TOPIC: Skiman's Surgimend Journey

I guess the next interesting question as far as timelines; we know it could take 6+ months for collagen stimulation to slow down or stop, but how long until vascularization is finished? adequate? I'm curious how long it takes for the graft to have all of the vasculature that it's going to have. My guess is that's going to play a large part in how much collagen you get AND the likelihood the implant is accepted permanently.

Have any of these docs spoken on this? Wondering how long until you're essentially "in the clear" and rejection or loss of the graft is no longer a concern. Especially reading about the guy who had a graft the "old way" some years ago and the second graft ended up rejected.

Be really interesting as well to see what the medium and long term results are of the PMMA injections Dr Liu is doing into the glans.

itgoesthud wrote: I guess the next interesting question as far as timelines; we know it could take 6+ months for collagen stimulation to slow down or stop, but how long until vascularization is finished? adequate? I'm curious how long it takes for the graft to have all of the vasculature that it's going to have.

This is a great question, I'll see if I can get answers.

If I were to make an educated guess it'd probably be "it varies person to person," based on factors like age, diabetes, smoker, nutrition, etc. Despite the educated guess, I would imagine there being a "top end" of what the majority of normal patients can expect to wait when recovering, something we'll need Dr. Liu or Dr. Solomon to chime in on (both of whom do Surgimend & Alloderm).

I'll see if I can get a response next week, or if @skiman happens to know and could share.

I agree that this is a great question. Based on things Dr. Liu has said I’m guessing up to a year, but I haven’t actually asked the question, so don’t know this for a fact. I’ll see what I can find out too.

I have a question for you #skiman. If you don't mind, what type of Circumcision scar did you have? Is that even an issue with Surgimend like it is with fillers? Or can the graft be slid up past the circ. scar where they typically can't get the PMMA to go? I remember you saying you didn't have a drop off or shelf like people get with fillers and the not so ideal Circumcision scar placement.
Thanks,
R350

Razor350,

Dr. Liu actually "rebuilt" my Circumcision. Originally, my Foreskin didn't really come over my glans, now it covers the lower 1/4 of it or so when flacid, and pulls back when Erect. The Surgimend does not come all of the way up to the glans, but when flacid it looks filled out all of the way to the glans. I hope this answers your question.

From Dr. Liu: vascularization starts after a few weeks, but can be a long process up to more than a year.

Dr. Liu told me that if I were to replace the old free-transfer fat and get surgimend or alloderm instead he’d make the incision through my old Circumcision scar.. I was Circumcised as a child and can’t remember anything from the procedure (fortunately).
I think I had an infection of some kind and they ended up having it done on me, otherwise it’s not a common procedure in my family..

Do those scars heal fast? Do people lose sensation around that area?
My old scar isn’t the most symmetrical so in a way maybe it’d be an improvement?..
Does your scar look good? Frankly I’m not sure what a “good looking” scar is supposed to be like?

skiman wrote: …My wife was part of the decision process and knew what the outcome would be. If she had asked me not to do it, I probably wouldn't have (been still would've wanted to anyways in all honesty.) Since we started having sex again she's told me several times that she wishes I had not done it.
I think there are other issues, such as menopause, that are contributing to the issue as well. I do think that once she gets used to the bigger size that she is going to start enjoying it.

Earlier you said your wife knew about the procedure you’re having done..
So how does a conversation like that even begin??
You and your wife must be very close?

I had the FFT procedure done several years prior to meeting my wife back then.
I’m divorced now so maybe it’s a moot point (or moo point for Joey’s fans ) to even think about that but one day I might meet a new lady..

I don’t think I could’ve ever shared that kind of information with my ex. She’s very judgmental about other people’s bodies and she’d have probably been as judgmental about mine.. ..and of course all of her girlfriends would know it too..
The fact there were important issues we weren’t able to talk about was definitely a huge factor in us getting divorced later on.. It’s all history and happened many years ago but I bring it up to emphasize how impressed I am with your ability to talk to your wife about this.. Frankly it kind of blows my mind…

So kudos to you and your wife for being able to talk about this!
…but how did this conversations start and was she supportive or hesitating?

PS.
I will totally understand if you aren’t willing to share information this intimate.. it’s very private and since it involves your wife I understand if you want to keep her out of it..

123abc,

There was no way to have the procedure without discussing it with her. I told her I was interested in having it done, she told me that I was fine the way I was. I pointed her at Dr. Liu’s website, and she even spoke with Dr. Liu. After her questions were answered, she still didn’t think I needed to get it done, but would support me if I did. As I’ve written, there were certainly challenges when we started having sex again, but that has gotten better as we’ve both adapted.

I know some have already chimed in but I got an answer directly from the Doctor verbatim, so it is worth sharing (Dr. Liu's response in Green text):

itgoesthud wrote: I guess the next interesting question as far as timelines; we know it could take 6+ months for collagen stimulation to slow down or stop, but how long until vascularization is finished? adequate? I'm curious how long it takes for the graft to have all of the vasculature that it's going to have. My guess is that's going to play a large part in how much collagen you get AND the likelihood the implant is accepted permanently.

