TOPIC: Restylane or Juvederm Voluma?

Aleksk, for your first time using Ellanse, why would you use the 3 or 4 year version? Why not use the short version and a relatively conservative amount, and just as a trial to see how you like it? Doing it in that fashion would mitigate some of your stated concerns, while being a pioneer, in a filler that you clearly believe is superior than others.

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Here\'s an interesting interview about ellanse and sculptra. Ellanse doesn\'t appear to be available in the USA, but it seems to be a better idea than juvederm - potentially. I don\'t really know if it can go wrong like PMMA with the lumps and things like that. I haven\'t heard much about it before. Sculptra went horribly wrong in a huge percentage of patients... they had to create a new dilution ratio - and it\'s not as bad now, but it is still a risky filler that is a pain in the ass and very expensive. Does it work like sculptra?

wrinkledoctor.co.uk/uploads/62-64AMOCT14EllancevSculptra.pdf

Thank you aleksk. You really bring a lot of valuable information to the board. When is your appointment with Dr. Oates. I hope you will keep us informed.

There are some negative reviews of Ellanse on RealSelf. There seem to be issues with swelling that are common. I don\'t really understand why many web pages say it is approved in the USA, but it\'s really not. That\'s odd. Considering it is another immunostimulatory filler, it\'s in the Radiesse and PMMA category - so I am not that excited about it. Also, if it accidentally blocks a blood vessel, you can\'t reverse it with Hydase.

Actually - a very reasonable assessment.

Dr Oates wrote: Actually - a very reasonable assessment.

Can you say anything about HA and Erection quality? That is, does it feel as hard / natural? To me that would be the most important thing. Also does the Girth gain increase or decrease relative to Flaccid Girth gain?

After reading the Korean study and Girth durability at 18 months I\'ve been considering this as a safe compromise over PMMA at least for the time being.

Thanks,
LL

To Aleksk: I\'m hoping to understand your patient matrix/breakdown a little better. For Ellanse you say to be prepared for complications. Is this just due to the lack of reports/data or is there something specific about this filler which can potentially cause complications? You also list PMMA as an option for those who are okay with high risk, so is the presupposed upside of PMMA longevity+cost or is there product performance advantages (look,feel, size etc) as well?

To Dr Oates: I\'d like to hear your input on Ellanse since you agreed with Aleksk\'s assessment and also since you have injected patients with it. Do you have any follow up data with your patients and/or reasons to believe this filler may be problematic or is it just that nobody knows right now?

I\'m also very interested to hear comments for the post above as HA firmness questions seem to be the least defined/described attribute for the procedure or at least at this point in time. Ive read that it\'s a \"little\" firmer that FFT or that it doesn\'t \"really\" move around that much. I would personally be more confident making a decision for HA if the look and feel questions were addressed with more detail so I can picture what it will be like before forehand.

So I just accessed the full text of the study done with HA injections.

Among the limitations and debates of PGE, the long-term satisfaction is very important. Both patient's and partner's satisfaction were assessed using five Grades (Gr 0, very dissatisfied; Gr 1, moderately dissatisfied; Gr 2, about equally satisfied and dissatisfied; Gr 3, moderately satisfied; Gr 4, very satisfied) at 18 months. All couples were satisfied until 18 months in this study. Patient's satisfaction score was 3.71 ' 0.46 at 1 month and 3.34 ' 0.53 at 18 months. In terms of percentage, 29.3 % scored 3 and 70.7 % scored 4 at 1 month and 61 % scored 3 and 36.6 % scored 4 at 18 months. Partner's satisfaction score was 3.65 ' 0.48 at 1 month and 3.38 ' 0.49 at 18 months. The relatively low satisfaction rate of both patients and partners was not from the size because the visual grade was not changed significantly. The low satisfaction rate was partly from lack of total rigidity because the outer enhanced Girth is softer than the hard corpus cavernosum in an erected status.

Not sure what they mean by \"relatively low\", since a score of 3 indicates \"moderately satisfied\", but the part about lack of total rigidity is my main concern and why I\'d like to hear more from people who\'ve had it and can give their subjective opinion.

LL

OK, I see what they meant--the satisfaction rate was 4 for the size retention at 6 and 18 months, the total satisfaction of patients and partners being less (3.x) was due to the lack of total rigidity. Also they say in the summary:

Considering the property of the materials, methods, and follow-up results of 18 months, PGE by injection of filler is not the best procedure, but its advantages over other techniques are less invasiveness, tolerable efficacy, and safety with rare complications from the proven properties of HA gels. PGE with filler can be done easily with a little experience and might be the better option until future development of an ideal technique. Proper patient selection and lack of total rigidity with corpus cavernosum are the limitations of this technique.

So to answer my question (should I do this) I\'d need to sleep with at least a few women with my rock hard 4.6 EG then the same women with my \"not totally rigid\" 5.3 EG! Only guys who have had it done can give us a clue.

Cheers,
LL

To Dr Oates: I\'d like to hear your input on Ellanse since you agreed with Aleksk\'s assessment and also since you have injected patients with it. Do you have any follow up data with your patients and/or reasons to believe this filler may be problematic or is it just that nobody knows right now?

The one patient, so far, with Ellanse is very happy. He had a lot of swelling with HA and says to him Ellanse feels more like normal.

