PhalloBoards - An Online Community to Discuss Penile Girth Enhancement

samsmithms wrote: I am scheduled for a fat transfer for girth in November. I am not circumcised. The doctor will remove fat and then transfer it to the penis. He also adds Renuva to the fat that he transfers. Does you penis feel soft (squishy) to touch? Do the veins show up more in the shaft post transfer? Did you do penile massage several times each day after the transfer? How much of the fat do you feel you have lost post transfer? Do you you have prior and post measurements of penis girth? Sorry for all the questions but I am trying to absorb any and all the information I can gather. Thanks! Sam

First off, you should know that dermal fat graft is very different from a fat transfer, but I believe that with the knowledge I have obtained I can still give you some advice. Generally, circumcision is NOT necessary, but if you had past problems with phimosis some doctors performing phalloplasty will recommend it. I even saw some clinics that seem to insist on performing circumcision as a preventive measure. Anyway, you should not be concerned at all about not being circumcised, I believe.

Different clinics use different fillers, but I never saw any clinic that advertised combining different fillers. It would be interesting to read what more experienced members think about this? From what I read; I believe that is when complications usually occurred when people got many different kinds of fillers over a long period.

Because different fillers apparently have very different qualities, resulting in different outcomes, and possibly different complications that can arise. With some fillers, it seems that massaging the penis each day is mandatory even. Then with some other fillers, the need for massage is not even mentioned, but it says there is still a risk of fat moving and forming lumps. Again however, I believe this is least likely to happen with fat transfer, because the fat will be absorbed gradually.

Fat transfer seems to be the safest, but at the same time the results seem temporary, with much of the fat being absorbed. I read that 70% fat absorption is expected, and 30% fat can remain, but here is where the information I found is contradictory: some clinics claim it is permanent, but I read on way too many places that this is NOT the case, so personally I cannot believe the claim that the result would be permanent. I believe eventually all the injected fat will be absorbed.

It sounds like an interesting approach then to combine fat transfer with some filler. As for what filler is best, it is very hard to say. In the USA, Europe and Korea they all seem to use different fillers. I cannot even say what is the safest, and I doubt anyone can say for sure, because different doctors in different regions use different fillers and they will surely all say that their choice is either the safest and/or has the best results.

(9.) Do you have a preference for Renuva or Hyaluronic Acid (HA) for penile girth enhancement? If not, could you describe the pros & cons of each?
This question is not that simple to answer. If it were for myself personally, I would want to use Renuva. The main reason would be longevity. HA's are safe and have been around for decades. The results are very consistent and predictable (in the right hands). Renuva is still a fairly new product to the market and not that many people are familiar with what it is and what it can do. Ive been using it already for more than 5 years for aesthetic purposes in the face and body. Initially, I would use Renuva in male enhancement to "top off" a fat transfer procedure that I had already performed because Renuva causes your body to grow its own fat. Gradually I am using Renuva more and more for girth augmentation even as an alternative to fat transfer. It is extremely easy to use right out of the box. There is no liposuction needed to harvest ones fat which reduces the downtime and recovery from a mini liposuction procedure. During Covid supply chain issues caused a pause in the sale of Renuva, but in 2022 the inventory has been robust and without any limitations on accessing product. So Renuva game on!


(10.) Do you use a blunt-tip cannula or needle for injections?
95% of time I am doing this procedure I am using a blunt tip cannula. Either a 22 G 50 mm or 22 G 70 mm depending on how long the organ is. When I reassess and have to finalize and even things out, I connect a 27 gauge 1/2 inch needle that comes with the HA product and inject the remaining with a needle for fine tuning. For glans augmentation I use a small needle and only inject a maximum of 5 ml in 1 session for safety reasons.


(11.) What, if any, are the risks of filler migration?
The penis not a static organ like a chin or or ear. It lengthens, retracts, curves and reaches different directions when being used. With that being said, filler migration is to be expected. For the first month following a girth enhancement procedure, the product can be manipulated/massaged to even out any irregular distribution. After 2 months the product has almost fully integrated into the tissue so there is less change of moving things around. As long as the product is placed in the proper plane, this should not cause any issues such as migration of filler somewhere else and staying there long term.


(12.) How many sessions can a patient expect to achieve an ideal result?
This all depends on the budget of the patient and how quickly they want to achieve their goals. If they want full correction as quickly as possible, this can happen with a 1-2 fat transfer sessions. With HA fillers or Renuva, this can take several sessions and the goal can be obtained incrementally, which is not a bad thing.


