TOPIC: Restylane or Juvederm Voluma?

Each company advises against mixing fillers, especially different classes of filler ie HA with stimulatory filler like Radiesse. But with HA\'s it is pretty common practice and there is not much of a reason to not do it.

Thanks for your feedback Dr. Oates.

I am still in the conflict of not knowing if I should proceed with 10cc\'s of Restylane (Resyland Lyft) for $2200. It is the only thing the doctor here on the east coast provides. I don\'t know if I should continue with this option or travel for Juvederm.

We do inject under the circ scar. But it does have higher risk for looking slightly lumpy, especially if not massaged. So using a slightly less cohesive and softer filler like plain Juve or Volift (another made by the Juvederm group but slightly softer) may be the best answer towards the glans.

I\'m pretty confident that you\'ve found a good solution with Voluma, Dr. Oates, through clinical experience. My only concern is the circ scar area, which you\'ve already said you don\'t even inject anyway. I think perhaps belotero could work well there, though it wears off quickly.

Hi Everyone,

My brain is starting to hurt already.

I would say that 90%+ of doctors injecting dont understand the ins and outs of rheology (science of fluids)for fillers. When I started there was none. And I still only have a basic functional grasp.

There are lots of factors that interact and overlap. Sometimes what you think might be the most important then turns out not to be. And each company then only reports certain elements of their products and if they do a comparison they only publish things that show their product in a good light and if their product does not do well in that test it goes to the bottom draw. No one ever comes to me and says \"look my product is not that great, we skimp on the safety/production values and we want to charge you a fortune for it!\"

(I got caught up and not finished this post for a few days....)

The article posted is useful but limited and a bit old.

Restylane/Perlane are the type of filler where the gel is cut up by the sieves into little bricks and made to be injectable by having some uncrosslinked HA. The Juvederm range are all \'monophasic\' smooth gels. These seem to have \'won\' and even the maker of Restylane has come out with a smooth gel too - Emerval.

I really dont know what is best. I am about to start work with a Phd researcher and try and get some published papers on the Calibre procedure. Then maybe we can get some industry support for more trials. I think this is a huge new area for the filler manufacturers - doubling the % of the population who have fillers (ie adding men) and them having 2 - 5/ as much per year. They should be lining up!

Yeah, I know that - but the point I was making is that people didn\'t seem that thrilled with temporary filler prices. I think the poll votes had more to do with the prices than the fact it\'s CaHa. If I changed that poll to Voluma, the prices would go up even higher for temporary results.

Radiesse might even be better in the penis since it causes an immunostimulatory reaction like PMMA, which makes it feel more integrated and natural than HA which just sits there and may not feel like it fits in to the existing tissue.

Radiesse (Calcium hydroxyapatite) is not a Hyaluronic Acid type filler like Restylane and Juvederm are.

I posed a question in the poll section a while ago about doing radiesse augmentation but not too many people replied. I used the real prices of the product and what I estimated you\'d gain from those prices. Some people would do it I guess... but it\'s a small poll and on a PE website. In the general population, I think what dirk digler said is what I agree with...who can afford it after everything else? It\'s a luxury like plastic surgery - and it\'s far easier for the filler manufacturers just to let people do it off-label. phalloboards.websitetoolbox.com/poll/pol...d=28192&forum=198401

The counterfeit fillers you see are no different than the counterfeit viagra or designer watches or purses. People in the counterfeit business know what they are doing. Their servers are well hidden (think Pirate Bay) and making a box look like it\'s the real restylane isn\'t that hard. The stuff inside is probably sterile too, but is it restylane? No. It might even be HA of lower quality, not cross-linked, or who knows. I\'ve just been told by people at Merz AND Allergan that there is no second hand distribution anywhere in the world. Allergan (Juvederm manufacturer) is so nuts that they wouldn\'t even talk to me until I had an account set up and was verified to work in an MD\'s office (which I don\'t - but my friend just set up the account for me). So, how is their product going to get out there so easily? They won\'t ship anywhere but an MD\'s office, and neither will Merz (Radiesse mfr)

So I read that article aleksk... I don\'t know what to make of it. It\'s like they took 8 pages to say that thicker fillers with a higher g\' are harder to inject...and likely slower to break down. Did I miss anything else useful in there?

