TOPIC: Infections, Complications, Risks of PMMA?

@ all of you

I was with DR C today and told him about this case. He knew it straight away and described it. It was a friend of his a good plastic surgeon who did it and he did use a micro canula. The patient had several face fillers in previously and requested something in an area you don\'t normal go. He simply shoudnt have done it. Dr c said it was all to do with technique and not product in fact hardly any PMMA went in there but the big vessel collapsed and that was it.
Dr showed me how the vessels in the face works and also how to approach the nose. He was with the guy yesterday who is full of regret and admits it was his technique.

He also said you musnt get complacent he approached every surgery with worst case in mind and is very worried about all the new breed of home trained surgeons arriving. He was with a big group from brazil yesterday discussin pmmaand that case came up. Sorry for typos

Justabitmore wrote: ...
I was with DR C today and told him about this case. He knew it straight away and described it. It was a friend of his a good plastic surgeon who did it and he did use a micro canula...

Well hopefully that clears up the statements that the doctor did not use a micro canula.Dr C sounds like a fantastic well grounded doctor. Could you please get a ballpark quote for his procedure using Artefill instead of Newplastic?

@EQ
Thank you very much EQ for bringing this point for me:-
In his e-mail was he talking about a serious distant organ complication from the migration of the phagocytosed small beads or he was talking only about the chances of foreign body formation from these small beads ??(which Dr.Cohen said the best treatment for FBG is to leave it alone for spontaneous remission).
He mentioned only that small beads can cause FBG . And the chances of FBG formation in the Brazilian products are higher.
So are you saying FBG is a very serious complication and it is the biggest fear for you.

@smartman - it really is sad when you can\'t leave well enough alone and start arguing against points that you made and claimed were clarified to you in an email from Dr Lemperle. Does this ring any bells phalloboards.websitetoolbox.com/post/sho...9208465&postcount=15 I suspect if you re-read your posts from Lemperle in that thread all your questions will be answered.

Hm, I\'ll pass word along that multiple people are having issues.

The Rt. facial necrosis in the picture is due to a bad technique (the doctor has injected pmma into an artery (branches of the facial artery)) esp. if the doctor used a sharp needle for the injection, they usually advice in pmma injection is to use a blunt cannula or if the doctor used a sharp needle he shouldn\'t inject the pmma at rest he should move the needle back & forth and the injection should be done during the movement to avoid any direct injection of pmma into an artery.
It has nothing to do with the amount of pmma it is due to the technique e.g. :-
A small volume of pmma injected by a sharp needle into an artery ----> a chance of necrosis.
A large volume of pmma injected by a blunt cannula and not into an artery--> no necrosis.
A necrosis of a tissue from an arterial embolism is not a long term complication it is an acute short term complication hours after the injection.
But if the injection was into a vein ---> possibility of pulmonary embolism
BTW the volume injected in the butt (around 500 cc) is 10 times more by volume than typically injected in the penis (around 50 cc in total) and I have never read any report of skin or tissue necrosis of the butt.
I agree with supa that there are other products beside pmma if you injected them in an artery---> embolism---> serious complication.
e.g. injecting steroid into the inferior turbinate (inside the nose) (used to be one of the treatment for chronic nasal block (allergic or vasomotor rhinitis)) can cause blindness
archopht.ama-assn.org/cgi/content/abstract/97/1/79
My doctor in Brazil used a micro-cannula during the injection of Metacrill but in some area of my penis he wanted to use a sharp needle (back & forth technique) but I refused even he told me he has a long experience of using a sharp needle. So I am sure some brazilian doctors still sometimes used a sharp needle beside the micro-cannula (so it is not a 100% a bioplasty technique (a blunt micro-cannula) what Dr.Almir Nacul has advised).
So the technique of the doctor is most important to avoid any serious complication and not the product per se.