(13.) What makes an ideal candidate?
An ideal candidate is someone who is circumcised, does not have any preexisting scar tissue, someone who desires mainly girth enhancement, and has reasonable expectations of reaching their goal. In many instances ones goals may change over time. For example, a patient may initially want to go from 3.5 inches in flaccid girth to 4.2 inches. This is 20% and visibly very noticeable. Its not KING KONG size by most standards, but they may enjoy that for a while and later want to go further and try to attain 4.8-5 inches in girth and be the king of the locker room. As long as one is doing this in a safe manner using safe products, this is the most important factor to consider.

I had dermal fat graft inserted and underwent ligamentolysis 6 weeks ago in Bangkok, and unfortunately I did not know about this forum pre-surgery. I also had a scrotal lift done at the same time, in addition to a procedure called selective dorsal neurectomy, which is well-known in the field of penile surgery in South Korea to increase the time to ejaculation.

I had not even researched penile lengthening and girth enlargement thoroughly before, because I thought it would just scare me, so I did not know about the various options. I wanted to believe that it was safe and low-risk, and hope for the best surgical outcome.

After reading like every post on this forum and PhalloBoards 2.0 related to dermal fat gtaft and ligamentolysis, I became quite worried about complications. There were some members of this forum who had their dermal fat grafts die eventually.

I will first summarize my impressions from what I read on this forum, and from different clinics and the studies I read, and then my own experience so far (6 week post-op):

Some of those forum members combined dermal fat graft with ligamentolysis. Ligamentolysis is commonly offered by clinics offering penile surgery in both the USA, Europe and Asia, but after reading a lot I think the procedure either did not do much or it had some undesirable side effect, hence the satisfaction rate is not high.

It seems however that the frequently-mentioned complication of losing penile support, upward pointing erection angle and having post-surgical penis retraction is greatly exaggerated, but many people seem to report a slight change in erection angle. I guess the surgical techniques might have been refined compared to when the first studies were made, but it still seems that satisfaction rate is not high.

As for dermal fat graft, many studies I found did not say it was generally bad, and the website of Dr. Gary Alter that I came across through this forum seems to sum up the general consensus pretty well: "The dermal fat graft procedure works very well most of the time and tends to stay permanently. However, some significant problems can occur, such as curvature and shortening"

The penile curvature and shortening seems to be consistent with what forum members here wrote when their dermal fat grafts started to die. They had their dermal fat graft removed eventually. Another possible complication I read about is that right after surgery the dermal fat graft might be rejected by the body, causing an infection and immediate need to remove it, but this seems very rare.

And a brief note on scrotal lift and selective dorsal neurectomy: scrotal lift seems quite safe, but it seems the recovery time can be greatly understated by surgeobs. As for selective dorsal neurectomy, it does seem rather scary when one reads about it, but supposedly the rate of complications is extremely low. The largest Korean study mentioned 0.4% reported erectile dysfunction. Many other studies come from China and report good results.

To summarize my impressions: in retrospect I might have considered fat transfer. Any kind of grafts whether dermal grafts or alloderm seem like they might need to be removed eventually. I know there is a general consensus on this forum that fillers are best, but I feel reluctant about that too, based on what I summarized from many different sources. Fat transfer might be absorbed very quickly, but it seems the safest option for short-term girth enhancement.

As I mentioned, ligamentolysis seems to have a low satisfaction. Selective dorsal neurectomy seems too invasive an option, with some risk that the nerves might be damaged. If someone wants to increase their time to ejaculation, there is dapoxetine available, which is considered to work very well as a pharmaceutical option.

And now for my personal experience 6 weeks post-op: after the initial swelling went down on the third week, I tried to use a penile extender to do stretching on the third week, but the penis was still too swollen. On the fifth week I tried again, and it was still too swollen. Some clinics wrote that after combining grafts with ligamenyolysis, it is a good time to start stretching on the sixth week.

Some people who underwent the procedure seem to have started stretching on the eight week. I plan to give stretching another try in the coming days, but I am not very optimistic that it will be possible at this time. Because I am not circumcised, it is also an issue at the moment to pull down the foreskin.

Contrary to what many people wrote after having underwent the same procedures, it seems my scars will heal completely, except on the buttocks where the dermal fat graft was taken. It is important to emphasize that the scar on the buttocks is likely to be very big, and it seems very unlikely to disappear.

