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

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)

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.

Dd71, I agree with your plan to have the 10% concentration. It\'s what I would do too.

The report I have seen also mentions the formation of a thin capsule around the PMMA which should help to prevent migration.

@sparticus
What do you think about using ArteFill or Radiesse instead of New Plastic (ignoring the cost/impermanence factors)? Do you have the same concerns about these materials?

If you don\'t think New Plastic was shown to be phagocytized please read ALL the posted studies on this forum and on forum 1.0.

As I have stated in the past, please take anything Lemperle states with a grain of salt.
With that said, the studies posted here recently and others I posted in the past show the potential for PMMA, more specifically New Plastic, to migrate. If a substance can be phagocytized it can migrate.

Im prob going for my appt. July 22 (work permitting) ! Im very nervous but more excited. I asked wade what dr.C would suggest to obtain the best esthetic and above all SAFE result from PMMA injections. He said he was glad that I asked because most patients just want the maximum amount possible despite the look/complications. He reccomended that for the first treatment I receive 10% concentration for the entire procedure. Wade says that this almost eliminates nodules and bumps, and allows the body to get used to the PMMA. The Girth added may not be as much as others, but it will increase and the second treatment will go much easier. Wish me luck boys

@capital:
Yes I think thats why he used a bovine collagen and this collagen will prevent any possibility of migration of the beads (I think he ment local migration i.e. around the injected area and not distant migration) and hold them in the injected area for around 3 wks till your granulation tissues and the connective tissues take over.
He mentioned that cellulose (in Metacrill and Newplastic) will be resorbed within 1 day ( so there is a great difference between it and the bovine collagen which will be completely resorbed within 3 wks) .
What I read if a doctor injects small microns beads than the diameter of the vessels you can have distant migration (e.g. lymph nodes,lung,liver or spleen) .
e.g. :- (1) Venules in the skin are 20-30 microns in diameter so the beads have to be 40 microns . (2) Sub-mucosal plexus in the lower esophagus and the urethra are upto 80 microns in diameter so the size of the beads to be used in this area are 125 microns.
www.giejournal.org/article/S0016-5107(10....org/article/8886492
If the treating doctor ignore these points , you can have distant migration of the beads
I have asked Lemperle these Q\'s about Newplastic injection and I will inform you his answers :-
1- What will happen to the beads in the period between ( 2nd - 21st day) post Newplastic injection (as we know there will be no more a carrier for the beads in this time) ? Is there any possibility of migration (local and distant) in this period ?
2- Any precautions should we take ? i.e. Is wrapping will be enough only for 1-2 days ? You have told me we have to wrap our penis for 1-2 wks as far as I understood I think you were talking about when the carrier is collagen and not cellulose .
3- Can be the cause of irregularities or unevenness (in the final result i.e. 6 wks) due to the usage of cellulose and not using the bovine collagen as a carrier ?? ( lets say the doctor\'s technique is excellent and he use the same concentration ) so is there any advantage in using bovine collagen in regard of the final result ?

@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 kill 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.