TOPIC: Concerns...My experience with Avanti Derma PMMA

In November 2023, I decided to try PMMA enlargement at Avanti Derma. Starting below average, I thought the risk and cost would be worth it. After two rounds— only 10% concentration the first time (0.3 Inch gain) and some 30% the second (0.1 Inch gain)—I spent $10,000 for just 0.4 inches of total gain. The results weren’t anywhere near what I hoped for. I’m still not at my goal of gains, but I refuse to spend another $5k for .1 inches.

The worst part of it all is that PMMA had migrated into my scrotum. After the procedure, it swelled up badly and I got concerned. Feeling uneasy, I got an ultrasound, and it confirmed that I did in fact have PMMA in my sack! The clinic I got the ultrasound from suggested I get a fertility test and it showed low sperm count, which very likely is linked to the presence of PMMA. On top of the $10k I’d already spent, I had to pay for these medical tests and consultations, none of which were covered by Avanti Derma.

I will need to figure out how to move forward with this...I believe this was probably a rare incident for them but it has shaken me and I feel frustrated with the whole situation.

Be careful y'all.

Can you include more information? 10% only is likely to get you the results you got. How many cc’s each round. What were your starting measurements. Any photos? I don’t see any other posts from you and this is in the forum guidelines category.

You’re right…posted in the wrong forum. I don’t have interest in posting my photos but I got around 18cc each time, though some leaked I believe.

@Longjourney raises relevant points.

A first-time poster (now two posts during the writing of this message) making claims of a complication that is virtually unheard of in my time Moderating the topic warrants additional scrutiny. Please in no way assume I'm dismissing or discrediting your situation, but it's within my responsibilities here to raise an eyebrow when something anomalous is posted (for those who are not Forum Veterans, this Forum has experienced its share of inauthentic or inaccurate posts for any number of reasons since its inception in 2010; so for the sake of ensuring information is of high quality & authenticity, and the peace of mind of thousands of men who have already had this done, it's my obligation to ask questions).

While it should be reiterated (something I post quite often throughout the Forums), no procedure is without risk, and penis enlargement is an elective endeavor. Every procedure under the sun, whether medical or dental, has a statistical probability of complication, and often times it's never made clear on whether or not the procedure (or materials involved in the procedure) had a direct or indirect impact on the development of a complication (in context to penis enlargement surgeries, an area still regarded experimental by many in medical circles, and still misunderstood by said-medical circles).

In my experience following this field, injectable phalloplasty, when performed by a skilled and experienced practitioner using medical-grade products, is a remarkably efficacious procedure. It also benefits from being conducted under local anesthesia on an outpatient basis. The nature of your complications are something I've heard about with silicone oil, but not so much (if ever) with PMMA. I personally find the idea that (1) the PMMA indeed migrated, and (2) it had any physiological impact on sperm production to be very unusual. I should note I'm not a Doctor, but I do possess sufficient background knowledge to at least discern the possibility & plausibility of such a thing, and while I suppose it is technically possible (and by that I mean a gap in my knowledge), I find the occurrence of both instances (1) & (2) questionable, necessitating a 2nd and/or 3rd opinion -- why? because you'd be surprised how many times I've read or learned about men relying on the diagnosis of a physician who has literally no idea what was performed or how it even works -- seeking the opinion of others who are familiar with the use of PMMA in the penis (be it for cosmetics or for revision) are best to ensure your sperm-count isn't associated with a multitude of other factors present in our day-to-day life known to have a similar effect (microplastics anyone??).

Would you be willing to post photos of the ultrasound and/or paperwork indicating the presence of PMMA in the scrotum (you can edit out any information that would compromise your identity of course)? Alternatively, it can be sent to This email address is being protected from spambots. You need JavaScript enabled to view it. where I can verify it to the Forum without posting it publicly. This can be done by having it confidentially analyzed by (unnamed but qualified) individuals to assess the degree of authenticity & accuracy. I believe I've earned the credibility & trust of this Community, I have no reason to disregard something that is extremely relevant and pertinent to this site -- it would be in my best interest that the Readership gets all the info available, the Good, Bad, and the Ugly. I myself have PMMA in me, so it would also happen to be in my own self-interest as well. By submitting something/anything to verify your claims, it will help to establish the legitimacy of this particular incident as a potential complication, even if exceedingly rare. On the flipside, we can also learn that a misdiagnosis took place and that a sperm-count decrease could easily be attributed to other factors, many of which are being analyzed given the dramatic drop in sperm-count in the past 4 decades. If these same pollutants have increased in our day-to-day lives, it becomes far more plausible that this continuing decrease would show itself up in test results. This doesn't even take into account aging, genetics, and lifestyle choices.

