TOPIC: Heard of PMMA (Medical Grade) OR Dr Casavantes? [PART 2]

at the risk of sounding naive, what would be potential complications due to migration with PMMA?

Sorry fellas, the thread is unlocked now.

As was the case for the Original Thread, you can continue with the last discussed topic or add/discuss any other PMMA-related topic. Last Page from [PART 1]:

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dd72:I just talked to wade and he said that the beads are 40-60 microns. He also said in another study they compared it to artifill and it was very similar. Ofcourse his opinion is bias being he\'s in the retail side of new plastic pmma. But he said he will double check and get back to me. It\'s very disheartening if it\'s true it\'s similar to arteplast. It being a dynamic organ its prone to more risk and complications.

supa:I might be able later to paste in this thread the EM pictures of Cohen\'s article.

By the way, which source states that 40microns is the average diameter of Newplastic\'s particles? Cannot find it on the website of the manufacturing company: www.biomedical.med.br/site/en/default.asp

supa:Moreover guys, at the cost of sounding like an anal stat teacher (I am not), two parameters are necessary (and sufficient) to caracterise the size of the particles (under the reasonable assumption of gaussian distribution, which I am confident would be confirmed by carrying out a standard statistical hypothesis test on a product\'s sample):

1) the mean (i.e the average)
2) the standard deviation

According to basic statistics, even if the mean were actually 40 microns, administered samples could contain undesirable amounts of tiny particles if the standard deviation is too high.

With an analogy: at school you might be only concerned with your average mark of your assignments, say it is B. But it is not the whole story. In particular, here, at our \"phalloplasty university\", we are also concerned on how many Grade C you scored, even if they are sort of conceiled in the output of the averaging out process.

capital:Very interesting article indeed. I have no medical background but if I am right, this paper focuses only on the risk of phagocytis and migration (no signficant problem with granulomas in this very limited experiment). They also notice the formation of a thin net that might prevent this risk to some extent.

So the question is: what is the risk associated with a partial phagocytis of the particles and what kind of migration could be expected, in the area of the penis?

@EP : how is your redness now? Do you notice any change? Did you get an answer from for Dr. C? I hope it\'s not anything serious.

capital:@supa : that\'s what you can read on the Newplastic website ( www.biomedical.med.br/site/en/processo.asp ) :

\"Newplastic consists of solid polymethilmetacrilate microspheres of smooth surface suspended in hydrogel. Looking for quality excellence in raw materials, a selection and purification process of the PMMA microspheres was developed so that they have a standard medium size of 45?. The size of the microspheres avoids phagocytosis, for particles smaller than 30' can be phagocyted by macrophages\"

It would be interesting to know what kind of selection they make to avoid nano particles...

hunkchunkI don\'t really know if any of said studies are relevant, unless this implies it will migrate to our vital organs causing something like necrosis? After all it isn\'t carcenogenic and at worse it seems to stimulate the growth of a little bit of collagen which being of our own organism wouldn\'t likely be life threatening?

Also would the alleged \"microsphere phagocytosis\" relate to the initial injection period prior to settlement and collagen growth, roughly the one month period during which the body responds to the foreign substance by surrounding it with a net of fibers which grants us girth? Or does this mean that years down the road we\'ll get a PMMA drift of sizeable consequence causing us to have lesions and bumps that beyond being uncomfortable during the dynamic phases of penile exercise might also become infected or otherwise afflicted?

HC

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cantwaitforpma wrote: Hello all. Just wanted to introduce myself. Because i\'m paranoid about posting my name i hope yall don\'t mind just knowing me as M. Thank you all who have taken the plunge and gotten the PMMA procedure done. I\'ve been reading or \"lurking\" at the old forum and can\'t wait till i can contribute and add to the wealth of information and experience knowledge yall have made available. I\'m ready to shed my lack of self confidence(all psychological) and start being a more confident person for both me and my wife. Thank you so much for again for your contributions.

Welcome to the forum! Judging from your username, do you have an appointment schedule or plan to schedule one? Or are you still in the research phase?

Isn\'t the big difference here that the PMMA binds with natural collagen to basically integrate with your own tissue in a way that injected silicone does not, which prevents migration?

Indeed, all available literature I have come across, except for the two 2010 Aesthetic Surgery Journal papers which we have discussed in the last pages of this thread in the old forum, seem to rule out the possibility of migration.

But, here, d71 just asked the question: what happens if PMMA\'s beads migrate.

Does it happen?

Let us be clear that what has surprised us is that the sheer possibility of migration of PMMA particles in Newplastic has been raised in the two quoted papers. Is it true? Only a couple of articles make this claim; I felt initially a bit uneasy however since the journal looks authoritative, the articles are recent and they bring clinical evidence.

On the other hand, as correctly repeated here, PMMA long history has got a completely different track record from SILICONE.

For what is worth, my gut feeling is that migration concerns for Newplastic are overdone, even if it clearly is inferior in quality to Artefill. Dr Casavantes has got an international reputation in his field which he has gained over many years: he must trust this product and that we need to keep in mind when we think of risk scenarios.

@smartman: thanks a lot for all this precious info you got from Dr. Lemperle. Even if he might be biaised he is without doubt one the most relevant sources of information for us.
So according to him, migration could only occur during the first 3 weeks after injection right? And the effect would be immediate, no long term complications are possible in terms of migration?
I would also be interested to have Dr. C\'s idea about that (even if I guess he did not analyse his product himself..)