Some people think that FFT injection is the safest method which has no serious complication and only has a low risk, I would like to know their opinion after they read these information would they still have FFT injection??? :-
(1) Danger in Glabellar injection page 461.
(2) Blindness and central nervous system injury (in a 24 y.o. lady after Fat injection about 0.5 ml in her Rt. nasal tip) page 461.
So it was only 0.5 cc of fat which had caused this serious complication and not the 20 cc pmma into a penis.
In fft injection you can also get :-
Absorption , infection (mycobacterial??) antibiotic before and after injection is advised , pulmonary thromboembolism , pseudotumor , skin necrosis , calcification , penile and urethral distortion , cavernous sinus thrombosis , big cyst formation , ossification and lipomatous hypertrophy (please, check the picture of the penis in fig. 54. 3 in page 422 in the following web-site) :-
books.google.co.uk/books?id=K-HYbvHxcKcC...t%20transfer&f=false
I think I should start a new thread about infections , complications , risks of FFT ???


So in conclusion:- as I have mentioned before it is the Technique and not the product per se.

I am not saying that PMMA is without any complications , you can have a serious complication if your doctor used a bad technique even if the product of PMMA was the best ( e.g. Artefill).
In PMMA injection you must find a very experience doctor who has done many cases and has a very good reputation, otherwise dont do it .
We are all here in this forum trying to help each other , and all of us want the best for our penises .
I dont need to convince anybody to have penile PMMA, everyone should do his research and find out what is the best for his penis .
I think all of us would like to have a permanent Girth enhancement with the lowest risks.
I found the product what I was looking for but I am sure some people like other products and they have good results too.

Also in my opinion in regard of the possibility of skin Necrosis and other arterial emboli from PMMA or other material injection :-
e.g. Injecting 20 cc Newplastic into my penis with a blunt micro-cannula is safer than injecting :-
1 cc of Artefill into my naso-labial fold (skin Necrosis) or 0.1-0.2 cc 0f steroid injection inside my nose (blindness) or0.5 cc of FFT into the tip of my nose (blindness and central nervous system injury) with a sharp needle.

supa wrote: Re: The horror picture portraying a disfigured face.

It would seem down to poor technique; I read in the article:

Not the product is to blame then, if we take the excerpt literally, but rather the location where it was injected.

Thoughts?'

If it was injected into the artery, that is poor technique and physician error. Very near branches of the ophthalmic artery should be fine. The material is not supposed to move. That would not be considered poor technique. In the nasogenian grove should be fine. The material is not supposed to move. That would not be considered poor technique. Very near the right facial artery should be fine. The material is not supposed to move. That would not be considered poor technique. Here is a video of Dr. C injecting into the glabellar region. He is using a microcanula so not likely to puncture a blood vessel (not impossible, just not very likely). How near is he to branches of the ophthalmic artery?

supa wrote: 'At the same time I did resent your patronizing attitude when replying to smartman '

I looked back at my exchanges with smartman and there isn't anything I would change. If you believe that the answers to the list of questions asked would provide value to you, as opposed to another list of questions for each answer and so on resulting in an endless debate that no one cares about, then I hope someone answers them.

I have mentioned before if a doctor wants to use a sharp needle (instead of the blunt micro-cannula) for the injection of PMMA he has to use the technique back & forth (injecting PMMA while withdrawing the needle) and never inject at REST.
I think most of the doctors in the US use a sharp needle for Artefill injection into the face and I have never read any case of skin Necrosis or blindness in the US, because they use the technique I have mentioned above.
e.g. watch the technique of this doctor during the injection of Artefill he is doing it while withdrawing the needle :-

The doctor has to be well trained about how to inject Artefill in a safe way.
Injecting the beads directly into a vessel (an artery or a vein) e.g. a sharp needle ---> serious complications (embolism).
In the other hand injecting the beads outside a blood vessel, the beads cannot enter the blood vessel by itself ---> i.e. NO embolism.
To prove that for you :- There are thousands of patients in the US who had Artefill injection into the face (which contains a lot of arteries and veins) by using a sharp needle but without any serious complications e.g blindness or skin Necrosis i.e. No beads had entered the blood vessels because these doctors are well trained.
If Dr.C. or any other doctors using a sharp needle for PMMA injection (e.g. in the US) and if they had one case of e.g. blindness , would we think they will continue to use it ??

