TOPIC: Infections, Complications, Risks of PMMA?

smartman wrote: @EQ,
Lets say the migration of these small beads is true :-
...
So from these points ( it is like human experiments and not animal experiments ) wouldn\'t be enough to show at least one ill-patient???
EQ I am only trying to get the truth as all of us from the whole thing, Dr. Cohen will make it easier for us if he can show us at least one patient , could you help us to get this information from him or from other doctors , I have tried but he unfortunately didn\'t answer my Q. (i.e. our Q.) .

@smartmanI was not sure if you were serious implying that there were no studies recording serious issues with (PMMA) Newplastic. Here are 3 I quickly found on the web. I suspect Portuguese speakers could find a bunch more fairly quickly'The Polymethylmethacrylate Effects on Auricle Conchal Cartilage: Report of 21 Cases' by Caldellas et alhttp://www.ncbi.nlm.nih.gov/pubmed/20601571'Extensive facial necrosis after infiltration of polymethylmethacrylate' de Castro et al www.scielo.br/scielo.php?script=sci_artt...lng=en'Complications after polymethylmethacrylate injections: report of 32 cases' by. Salles et alhttp://www.ncbi.nlm.nih.gov/pubmed/18454007 That\'s 54 cases after just a 3 minute search!!

Whoever said there were no risks were mistaken or misinterpreted. This procedure carries basic risks found universally in all medical facilities... the risk of bacterial infection due to negligence (i.e. lack of sterilization)... although these risks are greatly minimized by medical staff, even the finest clinics and hospitals deal with freak incidents. This particular risk is an obvious (and minimal) one, but it should be noted.
Complications as a direct result of PMMA have been attributed more to poor technique and/or poor grade of PMMA versus an actual adverse reaction to PMMA. While there is still debate on the matter, the only complications known to have arisen from PMMA injections have been limited to granulomas (a tissue growth induced by an inflammatory response). Conceivable complications like migration or rejection have not been reported with the use of medical grade PMMA in Dr. C\'s practice.
Relatively speaking, in the short term PMMA has a remarkable safety record. I believe Smartman is our longest reporting PMMA-Penis member at 3 years, and GSXR is our longest reporting Dr. C patient at 7 months (correct me if I\'m mistaken). Evil Pneivel did appear to have some type of nodule formation (although was never diagnosed as a granuloma) which was painless and benign. This was resolved with kenalog injections which he details here phalloboards.websitetoolbox.com/post?id=5360270 . I believe we had another member (will look to find his name from the old board) who had some sort of fluid build up (edema-like) in his shaft that eventually subsided. Outside of these significant reports, no other major complications have been reported from forum members.
It\'s also important to note that Artefill, an FDA approved brand of PMMA for use in the U.S. has shown no sign of migration, injection, or rejection.
There is a good convo going on in the primary PMMA thread regarding the relevance of PMMA brands and their respective \"qualities,\" and how that could potentially increase the chance for complication. Dr. Casavantes uses New Plastic, and some contend this product is not as \"pure\" as the American-approved Artefill.
My take:
I personally think Dr. Casavantes has established a portfolio and reputation that deserves consideration with respect to the brand of PMMA being used. He has been working with PMMA for a while and has his trust behind the New Plastic product. It is his faith in the product that reinforces my faith in the product. Simple as that.
As for my feelings on the risks with PMMA... I buy the (obviously plausible) scenario that most complications have arisen from poor technique and/or poor grade of PMMA.
I believe Artefill\'s high cost coupled with the complexity of masterful injection technique (especially in an organ as dynamic as the penis) makes this procedure uncommon, at least as far as the U.S. is concerned. It is, however, commonly practiced in Mexico and South America and in my belief, will eventually trend in the states when the prices are brought down and there is an increase in qualified injectors.
If I had to note any noticeable issue that required some attention it would be a non-visible ring of slightly palpable bumps that make a semi-circle just outside the base of my shaft. I believe these to be scar tissue spots from the entry points used, and was told that they will lessen in time. I was also told injections can help reduce them if they persist. These bumps are hardly noticeable yet palpable but you have to really inspect them closely, and they don\'t seem to cause any pain to the touch.
I do have a minor aesthetic issue where there is little to no PMMA between the glans and the upper part of my shaft, but I don\'t consider this a negative because it was to be expected (the doctor recommends 2 rounds because contour issues are almost inevitable given the unpredictability of PMMA\'s settlement after the first round).
Otherwise, there was virtually no pain after the procedure, just mild tenderness. There has been no pain since, nor any major change in sensitivity (although if I were to consider pre-op at 100% sensitivity, I did dip to 95% before returning to 100%...which may be explained by the creation of new nerves ?? ). The function of the penis is unchanged and the erections are remarkably firmer (it seems the collagen is slightly tougher than the pre-pmma tissue).
All in all, keep in mind anything phalloplasty possesses risks, but in my opinion, this one possesses the least of all the semi-permanent and permanent options available. Be sure your decision to entertain the idea of penis enlargement via medical intervention is a sound, healthy, and rational one. I\'m not judging those who choose to get it for sheer vanity, but I express caution. Otherwise, those who are undersized or wish to enhance sex for their significant others are the best candidates in my humble opinion.
Good luck.