Using the ArteFill price Lemperle quoted to smartman ($450 for 0.8 ml), this means that getting 20 ml of ArteFill (as opposed to New Plastic) would cost $11,250. This is a lot of money - but it isn\'t out of the range of what some people are paying for surgical options, and some patients may have more money to spend, or be willing to get a loan for something like this. I emailed Dr C to see if it is possible to use ArteFill instead of New Plastic (also asked about Radiesse), and will post back if I hear anything.

@smartman ' do you know if Dr. Lemperle has any official affiliation with Suneva Medical Inc the new owning entity of Artefill? Does he have any affiliation with NewPlastic?The reason I am asking is that it seems very clear from Dr. Cohen's commentary and also from a consultation I had today with a local plastic surgeon, who does a lot of Artefill procedures, is that there is clear emphasis on the point that Artefill is very different than NewPlastic. The point that Arteplast was a 'flawed product with significant issues' was raised over and over in my consultation, as was the point that NewPlastic and Precise are very similar to the older generation Arteplast product.This particular doctor was very high on Artefill and claimed to have done several thousand injections and several hundred Artefill injections!

@SO
No problem I will ask him , but I know he is very busy guy travelling a lot (giving lectures, treating some patients e.g. in China and Cambodia and other countries) , now he is busy with his research project about the treatment of reflux esophagitis with large microspheres PMMA injection . By the way he is >75 y.o.

@smartman
do you think the Professor would be willing to join the discussion community, or at least join this thread?

This was his answer about the possibility of infection of the PMMA :-I have not heard of an infected PMMA implant ! It contains millions of macrophages , which would every bacteria at once ! However, if an abscess is close by, one has to open and drain the abscess as usual - without antibiotics ! The near PMMA will help the healing of the abscess hole since it is well vascularized and bleeds when you cut through. It has not to be removed but heals like fresh scar tissue.

From Lemperle :
However, foreign body granulomas can occur after PMMA, especially when injected superficially into the dermis. This is not the case with cannulas ! Granulmas after all injectables occur in about 1:1000 in the face. In buttocks and penis I haven\'t heard or read about one case. As deeper from the skin injectables are deposited, are less likely they can cause granulomas.
If inflammation or granulomas should occur, thet treatment of choice are Cortisone (Kenalog) injections : 2 -5 and they should be gone within 3 - 6 months.

Guys Lemperle still didn\'t reply, but I have found in my e-mail\'s inbox his answer it was in 2009 -
1- (my Q. was to him about long term complications after PMMA injection ) :
It is true for Brazilian PMMA (because it still contains small microspheres which stimulate macrophages and can cause a foreign body granuloma years after implantation (mainly after a systemic infection) . This is the risk - which can be treated effectively with local cortisone (triamcinolone) injections ! - I just treated the moon face of a lady in China , who got 110 cc of Artecoll in 2005 (when it was still impure) with 8 x 40 mg Kenalog.
I have tested NewPlastic - and it is almost pure , e.g.free of small PMMA microspheres, which might cause inflammation. The FDA approved ArteFill is absolutely pure and causes no granulomas anymore, however , it will be 10 or 20 times more expensive : 0.8 ml cost $ 450 to the doctor ! And you will need 10 -20 ml! Thank God, granulomas are rare (maybe 1 : 1000) Best wishes and regards,Gottfried
So it is true the Brazilian PMMA still contain some small beads ---> macrophages stimulation ---> foreign body granuloma (1 : 1000) ---> Kenalog injection .
2- In another e-mail I have asked him about the possibilities of PMMA beads migration in long-term :
of course I am biased since I developed this tissue process - but I was always honest enough to hear all critics and engulf them: PMMA beads can be transported through open veins only during injection : that\'s why we have to increase its diameter in esophagus and urethra injections from 40 microns (venules are 20-30 microns in the skin) to 125 microns (submucous plexus has up to 80 microns in diameter). After the injection, however, no \"migration \" is possible anymore because the collagen keeps the beads in place until the collagen (( I think Lemperle ment here bovine collagen which takes a longer time to be completely resorbed than the cellulose )) is resorbed (within 3 weeks) and replaced by the body\'s own collagen (=granulation tissue) . This gr. tissue keeps the beads at the location where they had been injected. After injecting PMMA into a penis, however, the whole implant can be moved as a total for 1 - 2 weeks - until tissue ingrowth has occurred . This is a crucial time to keep the penis as quiet as possible , because movement of skin may move the whole PMMA forwards or backwards. After 3 weeks, however, no movement neither of the whole implant nor of a single bead is possible ! This can only occur with silicone or PAAG oil, which is not encapsulated and can slowly move according to gravity ! So what I understood from his e-mail (in 2009) that the bovine collagen (in e.g. Artefill or Artecoll) will prevent the beads from migration during the1st 3 weeks till it is completely replaced by your owen collagen, after 3 weeks no movement of the beads whats so ever.
In conclusion I think that was the reason why Lemperle has used bovine collagen (Artecoll and Artefill) in his invention and not cellulose (Newplastic and Mteacrill) .
So Artefill is more superior than Metacrill and Newplastic ( in regards the purity of the beads and the carrier)

@jlmb

Isn\'t the big difference here that the PMMA binds with natural collagen to basically integrate with your own tissue in a way that injected silicone does not, which prevents migration?

The point raised by one of the two articles is that it could be that there is excessive variation of size of the PMMA beads in Newplastic (as opposed to PMMA beads in Artefill which vary very little). If some beads are sufficiently small they can migrate.