TOPIC: HA injectable Phalloplasty - for safety

Skeptical One and members,

I am a doctor providing injectable penis augmentation with HA in Australia. So remember to take anything I say with the understanding that I will probably write to support what I do. But I will try and explain why i do it and why I don\'t think there is anything better available at the moment. When I find something better, then we will look to change.

I have been working in the area of cosmetic surgery for 17 years after originally training in ENT surgery. Yes this is a significant career change. I mostly did facial plastic surgery for 15 years but had occasional requests for Phalloplasty. After seeing how the surgery was done I did not really want to take it up - I did not think I would want it myself. But there were a number of articles published in the medical literature using HA\'s that interested me.

I began injecting cosmetic fillers (Collagen and Hylaform) back in 2000. I have seen a number of permanent fillers come and go. I have seen some significant complications of permanent fillers. I have also seen complications of temporary fillers - but the complications were temporary as well.

For any cosmetic surgery safety is the most important thing. It is not like cancer surgery where scars or significant issues are accepted. This is why I have avoided the permanent fillers. I have also avoided stimulatory fillers (Newfil, Elanse, Radiesse). Stimulatory fillers may be fine - but the risks are somewhat increased and not acceptable when we were starting a new procedure.

The issues to overcome were making sure it was painless, did not risk obstructing the penile artery or urethra, being smooth and even and minimal down time.

We are happy that we can get the penis nice and numb. Without needles.

The injecting layer (essentially just below the skin, between the Dartos and Buck\'s fascia) is easy to get into and stay in using blunt cannula. By using blunt cannula and staying in the right layer there is no risk of blocking a vital structure.

Getting it even is usually not difficult. The advantage of a cosmetic doctor over a Urologist for this procedure is that we are experienced and skilled in performing cosmetic injectables. We know how to get it nice and smooth. But even then there is the occasional penis with (circumfential) bands which can be difficult to even out completely.

Injectable Phalloplasty is a walk-in/walk-out procedure. We ask guys to give it a rest for a few days - but guys love to come back and tell us how they put it to use that night. Preferably give him a rest.

One of the great advantages of HA\'s is that they are completely reversible with a medication called Hyalase which is an enzyme to dissolve HA. This is one reason why it is our main injectable filler anywhere - you can get rid of it if you need to. In the penis the great thing is that if, for any reason, you were not happy we could do a few small injections and get rid of it all in a few minutes.

Obviously the main problem with HA\'s is that they are not permanent. We use Voluma (part of the Juvederm range) made by Allergan. This is the world number 1 HA by the biggest company in the business with the most research to back it up. They(Allergan) are intrigued by its use in injectable Phalloplasty but it is strictly off-label. That means the company has not researched it and had it approved for this use in Australia.

After reading all I could, trying to get in contact with the Korean doctors (but failing), we tried our first patient in 2014. With just 5 ml of a different HA (initially tried a different HA because HA\'s are really expensive in Australia and the other company was willing to let me have some at a discounted price for the trial). He was happy - as was his wife. We did another 5ml.

Then I honed the technique on number of friends (quite an unusual experience, handling your friends penis\'s - and sticking a needle into it). We gradually improved the early results and waited to see how it would last. The Korean\'s had 90% retention after 18 months with what I feel is an inferior HA. Even in the last 6 months we have made further refinements to technique to improve results.

To improve longevity we have switched to Voluma. I have it in my face and it has lasted over 2 years. Voluma has the best researched longevity of any HA. HA\'s always last longer when injected in large amounts. HA\'s should have good tissue integration when injected correctly. That is it should not be injected in 1 big blob. With correct technique there are lots of fine collagen bundles around and it will not move. There are places in the face, such as the tear trough, where HA\'s last much longer (routinely years). It is hoped the penis will be another of these locations where there is less local, natural hyaluronidase (the dissolving enzyme) so it will last a decent time.

So yes we do have clinics on the east and west coast of Australia. I believe we do more injectable phalloplasties than anyone else in the country - but we have really only been doing it a relatively short time. We focus on safety first.

