TOPIC: One year after PMMA infection

The photos are from today, a year after the infection. There has been some improvement, but I'm not completely cured.

Look good

Looks great man!

I wanted to update my situation. I'm still experiencing inflammation. Yesterday, I started a stronger steroid regimen to see if it improves. I've started shockwave therapy on the fatty granulomas to try to relieve the pain. I'm very worried about the surgery to remove these fatty granulomas that formed after a fat transfer. Since I have PMMA that continues to inflame after the infection, it's unclear whether the risk of surgery would be beneficial. I have pain mainly where the granulomas are, but sometimes also on the base of the right side. These photos are from today. What does it look like externally?

Unfortunately, you can see in the photos how it changes shape when I'm sitting down, it looks like a hot dog; when standing up, it looks more normal. I had a therapeutic Circumcision, and among all the problems I have, I still can't accept and live with all this. Having never seen my Circumcised penis before the fillers, I don't understand if this change in shape based on the position is normal. Anyone who has PMMA and is Circumcised has ever seen this change in shape based on the position? I was used to seeing it longer and less hot dog-like before all this. It could be the inflammation that causes this, but I would like some opinions from the Circumcised men here on the forum. I'm attaching photos of how I looked before having two rounds of PMMA. Quale sembra piu’ naturale?

@Zep83 I'm so sorry to hear you are still dealing with notable inflammation and pain, but in terms of aesthetics, and this is in no way meant to diminish your situation or concerns, I think aesthetically it's pretty good for one who's experiencing complications. In fact some angles look great.

The instances where you get the "hot dog effect" is typical when the shaft girth is so large that it creates a disproportion to the glans (penis head). It's kind of like how a BBL on a woman is noticeable when it dwarves her thighs (which remain slender in comparison to her butt, when often times most naturally large derrieres tend to be accompanied with thick tapering thighs). Would you say this extra thickening is due to the inflammation you are experiencing, or has it always been that thick? Pardon me if you clarified before, but by inflammation, what exactly are you describing (Inflammation is a very broad term, especially when discussing phalloplasty).

Thanks for the updates!

Thanks for your reply and support. I never thought I'd be in so much pain. The inflammation is all over the PMMA. My skin is always red. If I touch it, it doesn't hurt. The pain is at the base of my penis, especially on the left side, where I have some granulomas that I'd like to surgically remove to try to relieve the pain, but it's not guaranteed to work. I had an MRI yesterday in preparation for surgical Removal, and I'll have the results in the next few days. According to all the urologists who examined me, the infection has cleared up, otherwise it would have reappeared after more than a year, with abscesses and pus-filled discharges that my body is trying to expel. In my case, surgical Removal has been ruled out, but I continue to have this burning and pain at the base. I know my body well, and there's something preventing me from healing. It could be an excessive inflammatory response from my immune system. The PMMA would only cause minimal inflammation, but after an infection, it could be more severe to keep the foreign body under control. Sometimes when I have excessive pain I consider surgical Removal, but the Urologist believes it would be devastating due to the possible scarring, deformity, and especially the loss of sensation. Plus, I don't think I'd be able to have sex psychologically anymore. The only positive thing in this hell is that I don't have pain during sexual intercourse.

Zep83 wrote: Thanks for your reply and support. I never thought I'd be in so much pain. The inflammation is all over the PMMA. My skin is always red. If I touch it, it doesn't hurt. The pain is at the base of my penis, especially on the left side, where I have some granulomas that I'd like to surgically remove to try to relieve the pain, but it's not guaranteed to work. I had an MRI yesterday in preparation for surgical Removal, and I'll have the results in the next few days. According to all the urologists who examined me, the infection has cleared up, otherwise it would have reappeared after more than a year, with abscesses and pus-filled discharges that my body is trying to expel. In my case, surgical Removal has been ruled out, but I continue to have this burning and pain at the base. I know my body well, and there's something preventing me from healing. It could be an excessive inflammatory response from my immune system. The PMMA would only cause minimal inflammation, but after an infection, it could be more severe to keep the foreign body under control. Sometimes when I have excessive pain I consider surgical Removal, but the Urologist believes it would be devastating due to the possible scarring, deformity, and especially the loss of sensation. Plus, I don't think I'd be able to have sex psychologically anymore. The only positive thing in this hell is that I don't have pain during sexual intercourse.

