TOPIC: PMMA or Ellanse?

think wrote: As a guy who knows a hell of a lot more than us, I\'m just saying that his warning of caution is worth considering, and I gave a damn good reason why Ellanse mitigates this concern to a significant degree (4 years vs the rest of your life). You can talk around that all you like, but you\'re saying the same thing over and over, and there\'s not much point in restating what we already know and don\'t know.I\'m done wasting further effort discussing this. People have the information and can make up their own minds. But as valuable as this forum is, and I do not underestimate the value of the personal accounts here, everyone needs to make damn sure to have a lengthy in-depth discussion with whoever is doing any of these procedures on you. Check their credentials and background, and in particular their detailed knowledge about all related medical research that has been done, how to interpret it, how to extend it to other circumstances, and how to treat any adverse effects that you encounter. It\'s much easier to have someone a short flight away to deal with problems than it is to fly around the world, or find someone else to deal with any issues. Just keep that in mind, as there is definitely risk with either option. Use your heads, and think it through. And good luck!

It wasn\'t a waste. You raised some valid points and I\'m sure lots of guys reading the discussion will have learned things they were previously unaware of.

biggy wrote: Alter isn\'t making a prediction, he\'s just warning caution. He\'s not presenting evidence etc. He\'s just saying what anyone would in his place.

As a guy who knows a hell of a lot more than us, I\'m just saying that his warning of caution is worth considering, and I gave a damn good reason why Ellanse mitigates this concern to a significant degree (4 years vs the rest of your life). You can talk around that all you like, but you\'re saying the same thing over and over, and there\'s not much point in restating what we already know and don\'t know.I\'m done wasting further effort discussing this. People have the information and can make up their own minds. But as valuable as this forum is, and I do not underestimate the value of the personal accounts here, everyone needs to make damn sure to have a lengthy in-depth discussion with whoever is doing any of these procedures on you. Check their credentials and background, and in particular their detailed knowledge about all related medical research that has been done, how to interpret it, how to extend it to other circumstances, and how to treat any adverse effects that you encounter. It\'s much easier to have someone a short flight away to deal with problems than it is to fly around the world, or find someone else to deal with any issues. Just keep that in mind, as there is definitely risk with either option. Use your heads, and think it through. And good luck!

think wrote: The second quote above has nothing to do with the first. The concern he notes is about the possibility of issues decades down the road. Yeah, we have a lot of PMMA data, but nothing that long term. And even in the PMMA study there were a lot of non-responders, which is another concern he notes. So limiting the timeframe of that concern to 4 years huge benefit for Ellanse, IMO.
Teenagers absolutely should not do PMMA. But if you care about having a functioning penis 10, 20 or 30 years down the road, then that same logic advise applies to you. Wade told me they had guys in their 60s and even 70s having PMMA... so think long term guys

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Alter isn\'t making a prediction, he\'s just warning caution. He\'s not presenting evidence etc. He\'s just saying what anyone would in his place.

If we stick to what we know, then the advantages of Ellanse over PMMA and minimal to none and some cases will be negative. I\'m not trying to tell you not to get Ellanse, but just pointing out that idea that it\'s safer, in real terms, probably isn\'t true.

We were told by Nacul, the creator of Bioplasty, that when injected correctly and into the deeper layer and not the dermis, PMMA doesn\'t cause FBG. This seemed like a very controversial claim in 2011. The studies of the \"cleaner\" US PMMA products, injected in tiny volumes, suggested about 2% of patients get FBG. The less clean Artecol, which was comparable to the Brazilian products used in the penis, looked to have a far higher incidence, as much as 10 times, of FBG. So if Nacul\'s claim wasn\'t true, given the vast volume injected into the penis, we should have seen a large number of FBG over the last 7 years.

However, we\'ve seen potentially 2. One of those was treated immediately with surgery, none of the advised treatments occurred. The other interestingly showed that a biofilm was present. Keep in mind the one study there is on volume filling with PMMA in the penis, has over 200 patients, followed over 7 years and none reported a FBG. When Miracle had his issue with S1000, his Dr said the PMMA was invisible to the immune system.