At the moment I have some worries:

Penile retraction ( caused by inability to use penile extender and waiting a long time to do so)
Loss of penile support (ligamentolysis)
Loss of upward pointing erection angle (llgamentolysis)
Dermal fat graft dying
Inability to pull back foreskin
Continued penile swelling and pain
Possible nerve damage ((selective dorsal neurectomy)

My hope by posting here is that some people who underwent combined ligamentolysis and dermal fat graft might share their experiences, and hopefully it might calm my worries. If not, at least I can share my experiences in case someone has been considering the same surgeries.

The following are Q&A submissions from Dr. Tsay.

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(1.) How much girth/circumference can you achieve with girth enhancement?
Generally speaking, for our fat transfer patients, we can put upwards of 50cc’s of fat at a time, and patients can expect a 15-25% increase in girth in a single session. For example, if you start with a flaccid circumference of 4 inches, you could reasonably expect to go to 5 inches in circumferential measurement (which can be visually significant).

For dermal fillers, we don’t want to put too much in at one time. I generally like to cap that out between 10-15cc’s per visit. You’re going to get a mild increase in girth in one session. When you build upon that over multiple sessions, I find that 50cc’s (in total) is the sweet spot for the average size penis to really see a significant girth enhancement.


(2.) How long can filler injections take and what kind of anesthesia is used?
This procedure is all done under local anesthesia. I find that this is generally sufficient enough, and we also offer nitrous oxide (i.e. laughing gas) if you are at all nervous prior to coming in. We can also prescribe sedatives that will give you a calming experience throughout the procedure.


(3.) Can girth injections affect the function or sensitivity of the penis? What complications are there to consider?
Some of the common complications are bruising and swelling. This is usually self-limited and lasts 7-10 days. We usually recommend not to use the organ (penis) for at least one week after the procedure. Not only will the penis be sore, but there will be open wounds that need to be completely healed before resuming any sexual activity.


(4.) How does the newly girth enhanced penis feel?
We usually follow up with the procedure about 2-3 weeks afterwards, and at that time the swelling is gone, the bruising is gone, and you can really appreciate the final result from either the fat transfer or dermal filler placement.


(5.) Can you gain length from girth injections?
So the procedures (fat or dermal filler) don’t give you an increase in length per se, but more than half my clients who state they appreciate the increase in girth, also say that their flaccid length increases as well. So that is a beneficial “side effect” of girth enhancement.


(6.) What to expect with a procedure?
At Ageless MD, we offer a variety of different fillers, as well as fat transfer, to enhance the overall girth of your flaccid and erect penis. We also use dermal fillers to enhance and increase the size of the glans.


(7.) Can you tell us more about the use of Platelet Rich Plasma (PRP) to aid gains?
Many of our patients combine their penile enhancement with PRP. When that happens, the PRP has regenerative properties, so it increases the quality of the erection, the duration of the erection, and the sensation around the glans.


(8.) What is your preference of filler and/or brand?
At Ageless MD, we use a variety of different filler products to enhance the girth of your penis. The most obvious would be fat tissue; this involves a fat transfer via miniature liposuction from your lower belly. We process the fat to be micronized, and used in a syringe to be injected all along your shaft to increase your girth. I believe fat is the best filler, assuming you have enough to harvest for girth enhancement.

If you don’t have enough fat, there are a lot of other choices such as fillers made of Hyaluronic Acid (HA). There is also another filler called Radiesse that we use and that’s made of Calcium Hydroxyapatite (CaHa). The reason I like this filler in particular, is that CaHa is found in your bones. What better product that is already naturally occurring in your body, that we can use to put into the penis to mimic a firm, hard erection.

willy11 wrote: I was asked again to wait 6 weeks and see how it looks and feels. Remember, this is still not a treatment adopted or approved by the majority of doctors.

I agree about waiting out the 6 weeks and I wasn't endorsing the lidocaine theory, was suggesting it was plausible.

I would also challenge your assertion that this is "still not a treatment adopted or approved by the majority of doctors" -- that's because the majority of doctors aren't even aware of the decade long advancements made in penile enlargement via dermal fillers, let alone that the procedure exists. I've had people tell me that their primary care physician would have no idea what they were talking about during physicals when bringing up their enhancements, and I've heard this anecdote quite frequently over the years. And also let's not forget, the majority of doctors ARE familiar with the use of dermal fillers in general, which have been approved and widely used in other parts of the body with relative success.