Free fat transfer can give good results. But I have also seen infections, resorption, unevenness. PMMA/Megafil/Silicone/Articol etc are too great a risk. I am sure there are guys with great results they are very happy with. The question to ask yourself is \"If I get one of these minor/major problems how am I going to cope?\". Surgery with lengthening and dermal fat grafts can be successful, with the right surgeon. But is major surgery, very expensive (>$30K in Australia) and has protracted down time.

I am happy to answer questions - but remember again - I have a commercial interest in this. But that commercial interest requires happy patients.

The Effects of Penile Girth Enhancement using Injectable Hyaluronic Acid Gel, a FillerTae Il Kwak MD1, MiMi Oh MD1, Je Jong Kim MD2 and Du Geon Moon MD2,
The Journal of Sexual Medicine Volume 8, Issue 12,  3407–3413, December 2011

Use of Macrolane VRF 30 in Emicircumferential Penis Enlargement
Giuseppe Sito, MD,Sergio Marlino, MD,Adriano Santorelli, MD
Aesthetic Surgery Journal February 2013 vol. 33 no. 2 258-264

Human glans penis augmentation using injectable
Hyaluronic Acid gel
JJ Kim1, TI Kwak1, BG Jeon1, J Cheon1 and DG Moon1
International Journal of Impotence Research (2003) 15, 439 - 443

Thanks for taking the time to post Dr Oates.

How long have you been using Voluma in the penis? 

You mention you\'ve injected as much as 10-15 ml, but was is the average volume that you would inject?

What sort of gains would you typically see from your average injection?

Welcome to the board!
 

Actually I\'ve just checked the forum rules regarding commercial accounts and I\'m going to have to lock this thread temporarily until SO can read it and contact Dr Oates.  

(R4.)Individuals and/or companies affiliated with surgeons/doctors are NOT permitted to join the discussion; the only exception to this rule is if the actual surgeon/doctor or business affiliate is willing to speak directly with the forum community in an interview format - pending Administrative approval (this would be verified by telephone if necessary).

Member \"Dr Oates\" has been green-lighted to post per confirmation of his identity. He has been informed that this forum is not a place for (implicit or explicit) advertising, and that discussions of his procedure or Phalloplasty in general should be from a medical & scientific point of view. More-or-less a Q&A.

I should also point out that transparency is crucial. We once had a \"Doctor\" join these forums but was unwilling to answer the tough questions. As long as a question is reasonable and relevant, Dr. Oates is advised to address all member inquiries (minus repeat questions).

Thanks for everyone\'s patience, and please welcome Dr. Oates to the forum.

Edit: Dr. Oates account is a Commercial Account. This thread can, in effect, serve as both Q&A as well as advertising, at his discretion.

This thread is now unlocked.

Thanks Skeptical One,

The most important discussion I have seen here is Penile Dysmorphic Disorder. Most guys like the idea of a bigger penis. But when it rules your life it is a problem - one that wont be sorted with size increase. All cosmetic patients hate to hear this, but sometimes the answer is psychological treatment not physical.

This is why we often think of injectable Phalloplasty as a locker room procedure. The idea is being a bit bigger and feeling more confident. We find that having the extra volume under the skin circumferentially reduces \"shrinkage\".

HA injection is not the perfect solution - an we may try some of the longer lasting fillers eventually. But safety should be your number 1 concern. If you are unhappy with a normal but small (compared to what you want) imagine how unhappy you will be if you have a major problem. Permanent fillers can give major problems. Unregulated fillers/HA off the internet can cause major problems.

I will be able to come to the forum a couple of times a week to answer questions - so please be patient if it takes a couple of days to get answers.