So everything we\'ve seen, both on this forum and in the one published study, suggests that when inject correctly, not into the skin (where there are far more immune cells) PMMA doesn\'t seem to cause FBG\'s at anywhere near the rate it would when injected into the skin. But we do know that reactions do happen (Restoration) and we know it\'s speculated that late onset reactions are due to biofilm infections. The one definite case we\'ve seen showed a biofilm present.

So with that in mind, over the course of the first 4 years, there is no reason at all to think PMMA is anymore likely to react than Ellanse. We also know that most reactions will rear their head in the first year anyway. Technically it\'s possible they could happen later, but most likely earlier.

I totally understand your point that once the Ellanse is gone one doesn\'t have to worry about late onset reactions. However, in reality, is it not likely that anyone who gets Ellanse in the next couple of years is going to go back and get it again? So you once again risk introducing infection. We know the chances of this are very small, but we also know that\'s true of PMMA. But all things being equal (ie 1 round per filler), the Ellanse patients and twice as likely to see an infection get in.

So I completely understand your logic and if everyone was only going to have one round on either filler, then I think you are right, Ellanse is safer, but by the tiniest of margins, based on the premise it\'s technically possible a FBG could be triggered later on, though we\'ve never seen it. However, in a more likely situation, where the patient wants to maintain his Ellance enhancement, it\'s probably not as safe as having PMMA would have been.

There is of course a much safer option, which is HA. But the idea that Ellanse has great advantages over PMMA, really isn\'t true in most cases. I\'m really not trying to tell people not to get Ellanse and go for PMMA instead. I\'m just trying to point out the idea of Ellanse being safer because it\'s temporary is a bit misguided and it really should be ranked alongside PMMA, not HA, in terms of safety.

biggy wrote: Dr Alter didn\'t say anything we didn\'t already know or worry about.
[...]
In short I don\'t think we\'ve ever encountered an issue with PMMA, that required a dramatic intervention, that came after the life span of Ellanse products.

The second quote above has nothing to do with the first. The concern he notes is about the possibility of issues decades down the road. Yeah, we have a lot of PMMA data, but nothing that long term. And even in the PMMA study there were a lot of non-responders, which is another concern he notes. So limiting the timeframe of that concern to 4 years huge benefit for Ellanse, IMO.

biggy wrote: But I totally understand your point about hoping something better comes along in the future and therefore you like the fact Ellanse lasts only 4 years. Also Reklaw does make the point that for teenagers and younger men, a stop gap option may suit them. But I think there is little chance of anything in the next 10 or so.

Teenagers absolutely should not do PMMA. But if you care about having a functioning penis 10, 20 or 30 years down the road, then that same logic advise applies to you. Wade told me they had guys in their 60s and even 70s having PMMA... so think long term guys[/QUOTE]

think wrote: See Dr. Alter\'s comment that I referenced. The benefit of Ellanse regarding that particular concern is that it will be gone in 4 years time. I follow your logic with complications arising in the first year, but I don\'t see why you can\'t see the benefit of Ellanse in that regard.

And I read 3 of the 4 papers that you listed on biofilms. That applies to all fillers, and is not a reason to opt for PMMA over Ellanse. Also, it\'s not like you only have the Ellanse clinical studies to go by, as PCL has a 40 year history of safety in biomedical applications and FDA approval. I\'m sure that physicians like Dr. Oats and Dr. Morganstern, who are concerned with safety, took that into account before they started offering it. The credentials from Morganstern\'s practice include a chief Urologist at a leading teaching university. They tend to know how to do medical research.

Dr Alter didn\'t say anything we didn\'t already know or worry about. He wasn\'t revealing anything, just cautioning. I was just saying that in studies done on fillers, the majority of complications are reported in years 1-5 and not beyond. Most complications occur in the first year. That\'s also what we\'ve observed from PhalloBoards over the last 7 years. So the point I was making is that we don\'t actually have any real evidence of late onset complications of PMMA in large volumes, beyond one year. Where this get interesting is that it\'s postulated that fillers are far less likely to react when injected under the dermis, than actually into it, due to far fewer immune cells. This probably explains why we\'e seen so few complications.

