TOPIC: Foreign Body Granuloma — Allopurinol

I had 15 cc HA a year ago. The HA re-absorbed very quickly—the majority by 6 months and the remainder by 10.

My shaft developed asymmetrical and very unattractive Foreign Body Granuloma lumps. They are hard and large, unsightly clusters of tissue.

Needless to say, for $10k, I didn’t expect to pay for disfigurement following only a half year of benefits.

My surgeon said there is nothing we can do, but I’ve read Allopurinol can treat Granuloma. Any thoughts on this? I am tempted to purchase some and take it, self administering as this situation is depressing.

No pain, btw. Just a mess of hard tissue that is preventing me from wanting to pursue sex. This defeated the whole purpose.

penningbooks wrote: I had 15 cc HA a year ago. The HA re-absorbed very quickly—the majority by 6 months and the remainder by 10.

My shaft developed asymmetrical and very unattractive Foreign Body Granuloma lumps. They are hard and large, unsightly clusters of tissue.

Needless to say, for $10k, I didn’t expect to pay for disfigurement following only a half year of benefits.

My surgeon said there is nothing we can do, but I’ve read Allopurinol can treat Granuloma. Any thoughts on this? I am tempted to purchase some and take it, self administering as this situation is depressing.

No pain, btw. Just a mess of hard tissue that is preventing me from wanting to pursue sex. This defeated the whole purpose.

I'm sorry to hear about the presence of granulomas. Unfortunately, despite being rare, they are indeed a complication that can arise from (any) Dermal Filler.

That said, my understanding is that it can (1) be treated and/or (2) can improve over time. So for those reasons I wouldn't recommend any interventions on your own as you may exacerbate the problem -- instead, try and get a second opinion by other Clinics/Doctors that specialize in Male Enhancement and/or the Revision of male procedures. I emphasize "specialization" because many other Doctors simply aren't aware of what to do in these instances, especially since male Phalloplasty isn't mainstream.

I'm actually having a phone call with a Doctor (coincidentally) familiar with FBG's and I'll ask him if he has any recommendations in general.

Remain optimistic, I strongly suspect there are treatments that may work for you.

Very grateful for your response, especially being that you might ask any thoughts from the doctor you speak to.

Advice taken to . I’ll avoid going cowboy on my situation here and have some patience. I’ve reached out to the clinic to request some more support/suggestions. There isn’t a great deal of the work done in Vancouver Canada unfortunately.

penningbooks wrote: Very grateful for your response, especially being that you might ask any thoughts from the doctor you speak to.

Advice taken to . I’ll avoid going cowboy on my situation here and have some patience. I’ve reached out to the clinic to request some more support/suggestions. There isn’t a great deal of the work done in Vancouver Canada unfortunately.

Thanks for reaching out and sending the photos. From what I can see, I'd wager this is treatable. The Clinic you shared with me are not Sponsors but have been in talks with potentially coming on board short-term -- having this bit of information is crucial because no other Sponsor here would have thrown their arms in the air and said there is nothing they can do, and so I will reach out to them personally and see that they really expand their expertise in the area of "complication resolution" if talks are to continue.

From your message you also pointed out that the Doctor was in-fact good which is promising, and quite frankly, a granuloma is an immune response that could happen to any practitioner & patient.

After my conversation tomorrow with someone versed in granulomas, I will update this topic with additional suggestions. Stay tuned.

Thanks for this. I do want to be clear, my doctor at this space was very ethical, his consent form mentioned granulomas, and it wasn't that he just gave up on me or anything. For one reason or another though, the discussion didn't involve treatments beyond last resort excision. In any case, I contacted them and they mentioned having been in recent discussion about my case. They offered to meet with me in a few weeks to discuss things and explore options.

Hopefully this thread becomes informative for others as well as treatments come into discussion. My surgeon even said allopurinol was up for discussion.

From what I gathered today, granulomas are exceedingly rare in the penis where dermal fillers are involved. What I wanted to ask is if we are sure you're dealing with granulomas and not nodules or lumps left behind after an uneven dissipation of filler (in other words, uneven reabsorption of filler leaving some areas with product and other areas not so much)?

Foreign body granulomas (FBG) are immune responses that can be characterized by swelling, redness, heat, and/or itchiness - they can also be treated medically or even resolve on their own spontaneously. Nodules, lumps, and ridges are aesthetic irregularities either as a result of filler distribution in the shaft -OR- the result of uneven loss of a fillers, which can be seen with Hyaluronic Acid (HA), and even with Fat. Knowing what you have drastically changes the course of action.

How certain was your FBG diagnosis? Even after the pictures I can't say for certain it isn't just lumpiness created after loss of some filler. The exact answer to this can provide the appropriate outlook & direction needed for resolution.