So I want to make sure I understand this: the heightened inflammation is where you believe the granuloma resides (at the base where you said the pain is), and that Urologists have concluded with certainty it is a granuloma and are generally against its Removal -- correct? Did you ever go in for a consultation with your Injector for an opinion, and/or did any of the Urologists involved ever reach out to your Injector to get their opinion?

You say your skin is always red, but I imagine that must be localized to the area around your base where the presumed granuloma is, and not the whole (or most of the) shaft, correct? Because most of your photos appear pretty normal, with the underside seeming a bit redder (but also the background lighting is poorer), and perhaps a patch at the top base of your shaft that has a slight purple hue in one picture, which I can't tell for sure to be frank, because in other photos the top shaft looks uniformly even and non-red in color.

Unless the Urologists you are dealing with have good knowledge with dermal-filler related granulomas (remember, Urology has many specializations), they may be relying on their medical intuition and little in the way of available information, since after all, penile PMMA granulomas are incredibly uncommon. You have to remember that: (1) penis injections are not mainstream, even with its increased popularity in recent years; and (2) granulomas are rare complications for those who do get this already uncommon procedure, making it even less common in the general population, never mind the fact that most who do have this problem often go to a handful of specialists around the country who have the experience and know the proper treatment options -- this means that it is very plausible a random Urologist could be unfamiliar with this kind of granuloma, and may be relying on medical literature that deal with granulomas elsewhere in the body, which may have different modes/methods/means of Removal (or how to assess if Removal is necessary). If your Urologist is of this variety, I would absolutely get your PMMA Provider's opinion in addition to a Urologist who HAS dealt with these issues before ruling out surgical Removal. If the Physicians you are working with now do have a good familiarity with these circumstances and/or have thoroughly consulted with your Injector, than disregard the multiple opinion matter as a necessity (although 2nd/3rd opinions can't hurt regardless).

Were any other treatment options considered if surgical Removal was ruled out? If this is a true granuloma, I imagine surgical Removal is a last resort anyways, typically something like Kenalog, or a combination of anti-inflammatories and steroids could help lessen the prominence (and by extension, potentially the pain) of the granuloma. And yes, something like Kenalog can and should be considered in the proper (lower-end) concentrations as a 1st or 2nd treatment strategy, so I imagined this was done to no avail? If they did it and it had little effect, I wonder if the Kenalog concentration was on the lower-end and they could perhaps amp it up just a bit (still safer than surgical Removal technically, as long as the Kenalog concentrations aren't exceeding the upper bounds of what's recommended in this case; it's a powerful corticosteroid and should not be used in a cavalier way, and in fact can potentially damage tissue if used improperly). If they haven't employed its use, I would strongly encourage knowing why, both in layman terms and in medical jargon (so you can share it here). This is me thinking aloud, I'm not a medical professional and my advice is that of a Patient Representative to the Community who has seen, read, and heard about complications and the nuances to their treatment(s) many of times -- in hopes that all bases are covered when you go in again to talk with your treating Physicians.

Often times avoiding Removal of something that isn't (1) health-threatening and/or (2) extremely debilitating, could be a discrete way for an unfamiliar or unacquainted Physician from wanting to be held liable for "making more of a mess than there already is," but not always of course. I just want to be sure you aren't living with pain needlessly because some Providers are more experienced than others with filler-related granulomas, and treatment decisions can vary based on familiarity. This is especially true when the infection is gone and the condition isn't sex-prohibitive. They may prefer just "pain management" and "some hope" the inflammation (and by extension, the pain) will dampen overtime through your body's natural processes (and these strategies can work sometimes).

