TOPIC: New Phalloplasty Procedure-Volunteers Needed in South Florida

its too much of a head fuck. there will never be a procedure for length or a reliable procedure for Girth. so why obsess over a pipe dream for a bigger Dick? i will still check in every few months to see if there has been some miracle breakthrough for length.

tom kat wrote: its too much of a head fuck. there will never be a procedure for length or a reliable procedure for Girth. so why obsess over a pipe dream for a bigger Dick? i will still check in every few months to see if there has been some miracle breakthrough for length.

Having been following PE procedures since 1996, I can\'t say I disagree with you. Who\'d have thought that 30 years after they started offering these kind of procedures we\'d be no further forward! We might have some different options now, to what we had back then, but are they any better? Is PMMA really better that FFT? I would have said so a year ago, but now I\'m not so sure.

smalljay wrote:

hoddle10 wrote: Is PMMA really better that FFT? I would have said so a year ago, but now I\'m not so sure.

Can you elaborate on this, Hoddle? Just curious as to what made you change your opinion on this in the last year.

It\'s just that a lot of members appear to be getting smaller results and we seem to be seeing more aesthetic issues.

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Dance With Dragons wrote: Hoddle, this has really been confusing to me as of late. I have a thought on why we seem to be getting more reports of smaller gains and more aesthetic issues. Do you think it is because PMMA adoption is becoming more commonplace and there already so many progress reports that guys are only choosing to write when they have issues or are unsatisfied? I\'m certainly not doubting the possibility that something is going wrong, but it doesn\'t make logical sense either. Why would something that tons of guys have had great success with all of a sudden just stop working? Dr C and Wade should be like a well oiled machine at this point, and metacrill has obviously shown itself to be very amenable to penis Girth enchantment. Why would it all of a sudden just stop working for new guys? Just curious, not trying to start a shitstorm or anything, it\'s my scientist side.

I think it\'s coincided with the higher concentration, higher amount used and multiple injection sites.

These days it seems guys routinely get 20cc + of 30%. I\'m just not convinced that higher volumes mean bigger gains. I think the immune system response has a diminishing return. Meaning proportionally more collagen is produced per cc injected, the less the amount. I also think 30% is less predictable and possibly harder to mold. That\'s just a guess, but it makes sense that a denser material would be harder to shape. It seems that nodules appear at injection sites and thus the more injection points there are, the more nodules are likely to appear. One final possibility is that Dr C also seems to be injecting more on the underside and I\'m sure he used to avoid that area.

The problem with FFT is that it is unpredictable and can feel unnatural. But it seems to me, that of late, this is true of PMMA. But that\'s purely my observation from reading reports here, so has little real value. I just know that 2 or 3 years ago I was desperate to get my penis fixed so that I could get PMMA. But now, even though I\'ve concluded I could never fix the issues preventing me from getting PMMA, I\'m not sure I\'d want it anyway.

Dr Ress has assured me he will be performing the whole surgery. As for tge number of cadavers he\'s tested on...I\'ve emailed him and asked...will let you all know

Please excuse me for not joining in on the discussions earlier as I have a busy clinical practice. I appreciate the comments that my post generated. My interest in reviewing and ultimately modifying the current ligament release procedure was a male patient that had asked whether i performed penile lengthening. His question prompted me to review of the medical literature and ultimately redesigning the operation in such a way as to correct as many of its limitations as possible.

The revised operation was so effective in cadavers (3) that I actually sought to collaborate with an expert in human sexuality. Why? Because now there is the potential to change all the dimensions of the penis, both length and Girth. Then the question is what is the ideal length and or Girth to improve self esteem and better satisfy one\'s sexual partner. The study\'s goals are to show whether the procedure is effective or not (compared to historical ligament release data) and to see if there is a difference in self esteem and sexual satisfaction. I have attempted to make no claims or \'advertise\" other than posting the existence of the study so as not to introduce bias.

From a surgical standpoint I see the discussions here focusing on less important issues, like the use of electrocautery, which used nearly universally in all operations, than on how is the procedure truly different. Alas that is my fault for not participating here on this forum. To answer one comment: cadavers are the only way to test operative procedures safely as nothing else can duplicate human anatomy. Cadavers are routinely employed for surgical education. For example, Orthopedic surgeons train on knee, shoulder and wrist arthroscopy at a large facility outside of Chicago. If it doesn\'t work at the cadaver level than chances are it won\'t in real life. The next step is to perform clinical research. This study was designed with the help of a team of statisticians and a human sexuality expert/ psychologist.