The relevance of the biofilm studies isn\'t to compare PMMA and Ellanse directly, but to highlight the school of thought that these late reactions are due to biofilm infections. If you have a biofilm infection they can be impossible to treat. The advantage of HA is that you can dissolve the filler and then treat the infection. You can\'t do that with either Ellanse or PMMA. You can\'t just leave the infection either, so intervention is required, hence the \"advantage\" Ellanse being temporary is negated. Now I totally understand your point that with Ellanse you only have to worry about this for 4 years, but after that time, most people are still likely to want a bigger penis and will have to have it filled again. It\'s hugely unlikely that something that offers the same benefits as PMMA or Ellanse is going to come along in the next 10 years. On top of that, late onset of granulomas reaction from PMMA, in the penis, seems to be totally absent in the literature and from all the cases we have here. In short I don\'t think we\'ve ever encountered an issue with PMMA, that required a dramatic intervention, that came after the life span of Ellanse products.

But I totally understand your point about hoping something better comes along in the future and therefore you like the fact Ellanse lasts only 4 years. Also Reklaw does make the point that for teenagers and younger men, a stop gap option may suit them. But I think there is little chance of anything in the next 10 or so.

Ultimately, if these late onset reactions are caused by biofilms that get in at the time of injection, any non reversible procedure that requires redoing every few years, is probably more risky than a one off permanent procedure (i know people keep going back for more and more but that\'s a choice), unless you only do it once and then decide you don\'t want it again.

biggy wrote: We\'ve got 2 forums full of progress reports. NAme me one member who has reported a serious issue that required a serious intervention that occurred over a year after the procedure? If you can\'t, then explain the advantage of having Ellanse if you have a serious issue within the first year? If you can\'t do that, then explain why on earth the advantage of Ellanse is, unless you live near Dr Oates?

See Dr. Alter\'s comment that I referenced. The benefit of Ellanse regarding that particular concern is that it will be gone in 4 years time. I follow your logic with complications arising in the first year, but I don\'t see why you can\'t see the benefit of Ellanse in that regard.

And I had already read 3 of the 4 papers that you listed on biofilms. That applies to all fillers, and is not a reason to opt for PMMA over Ellanse. Also, it\'s not like you only have the Ellanse clinical studies to go by, as PCL has a 40 year history of safety in biomedical applications and FDA approval. I\'m sure that physicians like Dr. Oats and Dr. Morganstern, who are concerned with safety, took that into account before they started offering it. The credentials from Morganstern\'s practice include a chief Urologist at a leading teaching university. They tend to know how to do medical research.

Gg82 wrote: Well, look where we were 10 years ago.
No good option avaible, literally stone age of PE.

I\'ve no idea what we\'ll have in 5-10 years, but who can really know.

There\'s actually no improvements for the past 10 or even more years on this field. Things like PMMA for PE already were existing in early 00\'s in Brazil (and keep in mind that at the present time PMMA exists for 30 years). Also, I\'ve somewhere read about using of HA for penile glans enhancement like 15 years ago. If you want more (not only about fillers procedure): the ligament cutting procedure were first performed for cosmetic reasons by Chinese surgeon (forgot his name) in 1990, moreover, first mention of this procedure (not for cosmetic reasons) was in early 1970\'s.Now you see that there\'s not so much changes for the last 10-20 years?

chester wrote: Biggy, your information regarding Ellanse is quite far from factual. A \"fact\" isn\'t a fact because you say it is. It\'s a fact because science says it is, and multiple scientific, peer-reviewed papers unequivocally demonstrate much better biocompatibility and safer incorporation for Ellanse than PMMA. No offense here, but I won\'t even go into your medically unsupported theories, spoken with the confidence of an experienced physician. It\'s a good topic question and it deserves comprehensive research, which involves actually reviewing medical papers, case studies, patient reports and scientific data from manufacturers and independent entities alike, which is what I have done in arriving at my decision.
For you, or other members, who would like to become *properly* educated on Ellanse, please do a thorough search on Google. The data is available, and I share two detailed papers in the \"Ellanse\" thread on this forum. If not, then good luck either way.

What information? I\'ve pointed out the total absence of information on Ellanse as a high volume filler. What information do you have to contradict that?

They aren\'t my medically unsupported theories, I merely posted the theories of medical professionals. If it was spoken with the confidence of an experienced physician, it\'s because I learned it reading the work of experienced physicians. I did comprehensive research and reviewed actual medical papers before getting my procedure. Hence I was aware of this and am sharing it with the forum.