Fortunately, I think your visual aesthetics are pretty reasonable given the presence of complications, and even better news that the infection is gone. Let's wait and see what the MRI results are, and I would like to know the answers to the questions above if you don't mind, it can definitely help enlighten others should they (hopefully never) have to deal with what is otherwise a very uncommon dilemma, and even rarer given the level of pain (I've usually heard of most cases involving discomfort or soreness to the touch rather than "so much pain" as you described it). Good luck!

Thanks for your reply. I'll try to describe the situation better. The inflammation is all over the penis where PMMA is present. The skin turned red immediately after the infection and has never returned to its normal state. The pain is mainly at the base of the penis, where there is no PMMA, but rather "granulomas" from an old fat transfer. The Urologist used this term, but I personally believe they are simply fatty nodules that have shifted to the base over the years and through sex. They have never caused any problems, and during my first two cycles, I informed Avanti Derma that I had some fat residue, and there were no problems before the infection in the third cycle. The Urologist would like to surgically remove them, but I'm not convinced because he's not sure the pain will improve, and I'm terrified at the thought of surgical Removal. Fat granulomas are less complicated than removing PMMA, but they still adhere to the connective tissue where nerves pass. PMMA is very close to that area, and the risk of reinfection worries me. Kenalog is no longer used as an injectable solution in Europe, and no Urologist I've asked can help me with this treatment if I need it in the future. If I touch the PMMA even forcefully by pressing, fortunately I don't feel pain and I can have sex like before all this but with the help of Cialis and Levitra to compensate for the excessive weight due to the inflammation and lymphatic impairment that makes the penis very heavy and does not help in the duration of erections during sex. If I touch the PMMA even forcefully by pressing, fortunately I don't feel pain and I can have sex like before all this but with the help of Cialis and Levitra to compensate for the excessive weight due to the inflammation and lymphatic impairment that makes the penis very heavy and does not help in the duration of erections during sex. These are photos before the infection and after the infection and Circumcision. Sorry for my english

I wanted to share the MRI results: Diffuse thickening of the skin tissue of the penile shaft with faint contrast enhancement but without obvious signal alterations, no fluid collections to be correlated with ongoing inflammatory processes. At the penile root, there is concomitant IR signal hyperintensity, hypersignal for high b values ​​(1000), and diffuse contrast enhancement of a nonspecific appearance involving the Corpus Spongiosum and cavernosa. No obvious signal alterations involving the didymas. No obvious lymphadenopathy. No free effusion in the pelvic cavity. Based on the latest MRI results, the Urologist determined that removing the fatty granulomas isn't necessary; it might not resolve the pain I'm having at the base of my penis. Hypothetically, the PMMA itself could be causing chronic inflammation after the infection and an excessive immune response, as if my body were trying to isolate the PMMA by inflaming it, as if it were fighting an infection or something it needs to control. According to all the urologists, the infection has cleared up. I've had several specific blood tests to assess any signs of ongoing infection, and the MRI also ruled out any ongoing infection. Unfortunately, I continue to live with constant pain, and beyond the steroid therapy I'm continuing, I've begun to partially accept that I'll have to live with it, hoping only for a miracle that will improve the situation over time.