The penith procedure (ok I had to call it something that Google wouldn\'t censor and is to the point-- Im open to other names) differs from simple ligament release as I am performing a more extensive release of connective tissue and then ensuring that the penile shaft neither retracts nor loses side to side stability during erections which are the major flaws of the current ligament operation. I am doing this with autologous (one\'s own) tissues and no foreign implants.

Silicone implants have been described in two circumstances: as a spacer using a testicular shaped implant between the pubic bone undersurface and the penile shaft to prevent penile retraction, and a traditional implant used for co-existing erectile dysfunction. Any foreign material creates its own set of problems so I designed around using them.

I will participate more frequently on this board as time permits and look forward to answering your questions.

Sincerely,


Andrew Ress, MD

Thank you for taking the time to reply Dr Ress.

But ultimately, I still don\'t see how releasing the ligaments will really make the penis longer in the Erect state. Most of the literature I\'ve read over the years seems to simply assume that by releasing the ligament, it aids patients in making Erect length gains when combined with post operative physio, using stretching devices and so on. But there never seems to have been a comparison with men following the same post operative protocol only without having the surgery. Until such a comparison is made, then how do we know there is any benefit from this surgery in terms of Erect length gains?

Try thinking about this a different way. If the ligaments (suspensory and fundiform) are divided then why doesn\'t the whole shaft fall on the floor? The answer is simply that there are other points of attachment that are not distinct enough to have been given names, but that in sum total contribute significantly to support the shaft.

The suspensory ligament is the toughest of the ligaments. It\'s function is support but mechanically it creates a fixed pivot point for an Erection, while the infundibular ligaments form a sling around the base of the penis much like the tower and cables of a suspension bridge.

In a true double blinded study, one group would receive a sham operation. However that is not considered appropriate for surgical procedures. (In drug research the sham would be a placebo pill). The alternative is to perform the traditional operation in one group and the other receive the new procedure. Since we know that the traditional operation and variants of it do not work well, then that\'s not a good idea either. So what are the controls: the measurements before and after looking at each persons individual change(s). Meaning each patient acts as his own control. Also we can compare against the data in the literature using what statisticians call meta-analysis.

My postoperative protocol employs use of weights but much less than the current 10lbs. To me, needing 10lbs of traction on soft tissues means that you haven\'t released the ligaments and other structures completely.

Using weights and other devices alone are perfectly acceptable forms of what plastic surgeons call tissue expansion. As you and your readers are aware, for penile lengthening it requires a long term commitment to maintenance and works better for some men than others.

I didn\'t mean to suggest a sham operation. What I meant was that if you were to compare a group of men who had not had surgery, but wore and extender for 6 months, with a group that had had surgery and wore and extender for 6 months, there is unlikely to be any difference in results. This is based on over a decade of following patients progress on forums etc. It does seem to me that within the small section of the medical community that perform these surgeries, that this hasn\'t even really been considered. Even a very well respected surgeon, such as Gary Alter, does seem to think the lig cut aids Erect gains, yet I\'ve followed several of his patients over the years and I simply don\'t understand how he\'s reached this conclusion.

If we were to get the worlds 10 most prolific surgeons, in terms of lig cutting surgery, into a room and quiz them on their knowledge of the success of penis traction devices or weights, but without surgery, then I\'d bet they\'d be pretty clueless. Yet without this type of knowledge, how can they really know how successful the surgeries they offer are?

In terms of Flaccid gains, I think lig cutting is a viable option. But as a surgery to increase Erect length, I honestly think you are trying to modify something that has little benefit.

I think it\'s great to have a surgeon contributing to the forum and I\'ll look forward to being proven wrong. Whilst you are around, would you mind if we bounced some ideas off you for improving the Girth enlargement options?

Lol-- a sham operation in research means that all the steps of the operation are done except the critical one being studied. Say taking out a gallbladder was unproven and we want to see if it helped, we could design a study in which the surgery is all done the same exact way except in the control or placebo group, the gallbladder isn\'t removed at all, but all the other steps are performed. The members of the control group would have undergone a \"sham\" operation.. just a slightly different meaning of the word- not to mean fraudulent or hurtful in this context.

