PhalloBoards - An Online Community to Discuss Penile Girth Enhancement

Welcome, Guest
Username: Password: Remember me
Forgot your password? Forgot your username? Create an account
Forum
PhalloBoards 2.0 Archived Content (Posting Locked & Read-Only)
General Phalloplasty Discussion (2.0 Archive)
HA injectable Phalloplasty - for safety

TOPIC: HA injectable Phalloplasty - for safety

HA injectable Phalloplasty - for safety 8 years 7 months ago #1291912315

  • Androfill
  • Androfill's Avatar
  • Offline
  • General
  • General
  • Androfill www.androfill.com
  • Posts: 142
  • Thank you received: 11

hoddle10 wrote: @ Androfill, has Skeptical One verified your account already?

One of the Androfill surgeons will post a response.

Please Log in or Create an account to join the conversation.

HA injectable Phalloplasty - for safety 8 years 7 months ago #1291916631

Hi Androfil,

Good to hear from you, found your site just recently.

I wonder why you use needles rather than blunt cannula? I just did a patient with 15ml Voluma 2 days ago. Virtually not a mark on him at the end (saw him the next day and he did have very pale bruises). But the main reason is to eliminate (virtually) the risk of occluding a vital structure?

We have gradually moved up to Voluma from thinner HA\'s. What slowed us was that Voluma is the most expensive (we dont have Juvederm 3/4 in Australia). But we have not had any issue with discomfort fro the thicker product, indeed Voluma is more mouldable than Juvederm Ultra Plus (is that your Juvederm 2 or 3 ?).

Please Log in or Create an account to join the conversation.

HA injectable Phalloplasty - for safety 8 years 7 months ago #1291916682

smalljay wrote: Hi Dr. Oates, There are no cases of PMMA Necrosis on the glans (or any members who have reported having PMMA on the glans) here - although my guess is thats exactly what would happen if you injected PMMA there. I believe I know the thread which confused you. \'PMMA for glans enhancement can be done\' - the title of that thread is a misnomer of sorts as the bulk of the thread goes on to discuss Dr. Cho\'s Lipen D procedure (cross linked dextran, not PMMA, but still bad news in the glans). A lot of people were getting Dr Chos Lipen P (PMMA/dextran, for the shaft only) and Lipen D (just dextran) confused because of the title of that thread. I was an actual recipient of chos \'Lipen D\' dextran in the glans and did indeed get Necrosis. Someone please correct me if I\'m wrong about the confusion. I think smartmans original post was actually about some obscure doc offering PMMA for the glans but I don\'t remember any confirmed cases of Necrosis.


Thanks Smalljay,

Yes you are right, it was the Lipen D that I was confusing it with.
That is why we only inject HA fillers - reversible if necesary.

I was just at the Allergan meeting in Sydney. The most fear complication of injectable fillers is blindness. It was thought impossible to treat because we could not get the Hyalase into the central retinal artery (CRA). I had considered injecting it into the carotid artery (not that this has happened to me - just wanting to come up with a plan). But realized that although not difficult to do it wont go to the CRA because there is no blood flow going there due to the filler. Or injecting through the eyeball - but the back of the eye is full of natural HA and would all have to be dissolved before it got near the retina.

There was a recent case of incipient blindness in Australia. They treated it by injecting Hyalase directly into an artery (supraorbital) that has connections with the CRA (exactly what we avoid at all cost when injecting the HA). It flowed/was forced back into the CRA and the vision returned. First time reported.

This is great for us injecting on the face. Sorry if not interesting to Phalloboard members. But remember - there will be complications, it could be you, and you want to be sure there is an acceptable treatment that your doctor can do.

Please Log in or Create an account to join the conversation.

HA injectable Phalloplasty - for safety 8 years 7 months ago #1291916704

hunkydory wrote: Dr. Oates - I have HA now. The first Doctor went way to superficially which feels like an amateur mistake. I walked out with little hard bumps everywhere and was a little in shock - my penis looked ike the surface of a gourd. I have since had more done (not the same doctor) placed more deeply and it looks great. I am very happy with it. However, I still have the evidence of the bad work from the first guy.

In my opinion, the first Doctor went way to superficially which feels like an amateur mistake. (I had a loose skin issue from a prior Dermal Fat Graft Removal which lasted 15 years and died). I think the Doctor placed all the product just under the skin to fill it out, rather than treat me like a regular enlargement procedure. 

(1) How easy is it to dissolve very specific areas that are perhaps a few mm but in multiple locations and not disturb the rest of the work?
(2) will it resolve on its own before it all absorbs back?

Do patients walk out of your office with little bumps everywhere - this guy said it was perfectly normal and all would go away in a month or 2 - I am almost at 2 months (6 weeks out) and it is better but still odd. Everything I have since read says this is not normal and bad procedure.