By 4-6 weeks, vasculature should already be established in the Alloderm, and this will continue to grow. The Alloderm is slowly replaced by the body's own collagen and becomes "part of the body" and rejection will no longer be a concern.

itgoesthud wrote: Have any of these docs spoken on this? Wondering how long until you're essentially "in the clear" and rejection or loss of the graft is no longer a concern. Especially reading about the guy who had a graft the "old way" some years ago and the second graft ended up rejected.

Be really interesting as well to see what the medium and long term results are of the PMMA injections Dr Liu is doing into the glans.

Bellafill is a good permanent filler for glans enlargement. One has to be careful not to have nodules formation by making sure the injection is just subdermal and deep intradermal and not into the Corpus Spongiosum. Careful massages must be done starting right after injection and continue to do so until the surface of the glans becomes smooth and not bumpy. Bellafill is considered to be a permanent filler, although some reduction can occur over the years and sometimes it is necessary to do touch-up injections. Hyaluronic Acid, however, is temporary and completely disappears in less than 1 1/2 to 2 years.

Thanks for sharing. He’s the first doc I’ve come across raides Loria that says Glans can be enhanced permanently. That said, I’d love to know if he has performed this procedure with Bellafill (I assume so), does he consider it to be safe, what is the fail rate, what complications has he seen. Etc.

Skeptical_One wrote: By 4-6 weeks, vasculature should already be established in the Alloderm, and this will continue to grow. The Alloderm is slowly replaced by the body's own collagen and becomes "part of the body" and rejection will no longer be a concern.

It almost sounds like you end up with a massive network of blood vessels that builds within the dermal graft, eventually replacing the graft tissue with collagen, and removing the graft material via the newly-established vasculature.

Skeptical_One wrote: Bellafill is considered to be a permanent filler, although some reduction can occur over the years and sometimes it is necessary to do touch-up injections.

This is also interesting. What reduces, the carrier gel or the spheres? As long as the spheres are there shouldn't the body keep replacing any lost collagen if any is metabolized? Are we losing spheres to the lymphatic system? In the shaft we expect the gel to dissipate, spheres stay behind and get encapsulated by collagen like a pearl in an oyster. But the spheres stay there until you die, no? I guess I don't understand the mechanism by which it reduces - my worry is somehow the microspheres are leaving the site and entering the bloodstream.

itgoesthud wrote:

Skeptical_One wrote: By 4-6 weeks, vasculature should already be established in the Alloderm, and this will continue to grow. The Alloderm is slowly replaced by the body's own collagen and becomes "part of the body" and rejection will no longer be a concern.

It almost sounds like you end up with a massive network of blood vessels that builds within the dermal graft, eventually replacing the graft tissue with collagen, and removing the graft material via the newly-established vasculature.

Skeptical_One wrote: Bellafill is considered to be a permanent filler, although some reduction can occur over the years and sometimes it is necessary to do touch-up injections.

This is also interesting. What reduces, the carrier gel or the spheres? As long as the spheres are there shouldn't the body keep replacing any lost collagen if any is metabolized? Are we losing spheres to the lymphatic system? In the shaft we expect the gel to dissipate, spheres stay behind and get encapsulated by collagen like a pearl in an oyster. But the spheres stay there until you die, no? I guess I don't understand the mechanism by which it reduces - my worry is somehow the microspheres are leaving the site and entering the bloodstream.

To be frank I'm not sure of his comments regarding "some reduction over the years, but my guess would be either (1) atrophy/shrinkage some men experience with age and/or lifestyle habits over years, which may also impact the collagen or (2) speculation based on Suneva's (Bellafill's manufacturer) projection of a 5-Year lifespan of PMMA.

And as for Suneva's claims, I'm not sure why or what they are thinking but I have a few plausible scenarios:
(1) They had 5 years of data when obtaining FDA Clearance, so they could guarantee it for at least 5 years.
-or-
(2) It's a disingenuous marketing pitch -- a lot of Cosmetic Clinics aren't overly fond of permanent fillers and so if you advertise it as long-lasting instead, it may become more appealing to Doctors who would otherwise be on the fence.
-or-
(3) Perhaps it isn't entirely permanent, but so long-lasting that for most people it's effectively permanent (in other words, I'm 12 years post-op with no notable loss in size from PMMA, but maybe will notice some loss at the 15 or 20 year marker?). By all accounts, it is seemingly permanent.


The microspheres in Bellafill are pretty much in the same size range as Linnea Safe (which is crucial), the only notable difference being carrier. On paper, Bellafill should absolutely be permanent, and I have yet to hear a scientific/medical claim that would suggest otherwise.

If you guys want to continue discussing the merits of Bellafill in conjunction with Alloderm or Surgimend, I recommend creating a new topic. I don't mind the discussion of course, but I also don't want to hijack Skiman's thread either. Thanks

Skeptical_One wrote: If you guys want to continue discussing the merits of Bellafill in conjunction with Alloderm or Surgimend, I recommend creating a new topic. I don't mind the discussion of course, but I also don't want to hijack Skiman's thread either. Thanks

Good point. Noted on the above as well.

I think this is all good stuff. This thread is the first one on the board about experience with dermal graft, so I don't mind the questions etc about it at all, that's actually why I started the thread, to help educate others here that might be interested in this procedure.