Zep83 wrote: I wanted to share the MRI results: Diffuse thickening of the skin tissue of the penile shaft with faint contrast enhancement but without obvious signal alterations, no fluid collections to be correlated with ongoing inflammatory processes. At the penile root, there is concomitant IR signal hyperintensity, hypersignal for high b values ​​(1000), and diffuse contrast enhancement of a nonspecific appearance involving the Corpus Spongiosum and cavernosa. No obvious signal alterations involving the didymas. No obvious lymphadenopathy. No free effusion in the pelvic cavity. Based on the latest MRI results, the Urologist determined that removing the fatty granulomas isn't necessary; it might not resolve the pain I'm having at the base of my penis. Hypothetically, the PMMA itself could be causing chronic inflammation after the infection and an excessive immune response, as if my body were trying to isolate the PMMA by inflaming it, as if it were fighting an infection or something it needs to control. According to all the urologists, the infection has cleared up. I've had several specific blood tests to assess any signs of ongoing infection, and the MRI also ruled out any ongoing infection. Unfortunately, I continue to live with constant pain, and beyond the steroid therapy I'm continuing, I've begun to partially accept that I'll have to live with it, hoping only for a miracle that will improve the situation over time.

Damn, I'm sorry to hear that man but definitely glad to hear there isn't any infection that could cause more problems for you. I wish you the best of luck and hopefully some kind of solution presents itself for you.

Thanks for your candid and straightforward updating; on occasion guys come in with vague complaints and when questioned, either disappear, or provide what would often come off as complaints that are either overblown or arguably non-existent, the same kind of guys who will never be happy no matter how decent their results were. Then on the other hand, you have men who have no agenda, just a gut-felt responsibility to be a reminder to the Community that even popular methods are not without risk (like yourself), and this is commendable. And I hope these men (including yourself) utilize this Forum as both a place where they can express themselves with others (when it's probably not an easy conversation to have over Thanksgiving Dinner), as well as a resource to continue and find ways to remedy their situation.

What you're describing now is far more consistent with a localized, chronic inflammatory response around the PMMA, which can absolutely happen after a prior infection or immune “activation.” These reactions sometimes take months (many months even) to settle down, and the body often does slowly recalibrate and reduce its inflammatory signaling over time, especially once the infection trigger has been removed. Our body's have a remarkable way to alleviate & heal, especially if an ailment or illness isn't persistent (e.g. the spreading of an infection).

And while I'm in no way downplaying your condition, I will say the fact that you can still have sexual intercourse pain-free is a silver-lining if there were to be any!

Keep us posted as necessary, but for now my recommendation would be to begin reducing how often you visit the site (I'm not sure how often you do, but this is advice I give to most people who are in the healing/recovery stage, regardless of the complication or procedure type); it's the best thing you can do for your state-of-mind. I've learned that men who are undergoing treatment and/or are trying to heal can exacerbate their issues by rabbit-holing their concerns through many topics which may have little-to-no bearing on their own situation. This can create a negative feedback loop, and that is not the purpose of this Forum, but can be an unintended occurrence for guys who are dealing with a challenge/complication. The PhalloBoards is a place for Community, Physician & Patient Networking, and of course, Research & Education.

Healing is both physical & mental. And when I said to reduce consumption of the Forums, that isn't to say you shouldn't visit from time-to-time, only reduce said-visits. Whether it's to provide us an update you believe is important, or maybe to see if any developments have been made that could benefit a case like yours... but for now just stay the course and try to focus on other areas in life that you feel could use improvement; hopefully making progress in one direction in life can curiously create paths of progress in other directions, especially when you least expect it.

Best of luck.

I wanted to ask if there have been any cases here on the forum of lymphatic stasis after PMMA cycles that caused nerve pain and extra weight. I'd like to discuss this with anyone who has had this problem. Thanks.

Please elaborate on “weight”. Did u mean overall body weight or weight of penis?

Sorry if I didn't explain well. I live in Europe and use a translator. My penis has significantly increased in weight. This happened during the infection after my third cycle of PMMA. During the infection, the immune response created a lot of edema due to the lymphatic fluid. Unfortunately, it never completely reabsorbed. My penis deflated but remained very heavy. Numerous checks have shown no further infection or inflammation, but I still have pain at the base, which could be due to lymphatic stasis putting pressure on the nerves. I asked whether PMMA can cause lymphatic stasis, and not all doctors agree. I wanted to know if anyone else had a similar situation before me, and hope there's a treatment available to improve my health.