@eqstudent
I would not be so sure of that. The choice of placing the product very near the ophthalmic artery can be a poor one. The material is indeed not supposed to move from the location where it has been injected but if it was administered very near the artery it is conceivable that some of it has reached it during the procedure; what if the artery happened to be fragile in that particular spot and broke because of the \"collision\"; old people (the deformed patient in the picture is 77 years old) often have damaged/fragile arterial walls. If this was the dynamics of the incident (cannot be ruled out), I would define the technique as poor. It is conceivable that Dr C is extremely careful not to inject close to the artery while operating in the glabellar region; you could argue that not every surgeon can master the art of bioplasty (what/where/how to inject); in particular, and it is just my opinion, the glabellar region looks more complex to work on than the penis. Can I ask you again: would you consider bioplasty to the penis using Artefill? Not that you would actually go now and have it. Rather, if you feel that it is a sound procedure to seriously consider. Or, on the contrary, if you would also equally and firmly reject it, at this point in time. As for me: I am willing to be exposed to a moderate risk of granuloma formation (and deal with it if such event occurs). On the contrary, I am not going to have the procedure if there is a moderate risk of migration: I need (scientific) evidence that suggests that such risk is neglibile (e.g. <0.001).

supa wrote: ... I would not be so sure of that. The choice of placing the product very near the ophthalmic artery can be a poor one. The material is indeed not supposed to move from the location where it has been injected but if it was administered very near the artery it is conceivable that some of it has reached it during the procedure;...

Are you saying one should not do work in the Glabella? Once you work in that area you are going to be near a blood vessel. All the arteries in that region have significant anastomoses. Look again at the Dr C. video, was he near a blood vessel? The technique is fine, the area is risky. A lot of well-respected surgeons will not put any type of filler in this area.

supa wrote: ...The material is indeed not supposed to move from the location where it has been injected but if it was administered very near the artery it is conceivable that some of it has reached it during the procedure;....

Thank you for bringing this discussion back to the central point. The Caldellas Newplastic study of 21 patients showed Macrophage phagocytosis in all 21 patients. If the PMMA particles are small enough to be eaten by a Macrophage they will move!

supa wrote: ...Can I ask you again: would you consider bioplasty to the penis using Artefill? Not that you would actually go now and have it. Rather, if you feel that it is a sound procedure to seriously consider. Or, on the contrary, if you would also equally and firmly reject it, at this point in time;...

If one must have PE then IMO Artefill, if it performs in the penis like it does in the face in the 36 month interim study, may be sounder than all the other PE alternatives. Having said that we should be clear that for every 10 people that have the procedure, at the 5 year mark it is likely that 1 or 2 will have some adverse effect including lumpiness, swelling and redness, lesions, treatable granulomas, and granulomas that will need to be surgically removed. We do not know how the higher volumes (10x) required in the penis will change the risks.

@EQ
1) (( If the PMMA particles are small enough to be eaten by a Macrophage they will move! ))
I have posted one paper before which shows that Artefill does contain < 20 micron beads in < 1% \" by the number \"
www.ncbi.nlm.nih.gov/pubmed/19787393
Is there a chance of movement of the phagocytosed small beads in Artefill or is it only the ones in Newplastic ???
It could be only the phagocytosed small particles in Newplastic will move but not the ones in Artefill ?? It could be I dont know??
2)(( If one must have PE then IMO Artefill, if it performs in the penis like it does in the face in the 36 month interim study, may be sounder than all the other PE alternatives )).
In you opinion would you still advise Artefill if one must have PE ?
If your answer is yes ,wouldn\'t you be worried about the small beads and their movement the one you have mentioned above ?

Why do we make things so complicated we have two products to compare Artefill and Newplastic :-
smaller beads carrier
Artefill < 1% bovine collagen
Newplastic > 1% ?? methylecellulose

The carrier difference has nothing to do with the serious complicatios , we all agree the it has to do with the beads and your body reaction to them, and both of these products have small beads of PMMA but one has a smaller amount than the other .
So if we suppose to have a serious complication from the movement of these phagocytosed small beads ---> wouldn\'t we have the same complication in both products but of course in Artefill will be lower than Newplastic.
At least one case from Artefill ????
But what we have in regard of Artefill there is no serious complication (i.e. from the movement of the small beads) so small beads have no serious effect on our health.
If somebody tell me it is dangerous to have small PMMA beads (in regard of migration) I will ask him to give me one case which has a serious complication (e.g. migration of distant organ) in the US from Artefill, (there are thousands of people in the US who had Artefill during the last 5 years)