So what is essential at this stage is:

• Establishing your claims as valid ones, regardless of the merits or conclusions drawn from the test results.
• Establishing whether or not this is a potential complication (albeit rare given the sheer volume of Progress Reporting spanning over a decade), or a complete misinterpretation of the test results/diagnosis/prognosis/etc.
• Determining what can be done if it were indeed a real complication and were to occur again; perhaps identifying factors that could have lead to such an anomaly (scrotal-webbing comes to mind ??), etc.
• Or ultimately learning that correlation isn't causation, that seeking professional opinions of those without a background/understanding of these types of procedures can be riddled with misunderstandings, among other things, is a lesson that we can't jump to conclusions without demonstrable proof or overwhelming evidence.

I respectfully implore you to at least furnish enough information to satisfy the first bullet-point, it would do the Community a favor, and it would validate your warning(s), which you are well within your rights to do on this Forum. There are possible other avenues to verify your legitimacy without compromising your identity, but these assertions & speculations need to be validated before I move this to the appropriate sub-topic (ensuring information gathering remains of the highest quality for readers). I hope you have my sincere understanding.

Thanks for your thoughtful and detailed response. I’ll try to address your points as clearly as I can:

a. The ultrasound imaging was available via a link (so that I could share it with a Urologist for their opinion), but it happened six months ago, so the link has now expired. The Urologist (whose evaluation didn’t come with a written report from my memory) didn’t mention PMMA and said he doesn’t have the experience to make that kind of diagnosis. However, he noted there was foreign material in my scrotum, which is concerning (and very clearly PMMA given the circumstances). You don’t have to take my word for it—you can ask Dr. Morales, as she also confirmed that it was PMMA. The skin itself is permenantly thickened in certain areas.

b. You’re right that I can’t confirm the microplastics are causing the low sperm count. The Urologist mentioned that having any foreign material in the scrotum over time can't be good for sperm production but even he admitted he doesn't know. That said, I have no reason to believe PMMA in my scrotum wouldn’t be the cause, as I’m otherwise a healthy young individual and the PMMA is plastic inserted directly in my sack at far higher quantities magnitudes than anything that would occur naturally.

c. Regarding the lesson learned... I am not obese by any means, but I do have a large fat pad for some reason. I specifically requested that the area covered by the fat pad not be missed, as it would be visible when Erect. When trying to inject at the base, she accidentally went too far and injected into the scrotum.It’s a fairly easy error to make. Even at the time I could tell based on her reaction during the procedure that something went wrong but didn't say anything. I would encourage anyone with a larger fat pad to avoid making that request...Also don't talk during the procedure as it will distract them.

While I haven’t posted here before (I never felt any need to), I’ve been lurking for a long time particularly when first having concerns with this issue. In that time, I’ve seen at least a couple other reports from people saying the material leaked into their scrotum, so I know I’m not entirely alone in this—it does happen. I think Dr. Morales is skilled, but mistakes happen. I’m more upset about Avanti’s lack of support after making such a mistake (as well as only gaining 0.1 inches in my second round!)

Hello @jimmyboy ,
I cannot comment much on your results since I don't know your identity, but please read my preliminary comments.
As every member of this forum knows, results vary widely between patients and depend on many conditions, such as age, race, circumcision, and tissue laxity. I can post a more accurate comment once I can link this message to our actual patient.
Also, my comment cannot be factual because I don't have a report and images of your ultrasound; please note that I can always discuss it with your imaging service.
"Migration to the scrotum" is as vague as stating that you have a flaw in your skin. We need to know what structure(s) are affected and how they are affected. Is it the epididimus? the Vas deferens? the testicle(s)? or is it just under the skin? Spermatic cord? unilateral?, bilateral? I can go on, but wherever it could have migrated, I can reassure you that it is NOT inside the testicular tissue where the spermatozoids are formed.
An accurate diagnosis will require a biopsy to determine whether the PMMA is present anywhere in the scrotum. The ultrasound can show a mass but not the microspheres of PMMA. You mentioned having an extreme degree of swelling during your first procedure; in that case, another possibility for the ultrasound results could be that a hematoma occurred and hasn't fully resolved, giving the image of abnormal tissue in the area.
The only possible reason to link PMMA with decreased spermatozoid count is if both testicles were intentionally infiltrated with a large volume of PMMA; otherwise, there is no logical reason why this relationship could be possible.
Respectfully, I don't think you have enough elements to extend a warning.
I kindly ask you to contact us with your ultrasound results and your source of information about the effect of PMMA (if existing) in the area and the low spermatozoid count, which, by the way, is another condition that can have numerous causes.
Also, we have seen that once patients have injectable fillers, many link everything that goes wrong to the implant, forgetting that concomitant diseases can occur by themselves. I'm not trying to justify or ignore this situation, but I'd like to have an eventual closure with as many facts as we can produce. We will protect your identity in the forum but must provide the facts to the audience.
Finally, I am taking care of your case, so please keep our communication open and let Ian know when your emails are meant for me.
DrC

Hi Dr C,

I really appreciate your time. I am confident it is not a hematoma given that its been over a year and its still thickened (as well as the ultrasound results...). I will email you with more information. I will note that they found material in the testicle itself and could not confirm if it was Testicular microlithiasis or something else.