Here are some quotes regarding biofilms infections and reactions to fillers from a few studies:

\"biofilms form when bacteria is introduced during filler injections or are seeded in the filler during bacteriaemic episodes.14 Once present, they remain dormant for months or years on the surface of the filler and become a target of a delayed immune response, resulting in granuloma formulation.\"


\"Based on their clinical course and response to treatment, most reported hypersensitivity reactions are likely due to an infectious process\"


\"Delayed reactions associated with dermal fillers have often been attributed to hypersensitivity reactions; however, the evolving literature suggests that biofilms may represent an underrecognized cause and a difficult diagnosis to establish\"

\"The biofilm can either be dormant or active depending upon the external triggering factor. When the cell metabolism shuts down, it becomes dormant (persister). Thus it gets out of reach for antibiotics and also becomes difficult to culture in vitro.\"

aestheticsjournal.com/feature/granuloma-management

www.ncbi.nlm.nih.gov/pmc/articles/PMC2890130/

www.ncbi.nlm.nih.gov/pubmed/25207761

www.ncbi.nlm.nih.gov/pubmed/21246453

Herbert West wrote:
I\'m afraid that there\'s a strong chance that this will not happen nor in 5 nor 10 years.Do you have any reliable information or at least your own assumption of what it could be? Like some new or some old improved injectable filler? Are you talking about this area?

Well, look where we were 10 years ago.
No good option avaible, literally stone age of PE.

I\'ve no idea what we\'ll have in 5-10 years, but who can really know.

mediatps wrote: I guess one more advantage of Ellanse is that if there are some amazing developments in the world of Phalloplasty over the next 5-10 years you may still be able to make the most of them. Committing to PMMA now may reduce your chance of being suitable for other more effective methods in the future? Just playing devil\'s advocate but really trying to understand and make an informed decision.

I\'m afraid that there\'s a strong chance that this will not happen nor in 5 nor 10 years.Do you have any reliable information or at least your own assumption of what it could be? Like some new or some old improved injectable filler? Are you talking about this area?

Biggy, your information regarding Ellanse is quite far from factual. A \"fact\" isn\'t a fact because you say it is. It\'s a fact because science says it is, and multiple scientific, peer-reviewed papers unequivocally demonstrate much better biocompatibility and safer incorporation for Ellanse than PMMA. No offense here, but I won\'t even go into your medically unsupported theories, spoken with the confidence of an experienced physician. It\'s a good topic question and it deserves comprehensive research, which involves actually reviewing medical papers, case studies, patient reports and scientific data from manufacturers and independent entities alike, which is what I have done in arriving at my decision.
For you, or other members, who would like to become *properly* educated on Ellanse, please do a thorough search on Google. The data is available, and I share two detailed papers in the \"Ellanse\" thread on this forum. If not, then good luck either way.

Ok so I have come to a fork in the road. My two options are:

Ellanse, the 4 year version here in London with Moorgate or Androfil.

PMMA with Supermans new doctor in Italy. Using the little by little method of 8-10ml injected each session. I have spoken to him and he is willing to see for two sessions 12 Nov and then again on the 26th Nov.

The disadvantages of both.

Ellanse:
- More expensive
- Not permanent (I like the idea of not having to constantly worry about absorption as this is something i\'d like to fix in order to permanently move past my penis issues)
- If I decided lateron that I want to go for PMMA then it will be impossible to dissolve and I would need to be sure all the Ellanse was disolved before having PMMA. This would be impossible to tell and could be an extremely long time.
- Would need to keep hiding trips from partnets over the next years to get more injected.

PMMA:
- Potential complications
- Not much known about this new doctor
- Higher risk of unpleasing aesthetics

Advantages:

Ellanse
- Probably easier to mold
- The softness of it compared to PMMA would probably disguise bad aesthetics better
- If things look terrible then its not for the rest of your life!

PMMA:
- Harder firmer feel
- Permanent (Means I can move forward with my life and leave these insecurities behind) Don\'t have to worry about constantly needing to hide trips to get my Dick enlarged from partners.
- Would save a lot of money in the long run.


Any advice would be greatly appreciated. I am ready to pull the trigger but just not sure which way to aim. I am worried that If I go the Ellanse route I will just be conscious that over the next 4 years I will be slowly returning back to normal which means I won\'t ever feel completely comfortable.

Money isn\'t really an issue although obviously PMMA being cheaper is an advantage.

Help guys!?