This isn't in the experimental stage any longer, this stuff works. What must be stressed is that all cosmetic procedures are elective and aren't without risks. As a matter of fact, breast & butt jobs on women are performed casually nowadays & widely approved, and they still face plenty of risk & complication (possibly more so than penis enlargement via dermal fillers).

That's what we need to remember.

Keep us posted, I'm confident this issue will resolve itself -OR- be resolved through AD in due time. Good luck!

jassi31 wrote: Personally, I debated cosmetic surgeries in the past, things I felt I needed or wanted to look normal or pretty. Now I’m glad I didn’t.
Why should I go through pain and desensitisation just to be pleasing to someone else’s eye?

Just be careful to get a good Dr and read a good piece of material for information like Dr. Ghosh Medical Group to carry out the procedure, seen so many horror stories on this. Please do your research on the person and place carrying this out just to make sure you're not going to become one of those stories.

I do feel the need to ask, you know lip fillers desensitise your lips so the good sensations are basically nonexistent? Are you ok with losing that pleasure for appearance?

Well there have been hundreds of reports here (and thousands of anecdotes if you include the older site) from men with dermal fillers in their penis and the vast majority have not lost sensation. Those few who have lost sensation, it's been relatively minor, and in some cases, the increased surface area of the penis increased pleasure. But make no mistake, penile filler injections by & large have little-to-no impact on pleasure, and on the contrary, boost confidence which in turn can boost pleasure.

I'm not sure I understand your Dr. Ghosh link, was there supposed to be a link regarding a "horror story?" I'm confused.

And listen, if you don't think this is for you and you're comfortable with what you got, more power to you! This site is an information exchange for men interested in cosmetically enhancing their units, so this is not for every guy -- and THAT'S OKAY! If the research you gathered here made you conclude that this wasn't for you, the site did it's job. The PhalloBoards is meant to help men who may be interested to fulfill their decision making process.

Texas wrote: Note: For readers and future searchers: Not very many of the doctors doing fillers are discussing penile webbing and how it affects the fillers over ability to migrate and conversely stay in place better. I absolutely mean no disrespect in saying this/the following: They ( the doctors) may not be mentioning this because they do not know much about two things being related, they do not want to deal with it or the questions, and or they do not offer the services to fix this in the first place. No slights here, only facts. No problems per say either, but food for thought.
* I was in fact told by Dr Morganstern himself ( on a recorded call that I am sure they have ) and then Dr. Carney as well that I should get my Penis Webbing fixed prior to getting any fillers to ensure a better outcome. And subsequently it could make my look bigger too. lol. Like damn near everyone else out there, lol, I said fuck it and proceeded anyway without listening. lol. In turn, see my above comment, I did have some migration of my filler and a swollen sack and achy nuts. Now: Could I have achieved a slightly better girth out come? Could my product have stayed in place more ? Who knows.

This is actually a really important thing that I feel I will mention in my next discussions with Sponsors; it's very easy for Doctors injecting these fillers to not realize or dismiss the importance of how the webbing can act as a hinderance.

I'm glad you mentioned this, much like the cut-vs-uncut topics, there are things that can impact the aesthetic outcome of a filler procedure.

Texas wrote: On my very fist round Ellanse , 10ml, my sack got really swollen and discolored. I feared that some product had migrated down into there. I was later told that it would not be uncommon or impossible for this to occur if I wasn't ALWAYS stretched out and downward. After a video chat and me explaining the feeling of a hardish squishy type "material at the bottom of my sack, it was more or less confirmed that i had lost a bit of filler. Nothing bad to worry about, only sadness, hahaha. My overall result still matched the math as expected.
anyway, due to this my balls were pretty achy ( as yours were @aaarthur for a few weeks until the swelling subsided. the "material" also eventually went away as well.

Note: For readers and future searchers: Not very many of the doctors doing fillers are discussing penile webbing and how it affects the fillers over ability to migrate and conversely stay in place better. I absolutely mean no disrespect in saying this/the following: They ( the doctors) may not be mentioning this because they do not know much about two things being related, they do not want to deal with it or the questions, and or they do not offer the services to fix this in the first place. No slights here, only facts. No problems per say either, but food for thought.
* I was in fact told by Dr Morganstern himself ( on a recorded call that I am sure they have ) and then Dr. Carney as well that I should get my Penis Webbing fixed prior to getting any fillers to ensure a better outcome. And subsequently it could make my look bigger too. lol. Like damn near everyone else out there, lol, I said fuck it and proceeded anyway without listening. lol. In turn, see my above comment, I did have some migration of my filler and a swollen sack and achy nuts. Now: Could I have achieved a slightly better girth out come? Could my product have stayed in place more ? Who knows.