I also have similar concerns, i am 23 and i am leaning towards this being the best route. How on this board has had PMMA injected the longest?

\"Dr. Casavantes insists reduces (drastically) the incident(s) of inflammation, infection, etc.\"

I have not come across information supporting the use of a cannula in the reduction of any complication outside of Necrosis. Can you ask Dr. C to provide us with the literature on which he is basing these claims?

There was a full study I linked in forum v 1 that categorized type of complication, injector training, and PMMA brand. I recall New Plastic was associated with several forms of complications, not just Necrosis.

@Eqstudent
The PMMA brands used in patients have become significant as of late, mostly due to its discussion in other threads (you and others have helped bring to the attention of our community). The significance of the debate was whether or not the \"less pure\" alternatives to Artefill could pose increased risks in the long run.
It isn\'t that we need to state the brand of PMMA in all our posts... but we certainly can\'t assume the patient with facial Necrosis had New Plastic (or any other brand) without any proof. You said in an earlier post that \"it is reasonable to assume,\" and I took objection, hence my reaction.
Yes microcannulas were discussed but after some reading, the type of microcannula used is very important to identify when trying to piece together the reasons for these types of complications. With the growing debate on the relevance of PMMA quality, more and more factors are becoming relevant when trying to figure out why things go wrong.
You\'re right, the Castro paper does contain that picture, and I misspoke.

is this page really messed up for anyone else? i have several posts appearing on top of one another, so you can\'t really read them, with the last one extending way past the \"quick reply\" dialogue box that\'s usually at the bottom. I\'m using a Mac...just wanted to see if I\'m the only one with this issue?

Uh this is really important question so please keep your egos away so it would be easier to read and understand?
It\'s very very important to be critical as possible like eqstudent is.I am basically 50/50 should I go for the procedure at 10% on august or not.Does these serious long-term complications arise altho the amount injected to penis is small compared to facial procedures?
I am really at basic level on biology understanding when evaluating the risks - but still I better evaluate very well.I don\'t want my penis to turn black death when I\'m 30-40 yo.
Maybe one procedure at 10% is not so risky? .. Hmm.. I still could cancel my procedure time.. hard decision.

@eq,


1-
(( @smartman ' arguing against small particle migration is as silly as you arguing that one can't have an infection because the millions of macrophages surrounding the PMMA will kill any infection. Anyone with a basic understanding of biology will get these issues.))
I am just trying to understand the whole thing much better may be the reason is: I dont have a basic understanding of biology like you have, so could you explain (or may be the two local doctors in your area) Why we dont need antibiotic after Artefill injection ??? even after the second session ( that was the answer of Dr.Cohen and Lemperle , may be these two persons have no basic understanding of biology like me ?? ).
Do your two local doctors advice an antibiotic after Artefill ??
We could ask Artefill\'s company about the need of an antibiotic.


2-
You have mentioned (( A key requirement for FDA approval was that Artefill could not contain spheres smaller than 20 microns which were shown to be eaten by marcophages and in the animal studies found in migrated to lymph nodes and lungs!)).

But in the study (I have mentioned before) states

@smartman ' arguing against small particle migration is as silly as you arguing that one can't have an infection because the millions of macrophages surrounding the PMMA will kill any infection. Anyone with a basic understanding of biology will get these issues.The fact that small PMMA particles can migrate has already been answered, see post phalloboards.websitetoolbox.com/post/sho...286&postcount=110The fact that particles moving into the lymphatic or venous system can cause very serious issues or death has been established. See the de Castro paper and the articles about the Argentine beauty queen who died from pulmonary embolism in her lungs following injection of PMMA in her butt.I will not spend any more time discussing basic biology principles. The real takeaway from the Caldellas study on Newplastic is that the results were so alarming that that Artefill felt compelled to include commentary stating that those results were for Newplastic and should not be extended to Artefill. The two local doctors who are very big Artefill supporters told me that if the Caldellas study was on Artefill they would immediately stop using it and that in their opinion the FDA would recall and disapprove Artefill!I will not be using Artefill for chin augmentation.

