which would be an issue for me.

I did see the before/after's at Proud Urology, with a BUNCH of Koreans with far more retraction than myself, and came away very impressed. The suspensory ligament cut I'd probably skip...but I believe someone mentioned being able to use their fatpad lipo for their fat graft, with less chance of rejection. I'm a big fan of putting that fatpad to use.

Side note, not phalloplasty specific: from what I've read there seems to be a risk of removing fat cells from the body and NOT re-injecting them someplace else. Why? Because your weight re-distributes itself among your existing fat cells. Which means your visceral fat (the fat cells around vital organs) gets larger to compensate for the overall loss.

Ah, surprisingly never expected to have a Sponsor from Ohio, but especially didn't expect to have two sign on in the same year (the other being Jiva Med Spa / Dr. Nanda), so you have options. That's something I like providing for my readership so they can shop around, determine which Clinic is a "better fit" based on communications, photos of their work, etc.

Proud is a one-stop-shop of a Practice, with a team of 3 Urologists who specialize in different areas of Urology & Sexual Medicine. They do great work and have an overall great reputation. My only recommendation in that instance is to use Vacation time to travel to Seoul, you'll want to be there at least a week (complications often show up shortly after post-op, or late onset, which can be treated in the States) just for peace of mind (these are elective procedures and aren't without risk; that said, complications are generally kept to a minimum when dealing with established practitioners in this very specialized field).

As far as your side note is concerned, I'm not sure I understand your question correctly. I do know that Dr. Carney (Rejuvall) for example, prefers harvesting a certain type of fat (I can't recall exactly which off the top of my head), and if you are someone very fit and/or has very low body fat, may not even qualify for his Fat Injection procedures. But fat transfer to the penis has been the longest running male phalloplasty procedure as far as I know, and the only reason it isn't more popular is because of the advent & dominance of dermal fillers on the scene.

FFT Pros: of all fillers, it's safest in terms of its use as a filler since it is 100% bio-compatible seeing's how it came from your body to begin with, but takes 2nd place on my list for best safety profile (Hyaluronic Acid being #1). This is because of the harvesting process adds one extra significant step, and my philosophy with cosmetic work is any additional incision, injection, or major step to completing a procedure means one more window of opportunity for a complication to arise, no matter how rare. That said, FFT is generally regarded as relatively safe when compared to other options. Another positive is that it's typically going to be the least expensive, or on the lower end of the price spectrum when compared to other male phalloplasty procedures.

FFT Cons: You may find you need to top-off the fat periodically, so that means you'll need to always have just enough of the kind of fat the Doctor requires on you every appointment (which isn't necessarily a lot, since you just need enough to fatten the penis, not something much more voluminous like a butt). I want to stress that I'm not saying you need to be fat to get work done, but you can't have a runner/athlete's body either. Most average builds likely possess enough fat for these kinds of procedures. Another con is that periodic top-offs means long-term maintenance costs. Fortunately these are just "top-offs", and much like Hyaluronic Acid (HA), the moment you see some notable loss, you can go in and use much less volume than before because you only need to re-obtain your original enhanced size, which in turn may imply a reduced cost (Doctors who perform FFT would incentivize making follow-up rounders cheaper).

That said, I'm always a "go with your gut" as far as consultations & fact-finding are concerned. In other words, you seem to favor Dr. Rupeka, so I would make it a matter to reach out to them first to learn more. You may find you are content with your experience with Youthology and book an appointment. If you feel compelled to shop around, Dr. Nanda (Ohio) and Proud Urology (their Patient Coordinator James speaks very good English) can be your subsequent consultations. I'm confident you'll find a winning candidate between those 3 options alone, and the good news is, they are all winning options.

Thank you for all of your words and your wisdom from doing this for years. A service to many!

It's a bummer that fat transfer doesn't last forever/needs 'topped off'. I have plenty of fat so I'm not concerned about running out. But I find the idea of going to Korea every other year/etc to be 'topped off' to be very disheartening. Would you say that this statement from Proud Urology's website regarding permanence is...misleading?

"3S Glans augmentation (or enlargement) is done by MegaFill® injection. It is a similar material as dermal graft but in liquid form, so the enlargement is done by injecting. 10-20% will be absorbed and the remaining 80-90% will stay permanent. The glans will be increased proportionally to your Girth and length. For better shape on your first surgery, we would recommend you to add 10cc to 20cc of MegaFill.It is a surgical method that enlarges the glans penis using autologous fat and PRF growth factors."

Of course, I'll be asking all these questions to the patient coordinator ad nauseam.

EinMax wrote: Thank you for all of your words and your wisdom from doing this for years. A service to many!

It's a bummer that fat transfer doesn't last forever/needs 'topped off'. I have plenty of fat so I'm not concerned about running out. But I find the idea of going to Korea every other year/etc to be 'topped off' to be very disheartening. Would you say that this statement from Proud Urology's website regarding permanence is...misleading?

"3S Glans augmentation (or enlargement) is done by MegaFill® injection. It is a similar material as dermal graft but in liquid form, so the enlargement is done by injecting. 10-20% will be absorbed and the remaining 80-90% will stay permanent. The glans will be increased proportionally to your Girth and length. For better shape on your first surgery, we would recommend you to add 10cc to 20cc of MegaFill.It is a surgical method that enlarges the glans penis using autologous fat and PRF growth factors."

Of course, I'll be asking all these questions to the patient coordinator ad nauseam.

Honestly, I'm not entirely sure about the misleading part. Dr. Carney and Dr. Morganstern seem to have long-term retention rates and I wonder how much of it has to do with the layer being injected, and volume being injected. You see, in the past many Doctors would over-fill, and the body needs time to heal and vascularize the area to ensure cells survive, but often times they don't due to excess volume of filler in an area that normally doesn't deposit fat -- thus some fat loss. My recommendation is the "brick-laying approach" in which you lay a foundation first, and build on it incrementally over time (sure, this is costlier, but would give some plausibility to long-term retention of fat in the penis). I also think the inclusion of PRP may prove beneficial for this type of procedure (it won't provide gains, but may expedite the healing and tissue integration process).

A lot of Doctors of the past may have also been injecting it into the wrong layers of the dermis, and this DOES matter. Our body has networks and pathways (lymphatics, capillaries, etc.) to break down things that aren't typically supposed to be there, which is why for example Hyaluronic Acid (HA) hardly lasts in the penis glans (head of your Dick).

Furthermore, you can get topped-off in the States by any number of Practitioners, but they need to inject it in the same "site" as Proud Urology did. For that reason I'd opt for Megafill over Fat Transfer if you were to travel to South Korea. It's effectively a dermal graft (kind of like Alloderm or Surgimend in the U.S.) manufactured in filler form.