Thanks Texas. This makes me feel less nervous. I am still experiencing the pain on day 12.
Because of the pain I kept a retracted penis and got filler accumulated on bottom webbing. It is so bad. Anyway, I do not care the webbing filler now I just want the testicular pain go away.

On my very fist round Ellanse , 10ml, my sack got really swollen and discolored. I feared that some product had migrated down into there. I was later told that it would not be uncommon or impossible for this to occur if I wasn't ALWAYS stretched out and downward. After a video chat and me explaining the feeling of a hardish squishy type "material at the bottom of my sack, it was more or less confirmed that i had lost a bit of filler. Nothing bad to worry about, only sadness, hahaha. My overall result still matched the math as expected.
anyway, due to this my balls were pretty achy ( as yours were @aaarthur for a few weeks until the swelling subsided. the "material" also eventually went away as well.

Note: For readers and future searchers: Not very many of the doctors doing fillers are discussing penile webbing and how it affects the fillers over ability to migrate and conversely stay in place better. I absolutely mean no disrespect in saying this/the following: They ( the doctors) may not be mentioning this because they do not know much about two things being related, they do not want to deal with it or the questions, and or they do not offer the services to fix this in the first place. No slights here, only facts. No problems per say either, but food for thought.
* I was in fact told by Dr Morganstern himself ( on a recorded call that I am sure they have ) and then Dr. Carney as well that I should get my Penis Webbing fixed prior to getting any fillers to ensure a better outcome. And subsequently it could make my look bigger too. lol. Like damn near everyone else out there, lol, I said fuck it and proceeded anyway without listening. lol. In turn, see my above comment, I did have some migration of my filler and a swollen sack and achy nuts. Now: Could I have achieved a slightly better girth out come? Could my product have stayed in place more ? Who knows.

aaarthur wrote: I got Ellanse 10ML on 11 days ago at Avanti.
Since Day 6, one of my testicle starts to pain and it continues to day 11 now.
It is dull pain if not touching. But it like been kicked if touch or shake. Sleeping would make it felt better.
I thought it was bacterium infection and so did my physician. But anti-biotics does not help. I did blood and urine test and ultrasound. It mostly said normal except cysts found in scrotum.

So I guess it's filler related. Dr.
Morale said it could be swelling. But I have no swelling on penis now.

Any folks got the experience of testicle pain?
Many thanks. Now I am more nervous than painful and hoping it's not chronic.

I'm sorry to hear that, and I too hope it won't become chronic and probably won't be once you get a chance to read some of the links I posted below.

It sounds like these cysts are the culprit. However I've never once read a report connecting penile fillers to testicular cysts (or cysts in general), and I suspect it's a coincidence that you're experiencing them so close to a male enhancement procedure.

The reason I suspect this is because the filler gets injected into a dermal layer of the shaft and encapsulates; so my next line of questioning would be (1) why would it migrate to the testicles and (2) create cysts? Is it possible they are related, sure. However given that this would be the first time I've read of ANY filler leading to cysts in the testicle (or anywhere for that matter), leads me to believe this is coincidental.

I wonder if a biopsy can be taken of cysts in that location? If there were no traces of Ellanse, perhaps it could rule that out? Otherwise, testicular cysts are ailments men do experience independent of any surgeries they've had: here's something you can check out:
https://patient.info/mens-health/scrotal-lumps-pain-and-swelling/epididymal-cyst

https://www.nhsinform.scot/illnesses-and-conditions/sexual-and-reproductive/testicular-lumps-and-swellings#:~:text=injury%20or%20infection.-,Epididymal%20cysts,sometimes%20ache%20or%20feel%20heavy.

From my observation from speaking to girth enhancement patients and reading posts on Phalloboards, it seems to me that most of the men researching Phalloplasty or penile girth enhancement through the application of dermal fillers such as liquid silicone, PMMA, or hyaluronic acid (HA) dermal fillers, have the perception that HA dermal fillers are all the same. This isn’t necessarily true. I want to explain what could make "adverse events" or "complications" related to dermal fillers different from one H.A. filler to another.