Hi Dr. Oates, thanks for posting. I see that you referenced and article on Macrolane. What are your thoughts on that, as I know people who are happy with it - but have also heard by members on this board that it is not a good choice. Thanks in advance.

hi dr Oates im from australia  and have had the PMMA cocedure with  dr c and  have had a positive outcome, and very happy with the reults, would u be interested in trying out the permanent PMMA procedure in austraia any time soon, to see for your self  about the outcome of the procedure,

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hunkydory wrote: Hi Dr. Oates, thanks for posting. I see that you referenced and article on Macrolane. What are your thoughts on that, as I know people who are happy with it - but have also heard by members on this board that it is not a good choice. Thanks in advance.

Hunkydory,

Macrolane has never been approved for use in Australia so I don\'t have much personal experience with it. But it did help start me on the journey. I knew someone who had it done for breast augmentation in Singapore. Which interested me that she would have a temporary solution when there is a common surgery with quite good permanent results. She had problems with lumps - which is something which is just not acceptable in the breast (cancer worry). So I had to dissolve it with Hyalase.

Macrolane seems to be getting withdrawn from countries rather than expand - which does not fill me with confidence. The Italian Urologist who published using Macrolane have a Youtube video. It looked like someone who is not a cosmetic injector, not how I would inject. But I imagine that done sympathetically it could give a good result - it is a lumpy HA rather than a smooth consistencey and is made to inject deep. It is produced by a very reputable HA company with plenty of experience. And it comes in 10ml syringes and is a lot cheaper than the 1 ml syringes we have to use in Australia. I would want to see/feel it under the thin skin of the penis before using it myself.

Thank you - I actually felt it under the skin of someone yesterday and it was really smooth and natural - which is why I wanted to know as I have heard so many mixed things about it.
By the way - it is really great to have an expert on this board - thanks again!

polarsurfer wrote: hi dr Oates im from australia  and have had the PMMA cocedure with  dr c and  have had a positive outcome, and very happy with the reults, would u be interested in trying out the permanent PMMA procedure in austraia any time soon, to see for your self  about the outcome of the procedure,

Hi Polarsurfer,

PMMA is not TGA approved in Australia so we dont have the opportunity to use. I generally dont like the idea of permanent fillers anywhere. I take safety over permanency. In the face (where I have 15yrs of injecting experience) my thought was the natural fat pads that are part of your body and held in place drift down over time and we do facelifts to lift them back up. So what is a permanent filler going to do? How easy will they be to lift back up?

I have had to deal with complications of most fillers - fat transfer, silicone, Articol, collagen, Aquamid, Ellanse and even HA. HA is the easiest to deal with because it can be dissolved.

I would be very happy to see someone with PMMA Phalloplasty to understand the result but doubt it would change my mind.

Thanks.

thanks  dr Oates for the reply, im live in perth australia, id be more than happy  to show you the reults in person at your clinic so u can see first hand , i did speak to the reception there a while ago,  about PhalloBoards,

mischiefmkr wrote: Glad that Dr Oates is cleared to answer questions on the site ! Having a professional opinion to dispel myths and deal honestly with the tough questions is great. As members kniw I have had an HA procedure and am happy with the results. Keepimg my fingers crossed it lasts a year and also keep my eyes open for longer lasting HA or other temporary fillers coming into the market. (I had juvederm ultra plus and then voluma)

Good to hear you are happy with HA, so far, Centurian. Look forward to how it lasts for you.
Regards,

polarsurfer wrote: thanks  dr Oates for the reply, im live in perth australia, id be more than happy  to show you the reults in person at your clinic so u can see first hand , i did speak to the reception there a while ago,  about PhalloBoards,

Polarsurfer,

I will send you a PM on my clinic in Subiaco contact details.

Dr. Oates- Thanks for joining in.  Many on  this board have had PMMA for Girth enhancement for their shaft, but PMMA isn\'t successful in the glans (I understand).  As a result a proportional size discrepancy results between the shaft circumference and that of the glans.  The development of Voluma a few years ago (extending longevity) has provided some interest among many PMMA patients.  

Have you focused on glans-only procedures?  When the HA injections increase the glans to the normal Erection size, what happens when the patient then achieves an Erection?  Does the size; continue to increase, not increase as much, or not at all?  Does stretching pain occur?  Thanks,