@eq - (( @smartman - You are all over the map, I am done with this. Good Luck! ))
Why have you said that?? The most important topic we have discussed before was:-
Was there any patient in the literature complaining of a serious complication (e.g. DISTANT ORGAN) from Newplastic which can be due to migration of the SMALL beads , correct ???
These studies you have mentioned above were NOT the answer for that Q. , so if you think it was the answer , I am sorry you might be right.
But the most important thing I have found is the presence of <1% of smaller beads in Artefill , if that is true , and as we were discussing before that the Newplastic has small beads too , so why did the FDA give the approval for Artefill in 2006 ??
So it is either the FDA has missed that serious complication of the possibility of migration of the small beads ---> liver or lung failure . It will be a big mistake if it was true .
Or they did know about the presence of <1% of small beads (< 20 micron) in Artefill , but they were 100% sure there will be no distant organ complication from these small beads (i.e. small beads doesn\'t cause any serious complication).
So eqstudent I dont know who is all over the map ?? I will let the others to decide about that . May be the 3 minutes were too short for the research.
Would you still do the chin augmentation with Artefill by your doctor ??

@smartman - You are all over the map, I am done with this. Good Luck!

@EQ,
Thanks a lot for your 3 minutes research , I thought you still remember what was my Q. is about :- (( Any study about the Migration of the beads of the Newplastic or at least other products to a DISTANT ORGAN in human ---> distant organ disease or failure )), our argument was about the possibilty of the danger (e.g. migration) of the small beads migrating to distant organ, do you remember that EQ ??
In regards the 3 points you have mentioned above :-
1- 'The Polymethylmethacrylate Effects on Auricle Conchal Cartilage: Report of 21 Cases' by Caldellas et al
Is that a distant organ e.g. liver or lung ??? it is only a local (at the same area of injection) complication ???
Let us say this paper is 100% correct , the Q. is: Is this local complication due to the presence of small beads (e.g. in Newplastic) ?? If that is true why did FDA give the approval for Artefill i.e. it is safe ?? In Artefill there is <1% of the beads are smaller than 20 micron , I know it is low (<1%) but i.e. Artefill is not 100% pure, so is there any distant fatal organ damage after Artefill injection in USA, that will be a Q. for Dr. Cohen ( he will not answer me but of course we know his answer anyway).
www.ncbi.nlm.nih.gov/pubmed/19787393
2- 'Extensive facial necrosis after infiltration of polymethylmethacrylate' de Castro et al
I like that one , are you saying that the picture shown above is due to the product (e.g. Newplastic) ??? So do you mean if the same doctor used Arefill instead of (the Brazilian\'s product) wont happen this complication ???
First of all this complication can occur from injecting any product of PMMA directly into an artery ( in this picture is due to injecting PMMA into one of the branches of the Facial artery) which will occlude the artery---> necrosis .
So it is due to the TECHNIQUE of the doctor esp. by using sharp needle, and not due to the product per se .
Believe me EQ if you decided to have Artefill for chin augmentation (as you have mentioned before fft or Artefill) be careful esp. if your doctor use a sharp needle , he has to move it back and forth to avoid injecting the beads into your artery, otherwise the chance of having the same complication as in the picture is high.
BTW that is not the answer of our Q. it is not talking about migration of the beads to distant organ it is about the bad technique of the doctor by injecting the beads into an artery, as I said it can happen with Artefill also , correct me if I am wrong ?? i.e. the BEST product with a bad doctor ---> Disaster .
That was the opinion of Dr.Cohen ((the technique and not the product per se)).
So do you regard this case as a distant organ disease (e.g. liver) ??

3- 'Complications after polymethylmethacrylate injections: report of 32 cases' by. Salles et al
Again it is not a distant organ disease ?
5 cases tissue necrosis (acute complication) due to technique.10 cases granuloma (subacute complication) leave it or Kenalog injection.10 cases chronic inflammatory reaction in the same area were it is injected.Again they mentioned 10 cases chronic inflammatory reaction which is the same as above complication but in the lips (lymphedema).1 case of infection.
He mentioned one of the person who did the injection was not a doctor , I wonder which one was his patient ??
So are these the answer of our Q. in regard the possibility of small beads migration and the chance of distant organ complication ???

sparticus wrote: There was a full study I linked in forum v 1 that categorized type of complication, injector training, and PMMA brand. I recall New Plastic was associated with several forms of complications, not just Necrosis.

I\'m looking through all of your links from the previous forum and re-reading some, while \"Text searching\" others for the term \"New Plastic,\" and was having trouble finding it. You submitted a lot of articles so I may have missed it, was curious if you could re-link it here, thanks

sparticus wrote: \"Dr. Casavantes insists reduces (drastically) the incident(s) of inflammation, infection, etc.\"

I have not come across information supporting the use of a cannula in the reduction of any complication outside of Necrosis. Can you ask Dr. C to provide us with the literature on which he is basing these claims?

I am simply stating what Dr. Casavantes and his office feels about the product and their technique. It\'s his medical & professional opinion and not mine. I was not asserting that there was or was not medical literature backing up this claim in my statement. I was more-or-less relaying what I\'ve learned from them.
Another member mentioned that the Doctor would use alternative brands, i.e. Artefill, assuming the patient was willing to pay the difference in cost. It doesn\'t seem that he has some kind of financial stake with New Plastic, just a professional preference.