First, it may be surprising to know that hyaluronic acid is simply groups of sugar molecules suspended in water. And what’s even more fascinating about hyaluronic acid is that it’s found in almost every tissue in the human body. You can think of our bodies as a pool of hyaluronic acid. Even more fascinating is that hyaluronic acid can hold 1000 times its weight in water. So it’s a sponge that can actually expand and gain volume once injected into the body. For this reason most of us don’t have reactions to hyaluronic acid.

It’s important to understand that not all H.A. dermal fillers are created equally. (Neither are all men…. Praise be to girth enhancement!). Hyaluronic acid dermal filler in its natural state would absorb very quickly once injected into the body. In order to give H.A. dermal fillers longevity, the dermal fillers must be “cross linked.” Cross linking of hyaluronic acid gives the filler it’s “thickness”, flexibility, and it’s longevity.

Typically each brand of H.A. dermal filler has its own patented and trademarked cross linking technology. This is what could make one technology of “cross linking” preferable for one dermal filler application over another. For instance in the face the injector might choose a thicker and more flexibility dermal filler for the lips and a thinner more malleable dermal filler for around the delicate tissue of the eyes.

I decided to write an article on this subject this past week after I corrected a patient from another provider (not on Phalloboards). I was forced to use hyaluronidase (the enzyme that "melts" hyaluronic acid) to dissolve the majority (90 - 100%) of the HA dermal filler that was injected into this man’s penis for girth enhancement. He was impossible to correct with additional H.A. dermal filler because this product used in him caused some inflammatory responses and left his with nodules and granulomas.

The patient was treated with an unknown (unknown to to him) H.A. dermal filler 3 weeks prior. The following day after the procedure the patient woke up with an incredible amount of inflammation, swelling, and tenderness. After being prescribed an antibiotic by a different physician, 3 days later there was no change. At this point he began to feel self described “knots” otherwise known as granulomas in his penis. He contacted PhalloFill - Dallas and we suggested he see a local physician to exam him for inflammation. A course of anti-inflammatory steroids were prescribed and the inflammation itself was resolved in about 5 days. He was left with golf ball sized lumps on all sides of his penis from the base to the glans on the entire length of his shaft.

Now I get to my point of the post. When choosing your provider for dermal filler it’s important to understand the differences in the H.A. dermal fillers that will be injected into you. I’m going to present you non-biased, factual information taken directly from the FDA. And I will conclude with a graph with references.

Primarily when researching H.A. dermal fillers in the US you will find 3 generally accepted H.A. dermal fillers in the girth enhancement community. Galderma products often known as the Restylane line of products, Allergan products often known as Juvederm line of products, and Revanesse which has one product called Versa. All of the Galderm/Restylane and Allergan/Juvederm products are 1.0 mL syringes. Revanesse/Versa syringes are 1.2 mL.

The graph I’m going to show you presents what we refer to as “events of interests.” Events of interest are important to understand when selecting your H.A. dermal filler because they do happen in real world. They include granulomas, hyper-sensitivity, inflammatory nodules, and non-inflammatory nodules. Other "events" that would not be considered of interest would be things like swelling, bruising, soft tissue injury, or improper injection technique.

Now to the good stuff. This graph took the last 595 total events reported to the FDA on Restylane Refyne, Restylane Defyne, and Restylane Kysse. The next section is Juvederm Vollure and Juvederm Volbella which also has the same exact cross link technology as Juvederm Voluma. And the 3rd section which is only one product is Revanesse Versa. The last section is 3 dermal fillers from a company called Teosyal which we don't see discussed much. I'm not sure I've ever seen Teosyal mentioned on this forum.

The most important column in this graph is the 2nd column. It shows how many “Events of Interest” were documented for each product in the last 595 total "events" reported to the FDA at the time this research was compiled.

The data from the FDA shows the following "Events of Interest" out of the last 595 reported for each product:

Restylane Refyne = 5
Restylane Defyne = 10
Restylane Kysse = 0
Juvederm Vollure = 145
Juvederm Volbella = 24
Revanesse Versa = 0

It should be noted again that Juvederm Voluma uses the same Vycross “cross link” technology as Vollure and Vobella.

I hope that this helps you understand that the potential girth enhancement patient should ask more questions of their potential provider than just the price, the number of procedures performed, and how many syringes will be injected per treatment. Be an educated researcher and know your H.A. dermal fillers.