Thank you in advance - love having you on this board!


Hi Hunkydory,

No we dont expect lumps and bumps. Bit like injecting on the face want it to be as smooth as possible. Some HA products are more \"cohesive\" than others and dont mold to the tissue. At 2 months they are not going away by themselves soon. But if placed more superficial they may disolve away sooner.

It is possible to do Nodule treatments. Best if the person using the Hyalase has done some before (face experience is fine). In Australia Hyalase comes in ampules of 1500 units. I would use 5 - 7.5 to reduce/remove nodules. The first time I used Hyalase for a lump in the tear trough about 75U) it all disappeared and I had to refill the patient the next week. So dont want someone putting in too much!

Please Log in or Create an account to join the conversation.

HA injectable Phalloplasty - for safety 8 years 7 months ago #1291919039

mischiefmkr wrote: i know it seems strange but i am a bit freaked out about the idea of a cannula being used to inject the filler (and i guess, moving around under the skin quite a bit to spread it out) instead of multiple needle injections, which is what i have had done twice with no problems. 

for sure i am influenced by that terrible youtube video of some italian doctor ramming a cannula up and down under the skin of the patients penis like he was trying to clear a stubborn drain blockage !  although i understand that might not be \'standard procedure\'. i sure hope not.

from a cosmetic perspective, is there a benefit of using a cannula over multiple needle injections ?  i never got a single bruise or other problem from the needles, and am happy with the cosmetic result. however if a cannula provides noticeably superior cosmetic results, i would likely get over the concern about how it looked on the one video example i saw, and request it. 



It\'s interesting you should say that, as to be honest, the reason I never contacted Androfill after we exchanged messages, was because of the video you posted. It was scary seeing how Dr Horn was just jabbing and moving with that needle. I showed it to the guy who did my mothers botox and he cringed. I agree the Italian video didn\'t look great either, but I think a good Dr, using a micro cannula is far better than a needle. 

I think for us UK guys, we\'d benefit from someone like Mr Viel offering Voluma with a micro cannula. Basically we need a UK version of Dr Oates.

Please Log in or Create an account to join the conversation.

HA injectable Phalloplasty - for safety 8 years 7 months ago #1291919466

mischiefmkr wrote: i know it seems strange but i am a bit freaked out about the idea of a cannula being used to inject the filler (and i guess, moving around under the skin quite a bit to spread it out) instead of multiple needle injections, which is what i have had done twice with no problems. 

for sure i am influenced by that terrible youtube video of some italian doctor ramming a cannula up and down under the skin of the patients penis like he was trying to clear a stubborn drain blockage !  although i understand that might not be \'standard procedure\'. i sure hope not.

from a cosmetic perspective, is there a benefit of using a cannula over multiple needle injections ?  i never got a single bruise or other problem from the needles, and am happy with the cosmetic result. however if a cannula provides noticeably superior cosmetic results, i would likely get over the concern about how it looked on the one video example i saw, and request it. 


We have the same discussion in the face. Some doctors prefer cannula and some needles. I use both in the face. But the main thing it comes down to is safety. It is a poor cosmetic result to inject into the dorsal penile artery and have it drop off.

The cannula used in the Italian Urologist macrolane injection was large ( 12G which is over 3mm) verses the 22G (0.7mm) cannula we use. Needles are usual 27G( 0.4mm) for Voluma.

Please Log in or Create an account to join the conversation.

HA injectable Phalloplasty - for safety 8 years 7 months ago #1291921859

///

Please Log in or Create an account to join the conversation.

HA injectable Phalloplasty - for safety 8 years 7 months ago #1291921986

mischiefmkr wrote: @hoddle  there is absolutely no comparison between the video of the italian doctor ramming a massive cannula up and down a penis and my own experience of what i had done, which was entirely painless, without any post procedure bruising or complications.

does your mothers botox guy do procedures like deep filling sunken cheeks or he literally just a botox injector ? 


I was put off for different reasons. I wouldn\'t want the Italian method either. 

What scared me about your video was how he kept jabbing in and out with the sharp needle. 

For example, there 10 injections in the first 1.15 of the video. He barely lifts the skin. I\'m just not going to take that risk. Given the choice, wouldn\'t you much prefer one whole and the use of micro cannula? It seems crazy to allow a Dr to make all those injections, with a sharp needle and not even that carefully, when there is a micro cannula technique. 

In total there has to be over 50 injections in that one procedure and sometime the depth is scary to watch. 



The technique Dr Oates uses is infinitely more advisable in my opinion. I think we need to find a Dr in the UK who does or will do it. I\'m sure the Viels would be receptive, though I remember someone asked them about HA a while ago and they said they preferred fat. 

Please Log in or Create an account to join the conversation.