They appear to be in Australia, NZ and ZA.

If it was based in China I would totally believe But it seems that someone would go after them (legally) especially if they are operating in countries that have trade laws. They are showing photos of a Juvederm boxed on their pages.

Not to say that the internet is not fake, but seems like a lawsuit waiting to happen.

Regardless of the actual cost now, I do believe it has to come down for HA to be mainstream, no different than the bottleneck (cost) of Li-ion batteries for Electric vehicles.

Most people don\'t have enough money to enlarge their penis, At least looking at the median income in the USA, and assuming it will cost 6,000 usd/yr to maintain the HA. That\'s too much for most people, so that\'s a huge number of male clients priced out of the market.

Add HA to car payments, mortgage, kids, Heath insurance etc. There\'s not enough money left.

But I\'m also assuming some Dr\'s have the vision to \"go big\" doing tens of thousands of patients/yr. which is possible if it only takes 30-1hr of time. 1 doctor could easily do 5,000 patients in a year assuming 3 per day and six weeks off a year. LOL.

If the costs can do down it will be just as profitable just a lot more revenue. There\'s operating cost in all legitimate businesses so I don\'t think that\'s the main factor. Manufacturing is brutal where capital equipment cost are extreme but they are mandatory and where a 20% profit margin would be considered stellar.

HA injections are profitable, but the cost needs to go down to get the number of patients up.

Restylane, Juvederm and Radiesse are not sold through any channels other than directly from the manufacturer. What is on that site (or ANY website) is 100% counterfeit. It doesn\'t matter what country it is in. These products are not \"sold at a discount to other countries\" as people seem to think. Trust me, after what I went through wtith Linnea safe, I have been EXTREMELY careful with how I will get HA fillers.

it\'s pretty darn expensive to run an practice, all the insurance, employee\'s, rent and we just priced out a new laser at $180,000.00OUCH!!!

Useful post.

I noticed in Dr Oates post he said he has to do a 100% markup to be profitable so that\'s where the expense comes in.

I\'m thinking it\'s cheaper ,or at least I want to believe that because it means offices will eventually reduce the price as they can get their # of patients up. Then HA would become a reasonable solution long term.


Check this out, it\'s only 1 reference but $359 for qty (1-5) 2ml

www.medicadepot.com/juvederm-voluma-with-lidocaine.html

I still haven\'t read it just yet - and am curious to do it - so I will soon. But, I wanted to comment on the lack of penile fillers.

The current prices for 1cc of a filler are between 300-450, and that is the rate paid to the manufacturer. The penis isn\'t going to show any appreciable difference until you get up to 15cc. On top of that there is the doctor\'s fee.

Clinical trials in the penis will cost tens of millions of dollars, and that would keep the price of the filler too high to make the cost of the trial worth it - particularly since no fillers don\'t last more than 2 years if they are HA. So, if I were Allergan or the company who makes Voluma, I wouldn\'t invest my money there. There might me a small revenue stream, but would it pay off the cost of the trials? It\'s unlikely, I think. Also, doctors still can inject this stuff off-label without a multi million dollar trial (like Dr. Oates), so they are probably hoping that people just publish papers (like that korean one with Restylane) and docs will just inject off label as it gains more acceptance. They have no real motivation to do anything which is unfortunate.

Anyway, that being said - I still think HA has promise, especially in my case so I am trying to find out if I can get maybe 4-5 cc of voluma or another HA to just even out the mess that I have going on... but I don\'t know what the right filler would be - and 4ccs is like 1800 or something like that.

Good post aleksk... a lot of interesting variables to discuss. The article you requested is here.

docdro.id/IMBs0fO

I am gonna read it a little later. It looks interesting. Dr. Oates and a few others seem to like voluma the best for the penis, and this does last the longest for sure (2 years roughly) whereas belotero and restylane may only last year at best (belotero is even shorter sometimes, as it is very thin and often placed right in the dermis, not below). I remember Dr. Oates saying something about the thickness of voluma being a good thing for the penis... i forgot the context now. I\'ll have to find it.