Hello briceb, thank you for bringing up this common, yet poorly understood topic.
Here are some important facts about the glans:
- The glans is the distal end of the corpus spongiosum. A sponge-like tissue whose main function is to participate in the erectile process when it is filled with blood during the arousal.
- It is covered by the lamina propria, a thin layer of connective tissue that is found in many tissues like the digestive tract and others.
- Starting from the surface, we see the epithelial cells (epithelium), then the lamina propria, which in real life is of around ⅛ of an inch, then the corpus spongiosum directly connected to the vascular system. For obvious reasons, no fillers should be deposited there.
- Enhancing the thin lamina propria with soft tissue fillers is very tricky because of the risk of creating tissue necrosis and/or injecting the soft tissue filler into the corpus spongiosum, which is comparable to injecting it into a vein. In real life... how much can you augment a ⅛ inch membrane before destroying it?
- In a few words, we can create necrosis if we go too superficial.
- If we go deep, we will inject directly into the bloodstream, and we can create thrombosis and/or clog the spongy cavities of the glans.
For the reasons listed above,
1) We always use hyaluronic acid because the product is somehow safe if we go into the bloodstream (it dilutes), and the risk of thrombosis is low.
2) We use low volume because the thickness of the lamina doesn’t allow for considerable amounts.
3) I’m talking about 1cc. of HA, average, the results are mediocre, and they last probably a couple of months.
Using any of the microsphere-based bio stimulators like PMMA (Linnea), PCL (Ellanse), or CaHA (Radiesse) risk the added issue of promoting collagen formation and potentially worsening the risks mentioned before.
Please see the attached illustration that shows the lamina propria (LP), the epithelium (E), and corpus spongiosum (CS).