I have 1 patient with Ellanse in her face with granulomas....

I\'m also very interested to hear comments for the post above as HA firmness questions seem to be the least defined/described attribute for the procedure or at least at this point in time. Ive read that it\'s a \"little\" firmer that FFT or that it doesn\'t \"really\" move around that much. I would personally be more confident making a decision for HA if the look and feel questions were addressed with more detail so I can picture what it will be like before forehand.[/QUOTE]

With all the guys we have done with HA, no one has complained about the feel of HA with an Erection, it is pretty much normal. HA gets tissue ingrowth and is not mobile so you can just push it anywhere you want at any time. When it first goes in with some swelling there is a little mobility.

aleksk wrote:
Thanks for posting that. That\'s really something to worry about.

I wonder though which HA filler they used. They are really not all equal. We discussed here before that the firmness may be correlated with the viscosity which varies a lot from one filler to another. Did the study use Macrolane by any chance? It used to be (and still remains) a popular HA filler for any body enhancement because of its price. Does the study say which filler they used? How many men were there in their sample?

That\'s a good point. I\'ll try to find the thread where that was discussed.

In answer to your question:

The authors performed PGE with HA gel in 41 patients (mean age, 42.5 years; range, 27'61 years), who were dissatisfied with their small penis and followed the efficacy and satisfaction until 18 months, and reported the results in 2011. Mean injected volume of Restylane Sub-Q' was 20.56 cc (18'22).

The results were rated by the 41 men and their partners.

Dr Oates wrote: With all the guys we have done with HA, no one has complained about the feel of HA with an Erection, it is pretty much normal.

I think I recall you saying in another thread that it is often difficult to follow up with some patients because they don\'t wish to be contacted. Can you give us an estimate on the number of patients you\'ve had positive feedback from on the Erection quality? There was at least some negative feedback from the korean study of 40 something patients including partners--any chance it may have something to do with Restylane sub-q vs juvederm in your opinion?

Thanks,
LL

Dr Oates wrote:
To Dr Oates: I\'d like to hear your input on Ellanse since you agreed with Aleksk\'s assessment and also since you have injected patients with it. Do you have any follow up data with your patients and/or reasons to believe this filler may be problematic or is it just that nobody knows right now?

The one patient, so far, with Ellanse is very happy. He had a lot of swelling with HA and says to him Ellanse feels more like normal.

I have 1 patient with Ellanse in her face with granulomas....

I\'m also very interested to hear comments for the post above as HA firmness questions seem to be the least defined/described attribute for the procedure or at least at this point in time. Ive read that it\'s a \"little\" firmer that FFT or that it doesn\'t \"really\" move around that much. I would personally be more confident making a decision for HA if the look and feel questions were addressed with more detail so I can picture what it will be like before forehand.

With all the guys we have done with HA, no one has complained about the feel of HA with an Erection, it is pretty much normal. HA gets tissue ingrowth and is not mobile so you can just push it anywhere you want at any time. When it first goes in with some swelling there is a little mobility.[/QUOTE]

In my experience HA wasn\'t firmer than FFT.

The trouble is finding any sort of consensus will be hard. I\'ve seen 4 HA procedure results. All looked good, but 2 felt noticeably soft, one was less firm than ideal and the other almost undetectable. I\'ve noticed a similar phenomenon with FFT, where some people say it feels completely natural, whilst others who go to the same Dr, say its feels soft and weird.

Ultimately I think so much has to do with individual anatomy. Things like skin compliancy and even the thickness of the dartos layer must have an effect. With the guy I mentioned, who had a great result with HA, as it was being injected, it seemed to literally melt into his tissue. It looked and felt totally natural straight away. I think there are just so many variables that outside of the Dr\'s hands and therefore getting consistent results with HA might prove tricky.

I think, despite their drawbacks, Ellanse and Radiesse will ultimately prove better options for temporary enhancement. Of all the different things I\'ve had in my penis over the years, I\'ve got to say, scar tissue is the best filler by far!

I\'ll beta test and report data for Ellanse if someone else pays for it Lol.

Catching up here thanks for the replies to the questions I posed Thank you to Dr Oates as well.

Aleksk, certainly don\'t go out of your way to give information to people if you don\'t feel its reciprocal but I do sincerely appreciate the info you bring... Ive been following your posts and I missed the section on the guy down in Mexico that used to do Ellanse. I\'ve done research on Ellanse but not searching specifically for PE injections but I will certainly keep looking and will share anything new that can be useful.

I am also very intrigued by this product but I don\'t yet understand if its a filler you can \"top off\" over time so to speak or if you only get 1-2 shots at it and then you have to wait. If the first, what do you guys think of doing a small amount say 5ml, do an assessment after 4-8 weeks then go from there?

Hoddle, your assessment of HA was exactly what I originally thought/was concerned about when trying to understand the firmness level. My skin is very thin and flexible, so I\'m not sure if that\'s a bonus or a liability. Ive read both so I\'m confused... For example skin too loose can lead to clumping/migration but skin too tight then it cant be injected evenly? (Not sure)

Despite skin types It seems that the results should be feasible to characterize in which (assuming) there just inst enough sample data yet. Certainly different skin types but I imagine groups/patterns would develop when 200+ patients are evaluated