HA injectable Phalloplasty - for safety 8 years 7 months ago #1291924726

  • Androfill
  • Androfill's Avatar
  • Offline
  • General
  • General
  • Androfill www.androfill.com
  • Posts: 142
  • Thank you received: 11
Dr Oates - replied via private message.

Dr H. didn\'t use a cannula in the case of Mischeifmkr, but he can do so next time if Mmkr prefers, and perhaps film it for comparison.

Please Log in or Create an account to join the conversation.

HA injectable Phalloplasty - for safety 8 years 7 months ago #1291925527

mischiefmkr wrote: i know it seems strange but i am a bit freaked out about the idea of a cannula being used to inject the filler (and i guess, moving around under the skin quite a bit to spread it out) instead of multiple needle injections, which is what i have had done twice with no problems. 

for sure i am influenced by that terrible youtube video of some italian doctor ramming a cannula up and down under the skin of the patients penis like he was trying to clear a stubborn drain blockage !  although i understand that might not be \'standard procedure\'. i sure hope not.

from a cosmetic perspective, is there a benefit of using a cannula over multiple needle injections ?  i never got a single bruise or other problem from the needles, and am happy with the cosmetic result. however if a cannula provides noticeably superior cosmetic results, i would likely get over the concern about how it looked on the one video example i saw, and request it. 



With the cannula you have only one point of entry. When the cannula travels inside you don\'t feel anything, I personaly didn\'t get any numbing cream amd didn\'t feel anything at all. Using a cannula will prevent the doctor to hit a blood vessel of a nerve. There are no advantage of using a needle, it can only leads to complications.

When you get HA injections, the mirco cannula used is small and very thin. Usually two hours after the injection you don\'t see the point of entry anymore.

Please Log in or Create an account to join the conversation.

HA injectable Phalloplasty - for safety 8 years 7 months ago #1291925732

  • 's Avatar
  • Visitor
  • Visitor
MM - after having experienced both a needle and a cannula - there is no comparison. With the cannula you can also pull out slowly and keep injecting the HA as it is much longer, leaving a more uniform mass, unlike a needle where you leave little blobs everywhere that don\'t really blend (in my case).

Also you can go much deeper toward the shaft where you would never want a needle for risk of damage, but is a much better aesthetic. I think a 13 gauge cannula would be very scary - I did not see the video, I think you said it was for Macrolane - but almost all HA can be delivered with a 27 - 25 gauge micro-cannulas.

Having both experiences I can\'t believe I let Mirza near my Dick with his needle and crappy technique. Live and learn, I would still like to have HA administered correctly as I have seen 2 really good jobs so far that I would be happy with (one by Mirza ironically). I just can\'t afford to fly to Australia Dr. Oates or I would be there.

Dr. Oates I would like to send you a picture via PM for your professional opinion if that is OK - feel free to post the answer on here if that adds to the discussion.

Please Log in or Create an account to join the conversation.

HA injectable Phalloplasty - for safety 8 years 7 months ago #1291929219

Below is a PM that Hunkdory has allowed me to post in case it is useful.

hunkydoryDear Dr. Oates, if you have time to look at this and give me your professional opinion I would be greatly appreciative.

I had a Dermal Fat graft that went fibrotic after 15 years and had it removed a year ago.

After leaving the Dr.\'s office for HA because of left over loose skin from my surgery, my penis looked like it did in the first image ( not using publically) - I was in shock but he told me this was perfectly normal and would smooth out. I went 3\'xs more as the only way I could make sense of this was to add more and \"connect the bumps\"

Dr. Mirza used a needle not a cannula. It has gotten better but when I get an Erection it looks like a wavy mess which makes me not want to have sex. 1)   Do I need to get this dissolved and start over?

2) Would adding more with a proper Dr. and good technique fix this. I spent $5,000 to do this which was what I had saved to fix my penis after the fat graft. I would love to salvage this.  

3) Is the issue that he did not go deep enough toward the shaft? - or that I had a loose skin issue from a prior surgery?

Someone told me it looked like he did this way to shallowly, just under the skin and that is bad technique - (it is a mixture of Juvederm, Restylane and Belotero - he could not figure out what was best for me)

Thank you so much, I really appreciate your time on this board.
 Me -Sorry you are having so much problem. Problems are why it has taken me so long to really get up and commercial with this - about 5 yrs.

So the first picture is after injecting HA (lots of lumps from each individual injection)? That is why i dont use a short needle. We tried long (70 - 90mm) needles but too much bruising risk and the risk of going too deep.

Also possibly using a HA with too much \"cohesivity\". We want a HA with the longest duration, to be firm but also moldable on initial injection. After 4 week good tissue integration has been shown with Voluma injected in thin threads.

It could be, with a needle and multiple punctures trying to be safe it is done too superfical. There is the mobile layer between the Dartos fascia and Bucks fascia. That is where we go with the cannula. But if there are lumps more superficial then they would still be visible over the top.