Also, thanks for clarification with your Doctor. This field has a history of attracting those less qualified or ethical, so it's always refreshing to know when a Doctor upholds a high standard of care, even in light of complications.

Hi again.

It isn't a certain diagnosis. It is one doctor's opinion without imaging. This alone will guide caution in how we approach it and perhaps necessitate setting up ultrasound.

They aren't nodules, just because if you saw the extent and coverage in real life with an Erection, you'd see the mass is just too great.

Migrating clumping HA though? I had first said to my surgeon that this is what it was, but he said it was too hard. My gut has said it is just all the filler migrating together though. Do you think it's possible that if it clumps it could become VERY hard? It seems to slowly move over the months, which if true would mean it cannot be native tissue.

I wont be filling in any holes (he turned down doing this, since he said it wasn't HA but was more likely granuloma). The reason is that most of the stuff re-absorbed within six months. This would be preposterously expensive to maintain over time, especially being that as soon as it started reabsorbing it already had gone very lumpy. Furthermore, it may indeed migrate so much in my body it's just setting up an ongoing disaster.

If it is just clumping, I will get it dissolved as much as possible and seek out Ellanse or PMMA. If it is granuloma, I will likely step away from the practice and accept my fate.

The following is a response from Dr. Casavantes (now retired) who has worked with dermal fillers in the penis for about as long as anyone, and is familiar with the rare complications that can stem from these kind of procedures. The following is his expert knowledge on granuloma's, and he hopes to shed some light for you and others regarding this matter.

---

Hello,
The topic “Granuloma vs. Nodule” has been discussed several times in this forum.
There is no consensus about the difference between the mentioned lesions, and the line between the two of them can be blurry at some point. However, granulomas must be distinguished from nodules, as they may look the same; each has its triggering factors and different treatment approaches.
- Granulomas: acute and active lesions that usually appear after several months, even years after the injection of soft tissue fillers. Since it is a blood-mediate immunological reaction to the soft tissue filler, symptoms can appear in distant areas and all injected areas; they show clear signs of inflammation, red, target skin, tenderness, higher temperature, and pain.
- Nodules are inactive lesions that are present immediately after the injections or a few days later. There is no immune reaction and no signs of acute inflammation or pain. They are the typical result of excess, migration, or shifting of the soft tissue filler.
The treatment of choice for granulomas is the control of inflammatory reaction with drugs like allopurinol, colchicine, NSAIDs, and in extreme cases, cortisone p.o. or injected (systemic or intralesional).
The treatment of choice for nodules is surgical reduction or extraction.

The following table summarizes the differences between a nodule and a granuloma:

I’ve been following this discussion and I read through dr c’s explanation and chart. I see he mentions nodules are easily extracted but respond poorly to steroids. In this case , since HA was the filler why could he not just have them dissolved with hyaluronidase ?

The above matrix doesn't help a lot, I'm afraid. It has qualities of both and in cases, none.

With that said, it seems far more likely that I just have a very rare case of extremely uneven absorption and migration into hard clumps. It lacks any pain or redness, however they formed five months or so after the HA. I think I just had the worst results of HA in history, being that it turned into an assymetrical hard grotesque series of clumps within half a year, hah.

I've checked photos though, and I see month to month it is shrinking. I have an appointment on the 11th and could request hylauronase.

The confusion was just that while I had plainly assumed it was just lumpy and uneven absorption, the doctor had a sense of shock and just said it was way too hard to be the filler. I believe he was mistaken.

Dickwhitman79 wrote: I’ve been following this discussion and I read through dr c’s explanation and chart. I see he mentions nodules are easily extracted but respond poorly to steroids. In this case , since HA was the filler why could he not just have them dissolved with hyaluronidase ?

I may have forgotten to cite the specific filler to him, and he likely presumed it was PMMA or Ellanse (since that is what he worked with the most) - however, that said, it still largely applies to fillers in general. I'm certain if he knew it was HA in this context he would have mentioned hyaluronidase, it's a textbook treatment protocol.

Sorry to everyone. My doctor had initially had a shocked reaction at the grotesque hard lumps, feeling there is no way it could be filler since it was so hard.

I had a feeling though I was just a rare case where it migrated and absorbed unevenly, created long and ugly, uneven lines and bumps.

This turned out to be the case though, as we had a strong hyaluronidase treatment yesterday on the left side. The deformity melted like butter over the evening.

False alarm—there were never granulomas and indeed these continue to be extremely rare. I am very pleased with the outcome (though not totally happy I spent $10k for a product that deformed into something hideous very quickly—but that's just how my body handled it and I was well warned it was possible).

Thanks all.