TOPIC: 42ml HA Dissolved to go PMMA with Avanti Derma 9/12/2023

Hi guys, I started this journey 18 months ago. Below is a log of the process I’ve do with 4 rounds of HA. Ultimately it was dissolved on 8/8/23 to prepare for my first round of PMMA appointment with Avanti Derma on 9/13/2023

I hope that my plan to test the waters with HA and then go permenant will be worthwhile. I’ve studied the aftercare forum and think I’ll be able to keep it mounded and extended to achieve a natural looking result.

I uploaded a ton of photos from my charting app.
2/28/22
10 ml
3/15/22
16 ml
3/24/22
10 ml
Dissolved some my left side
4/29
13 ml

Im really looking forward to doing the work in aftercare to get esthetic results that are permenant.

This was Round one HA 2/28/22

Round 2 HA

More from 3/18/22

More

Next round

4/8/22 round

Part of 4/28/22 round

4/28/22 part2

4/29/22

Despite many of your photos appearing to be taken immediately post-op (hence the discoloration from bruising & swelling), much of the HA work I'd say was pretty good. Are you saying you dissolved all the HA? It's not necessarily easy to ensure all 42 mL are gone, other than the passing of time (since HA is a temporary filler).

Also, did you let Avanti Derma know about your previous HA + (presumable Hyaluronidase) dissolving? It's vital they know before performing any work on you (although HA is rather benign all things considered, but it's information you ought to let your practitioner know).

Good luck.

Good for you! Hope it goes well!

Sort of related. Why are some so against adding PMMA when there is HA there? Meanwhile there's other practitioners who deliberately use both. I'm just trying to understand the rationale in both directions. I do understand Avanti wanting a clean slate. But... if they're compatible... What's the issue when others deliberately do it?

justn8 wrote: Good for you! Hope it goes well!

Sort of related. Why are some so against adding PMMA when there is HA there? Meanwhile there's other practitioners who deliberately use both. I'm just trying to understand the rationale in both directions. I do understand Avanti wanting a clean slate. But... if they're compatible... What's the issue when others deliberately do it?

I'll be happy to explain because I'm privy to some of the policies and sentiments of these Doctors & Clinics. The use of different kinds of fillers on the same day (or subsequent appointments) aren't the issue. I've seen some interesting & innovative techniques, including Fat + PMMA among others (some which will hit the forum in the near future).

What first must be understood is that penile injectable Phalloplasty is neither standardized, nor are all results created equal among all the providers out there. Some could argue that male Phalloplasty in general remains experimental. Some are great at it, and some aren't. For this reason, there is a higher risk taking on a patient that had prior penile work done from another Doctor/Clinic.

Think of this example--> a guy comes in with silicone oil injected but wants PMMA (which Avanti wouldn't normally do). Suppose however, hypothetically, Avanti Derma agreed and injects the patient with 15 cc's of PMMA. Months later the patient is experiencing symptoms and complications, and assumes it has to be the PMMA because it was the last procedure he had performed. The reality is that silicone oil can take months or years for complications to manifest, and it can become extremely difficult to determine who or what is responsible for the patient's situation.

Some Clinics don't want to deal with that liability, negative press, or no-cost Revision/Repair for something that wasn't their fault to begin with. In other words, if you have had prior penis enhancement work done on your penis with a separate Clinic, some (not all) alternative Medical Practices will turn you down, especially if it involves Doctors they aren't familiar with (or feel good about).

In summary, it isn't the combination of fillers that is regarded as problematic (I don't believe it is), it's the responsibility of taking on a new patient who could already be compromised by inferior work from a less experienced, less ethical, and/or less skilled practitioner, jeopardizing their own brand along the way. This is elective aesthetic medicine after all, you're far more under the magnifying glass than those who work traditional medicine (in terms of online popularity).

I'm not suggesting that HA (and subsequent dissolving) will disqualify anyone from receiving injections with Avanti Derma, but I can promise you they won't be thrilled if someone kept that information from them (and they'll know either way once their cannula is under the skin). It is imperative patients share with their Doctor any prior Phalloplasty performed, both for their penile health & the success of their procedure(s). Obviously consult first before booking an appointment.

I hope that shares some insight.

I was absolutely upfront with and shared all of the info and photos with Avanti to ensure they understood exactly where I was at. I shared the info so they were prepared and had the best information to make sure I could do the procedure and also that the preliminary information would help them plan for the best procedure hence outcome.

I dissolved it on 8/8/23 with 4 ml of hydralanees. It was an interesting experience having it mostly dissolve in minutes, hours and then gradually over the following weeks. The HA filler was 14-18 months old and had dissolved a bunch naturally. I was glad Avanti made me wait 30th us after the dissolution to schedule because it allowed for the penis to really normalize after dissolution.



Being upfront is the best policy for doctor and patient. Having been through the process over the last 18 months I feel confident the PMMA injection is going to go great. I am excited to have Avanti do it and feel like they are world leaders in the procedure.

I’ll keep you posted.

One more thing is sequence. I have seen HA primarily be used after PMMA by some patients on the forum. All my research has indicated the requirement for all existing HA to be pretty much fully dissolved prior to any injection of PMMA.