Wow, so sorry to read about your experience @jimmyboy

I would definitely like to know how this situation evolves @Skeptical_One , so if there's a way we can keep this thread active up-to-date, that would be good to know. I really appreciate @Avanti_Derma stepping up to help address these concerns, as valid as they might seem (for now). As a former patient, I just want to make sure I can continue to feel confident that I could go back to them for future procedures without any worries (beyond the usual).

Also - I just don't understand how it is they've performed 2 sessions and only gained about 0.1 inch?? They practically guarantee half inch gains each session ( although I know it's not guaranteed).

Odouble wrote: Wow, so sorry to read about your experience jimmyboy

I would definitely like to know how this situation evolves Skeptical_One, so if there's a way we can keep this thread active up-to-date, that would be good to know. I really appreciate Avanti_Derma stepping up to help address these concerns, as valid as they might seem (for now). As a former patient, I just want to make sure I can continue to feel confident that I could go back to them for future procedures without any worries (beyond the usual).

Also - I just don't understand how it is they've performed 2 sessions and only gained about 0.1 Inch?? They practically guarantee half Inch gains each session ( although I know it's not guaranteed).

Yes I can keep this post up for as long as the poster can verify their situation through me, Avanti Derma, or some other means. In no way am I suggesting dishonesty by any party, but rather, Avanti Derma's assertions that the matter isn't entirely conclusive leads me to hope that my requests to furnish whatever evidence or proof are reasonable, and this can be done through private channels that won't compromise anything or anyone.

I should note that if everything user jimmyboy says is true, this would certainly be an anomalous or rare case, and all elective procedures are susceptible to complication, even if very small. On the flip side, this could also be a learning lesson that there is more at play here than PMMA alone (or PMMA at all) if the conclusions were evidently of a different nature.

While it isn't common to hear, I myself had negligible gains my 2nd round via 10% (11cc's if memory serves me correctly, but I am not 100% on that) -- I suspect sometimes (for some people), 10% may not induce or trigger the kind of collagen we're used to from our initial round (or subsequent rounds after). And by negligible, my gain was about 0.1-ish as well and it wasn't until my 3rd appointment that a combination of 30% and 10% bulked me up. This has been reported by some users in the past, where low-to-modest volumes of 10% (especially in follow-up appointments) don't provide much yield, but it is a minority experience all Progress Reports Considered.

Lastly, Avanti Derma has more Progress Reports (by miles) than any other Practice I can think of with respect to penis enlargement anywhere on the web, and the sheer volume they have is bound to create some statistical likelihoods, most of which are relatively benign when considering other procedure types (think silicone oil and rigid implants). They have demonstrated a remarkably efficacy in a field marred historically by complication and incompetence. Whether or not this matter was a result of the procedure, it would be ludicrous to consider them any less safe or effective than any other Provider given the overwhelming abundance of satisfactory cases dating back a decade+ (food for thought).

I would like to see a resolution to this topic, especially my first point with respect to verifying the labs & images (which can be sent to Avanti Derma); it should also be noted that if there was migration, it would still require additional evidence to determine if it alone was directly (or mostly responsible) for sperm count reduction, since we've been seeing these trends in the male population well before the advent of injectable PMMA. For this reason, I have opted to remove the "Warning" tag from the Topic Title and replace it with a more accurate "Concerns," until hard facts are established. I'd hate to have to inject anxiety into the discussion when dealing with uncertainties, especially since the topic of PMMA is involved (although I know jimmyboy meant no ill-intent, and given his beliefs on what has happened, would be within his rights to issue said-warning; but now is not the time).

Now that Dr. Casavantes is taking over the case (coming out of retirement to do so no less), I'll do my best to stay out of this thread while they exchange information behind the scenes (as to protect everyone's privacy), and will allow either party submit any new revelations regarding this matter if they choose to do so. As I stated before, regardless of the outcome of this particular case, in no way would it impact Avanti Derma's Industry-leading reputation with respect to patient care, efficacy, and methodologies in my mind, and I suspect how they handle this case will be a testament to that.