Using very low dose Hyalase (5 - 10U/ injection max) could reduce/eliminate the bumps hopefully with losing all the gains.

Remember HA is temporary (how long has it been?). Some brand/versions moreso than others. I have wondered if I would get patients wanting ridges/ lumps along the top for partner stimulation. But not yet.

Do you mind if I post this, minus your name? (agreed to)

Please Log in or Create an account to join the conversation.

HA injectable Phalloplasty - for safety 8 years 7 months ago #1291932217

Hi Dr. Oates,

Thanks for contributing here.

I have had a complicated case. I had Peyronie\'s disease which decreased the size of my penis about 30%.  I had two rounds of PMMA which went fine.  The third round was a disaster, and I had (and still have) rock hard lumps all over my penis.  Do you know why something like that would have happened?

I had some of the lumps excised, but the excisions wouldn\'t close - and I had to go to a reconstructive Urologist to close them by excising a lot of of skin (1 square Inch - which is a lot considering I am 5.5-6\" Erect).  This left the penis looking even more strange, in a way, since it exaggerated other lumps by pulling the skin very tightly around them.

I tried to fix this in November by camouflaging the abnormalities with Radiesse.  I only used 1.5 cc.  It is now April, and I am nearly back to where I started.   Do you think HA can help me, and if so - what kind of cost am I looking at?  $1500 / year? Thank you.


Left - after all excisions, still with numerous lumps
Middle - after Radiesse 1.5 cc 
right - 6 months after Radiesse

Please Log in or Create an account to join the conversation.

HA injectable Phalloplasty - for safety 8 years 7 months ago #1291936408

Hi Restoration,

Sorry to hear of your problems. Now, as you say, a complicated case.

PMMA is tiny Balls of plastic in a carrier for injection (as you know). The carrier breaks down leaving the plastic Balls which stimulate a foreign body reaction causing collagen/scar tissue production. Why some guys get nice smooth results and some lumps is not entirely clear. Some people get granulomatous (excessive tissue reaction) to injectables - that goes for all fillers even HA.

The problem with injecting HA now is the risk of starting up problems - especially infection. As you have already experienced, healing after excision is an issue with granulomas. This is also why all injectable manufactures recommend against using their product where a different companies product (especially permanent) has been injected.

So could HA help to even out the lumps and bumps on your shaft? Yes it could. Is there a risk it could start up a problem with the PMMA, yes it could. That could be worse than just having lumps. We could add in extra precautions such as antibiotic cover and even more sterile ds while doing the procedure - but some risk remains. The clever thing for me is to say no - and not risk my reputation.

But lets keep talking. I hate to tell people \"you are stuck with your problem - I don\'t want to risk it\". But want you to understand the risks are there.

Please Log in or Create an account to join the conversation.

HA injectable Phalloplasty - for safety 8 years 7 months ago #1291940270

Thanks Dr. Oates.  If it is done with sterile technique (as opposed to the usual \"clean technique\" with injectables in the face) do you think that would help? I am talking about a chlorohexidine w/ alcohol wash.  Is there something else that contributes to the risk of infection, if not for the skin surface and cannula / needle impregnating the PMMA tissue with bacteria?  I know this is always a risk when injecting filler around a facial implant, but PMMA has caused a tremendous amount of scar tissue to form, rather than just sitting there as an inert implant with limited immune cell access.  This scar tissue is full of lymphocytes (histocytes, multinucleated giant cells) - so I wondered if that would actually make it more difficult to get an infection, given their presence.  I posted my pathology slide before here.  Even though I had those open wounds, they were never infected - oddly enough.  Perhaps if the session was limited to <1 hr and just 1-2 entry points (with a long cannula) that could cut down on the risk of infection as well?

Infection issues aside, the penis is so complicated that I wonder if I am just going to be chasing my tail to try to put 1 cc here and 1cc there and then 2 months later it\'ll be gone or have shifted.  I still am having a hard time understanding  how non-particulate HA is placed Flaccid, when the penis (at least in my case) is drastically different Erect.  (This is why I used Radiesse at the time - though I suppose the CMC had a long duration as well and now I just am seeing now actual growth from the calcium particles).   Anyway, it seems like HA would move around a lot and suffer from an accordion effect as the penis changes from Erect to Flaccid.  And, if I am trying to camouflage PMMA nodules, I might just be playing darts with a moving dartboard.  Having no HA experience, it\'s just something I\'ve wondered.  I really liked my penis after the Radiesse, but unfortunately that was short lived. 

Thanks again.

Please Log in or Create an account to join the conversation.
Forum
PhalloBoards 2.0 Archived Content (Posting Locked & Read-Only)
General Phalloplasty Discussion (2.0 Archive)
HA injectable Phalloplasty - for safety

Main Menu