Let me rephrase your questions slightly into science-speak: Do penile extenders work and how effective is it? Does penile lengthening surgery work? How does penile extension results compare to surgical penile lengthening results?

This is more complex than you might think. In order to have two equivalent groups to compare with one group getting surgery and the other getting extenders. Unless we signed up identical twins, or men matched as closely as possible by age, health, size, penile dimensions, etc. Without having equally matched groups the number of variables would be too great. The better way to study this would be to have each man act as his own control and uniform measurements are obtained at set time intervals. For the extender group, the men would have to use the same exact type of device or weights, apply it identically and set it to the same tension. Measurements must be performed by a person without knowledge of the study so as not to introduce bias. (The correct scientific term is blinded but don\'t want you to think that to poor fellow is getting poked in the eyeballs.) Enough men would need to enter the study in order to reach adequate statistical power. This sort of study should be straightforward to get going and I would be willing to help organize it.

I agree with you: getting the opinions of doctors is just that- opinions, with not enough information to either prove or disprove their points of view. Well designed studies can and should determine the truth, and I hope to prove you wrong with data not opinion. Then again I may be proved wrong. My background includes a research fellowship at Johns Hopkins in plastic surgery, and I authored numerous studies at Mayo to answer questions to clinical problems we faced. I trained at Mayo Clinic at the same time Dr. Alter was in plastic surgery there by the way.

Will do my best to answer any of your questions.

From your research following the consult you had with the patient requesting a lengthening procedure, did you just assume that the lig cut does in fact aid Erect length and thus look at ways to improve the current procedures? Or did you actually question whether lig cutting is even the right approach period?

I\'m genuinely curious but prior to this discussion, had it even crossed your mind that the success of these surgeries are in fact mainly down to post operative stretching/weight Hanging and has little or nothing to do with the surgery? I don\'t ask that to be impertinent, but it\'s something I\'ve noted from discussions I\'ve had with several plastic surgeons and urologists over the years. I\'m yet to talk to a Dr who actually asked himself that very question.

Surely you\'ve got to at least wonder why we don\'t seem to ever see post surgical gains, above the gains made by men who haven\'t had surgery. That alone must be a real head fuck (for want of a better word). In fact, in all the research you did before your started working in the lab on this, did you see a single, properly measured before and after photo, showing Erect length gains from lig cutting surgery? I can honestly say, that after 15 years as a member of every surgical enhancement group on the internet, I\'ve never seen one, yet have read literally hundreds of reports of guys having the surgery. I\'ve never heard of a single case in which a Dr has requested their patient update them with their gains 6 months later. I just don\'t understand where the evidence is that these procedures actually work and strongly get the impression that it\'s based purely on assumption.


Do you offer any Girth procedures?

The simple answer is that half of the penis sits behind the pubic bone, so if one can advance the shaft and keep it there you should gain overall length both Flaccid and Erect. That\'s what I designed my procedure to do. We are measuring 6 weeks and 6 months after surgery and hopefully yearly after that.

I don\'t think any of the surgery techniques to date have been particularly effective. Nor has stretching proven itself predictable and it requires a lifetime of maintenance. Certainly there isn\'t enough information to prove anyone right or wrong. That\'s why doing the research is so important.

Now I\'m going home!

What constituted a \'success\' with the cadavers? Isn\'t it hard to judge the success of such an operation because one of its main problems is the severed tissue reattaching which would be impossible with cadavers seeing as they\'re..well, dead. Or maybe I dont know enough about how cadavers work haha.
Also, what types of incision(s) does this procedure use?

Hoddle - sorry to jump in here and hijack your thread but could I ask 2 questions please?

To Dr. Ress, you are literally the person that everyone has been talking about. You do realize this don\'t you? Literally in this very thread there was someone bemoaning the fact that we are 30 years on and nothing has been done with reasonable success. If you continue to think outside of the box you may literally revolutionize the industry and the world in the future - and that is not an exaggeration.

Secondly, there is a Dr. in Canada who has had (what appears to be) pretty great success but it involves time and adjustments. His main source appears to be relaxin. Have you thought of contacting him? Again, if successful, the return on your investment will be 100 fold. Virtually every person in the world with a 5\" penis will drop 10K for a 2\" length increase and maybe 50K for 3\".

Congratulations to you on your journey. If I had pursued medicine instead of engineering I would have almost certainly went your route as the journey is too enticing. (Unfortunately I would have probably been another Dr. Elist LOL)