Honestly any filler will do, it's a matter of communicating your desire to your practitioner on what you're trying to achieve: for example, those with "baseball bat" style penises will likely want most of the filler at the base, tapering upward toward the glans. This can be achieved with Hyaluronic Acid (HA), Radiesse, Renuva, (your own) Fat, Ellanse, or PMMA; in other words, all viable penile fillers.

LoriaMedicalReview wrote: You're right. I think he's only a dermatologist. He's promoting himself to a surgeon. Ha ha.

He doesn't care about his patients. He's just out to make another dollar. The man contradicts himself on his website. Supposedly, he's always been against the suspensory ligament cut. He probably should update his website. Here's information that is still on his website.

"Suspensory ligament cutting is a procedure that supposedly lengthens the erect and flaccid penile shaft. Loria Medical strongly disagrees with the claim that this procedure has any positive value. This procedure involves a major surgical operation that cuts certain ligaments located at the very base of the penile shaft near the pubic bone. This procedure typically yields not only poor results but may actually shorten your penile erect length. This procedure is supposed to increase the penile erect length; however, it fails to do this in the majority of cases and in the best scenario may increase the flaccid length by ¼ to ½ inch.
Suspensory ligament cutting is not recommended."

However, new Leep procedure now, which involves ligament cut and sleeve. Every surgeon that I have found online that does the sleeve or Penuma implant, does the insertion at the base. I'm with you, his method sounds pretty risky. I was definitely interested in flaccid gains with the sleeve, but I want to have a working penis.

People hate him now. This new procedure could be disastrous for him.

To be honest, I'm not even sure he's a Dermatologist. I think he's just internal medicine/family doctor type who got into hair restoration years ago, then realized the cash cow penis enlargement was and knew he could use fillers off-label. If he's an ACTUAL dermatologist, that'd be news to me... and would give dermatologists a bad name.

Anyways I just realized this was a Penuma thread lol so we should get back on topic. As for length loss, it's to be expected with the implant, despite claims that the weight of the implant will create new length.

penningbooks wrote: Hi there,

I'm someone whose Teosyal Ultimate has produced quite temporary results, requiring an expensive and unrealistic amount of maintenance. I am torn between waiting for complete dissolution before internationally seeking Ellanse OR receiving Teosyal Ultra Deep (TUD; the hardest HA) locally.

Has anyone had TUD? Has anyone heard any evidence that it would have superior longevity to softer fillers? The surgeon said it might, but I can't find any evidence that hardness = longevity. The Androfill site rates its longevity the same as any other HA fillers.

Curious thoughts, thank you!

I've noticed varying degrees of product dissipation; some guys see HA last a year while others 2+ years. A lot of it has to do with one's own physiology (the mechanisms by which your body breaks down and absorbs foreign bodies), otherwise these fillers would last the same for everyone. I'm sure other factors play a role like age, smoking, lack of collagen supplementation, those which I don't know. That said, I'm of the belief that the "formulation" (a.k.a. cross-linking) of the filler brand also plays role in structure (i.e. firmness) & longevity, and part of this forum's mission is to monitor which brands of HA present the best penile application (as opposed which brands are best for "wrinkles in an aging face").

Would you mind if I asked how long yours lasted? If I were you, I'd consider low volume of the Ultra Deep evenly along the shaft to test it out; there is no doubt the difference in "formulation" I spoke about will play a role in a better outcome, just how good I don't know. If worse comes to worse, then proceed with Ellanse.

Free Fat Transfer (FFT) is a surgical method in which your own fat is harvested for girth injections. However, not all candidates are ideal --> lean men, etc.

The evolution of FFT is based similarly to the advancements in dermal graft matrices --> you cannot overfill because if you do, the implant will not vascularize and integrate into the surrounding tissue, and thus will be absorbed/broken down over time, eventually leading to lumps and bumps. If you are to take a conservative approach and layer incrementally, you can extend the life of the fat implantation considerably, thus requiring less top-offs. It's also your own tissue making it relatively safe.

As for their contention of permeance, I simply have to take them at their word but I cannot say I know for certain its actual lifetime when "done correctly."

However one thing worth noting: Hyaluronic Acid (HA) and Ellanse are showing longer lifespans than indicated by the manufacturer. A circulating theory behind this is that the layer in which you get fillers injected into the penis have less lymphatics versus a place like your face, where dermal fillers are popular. These lymphatics are the pathways and mechanisms by which your body dissipates foreign material, and it could explain why fillers last longer in the penis than in the face (and faces are largely where the manufacturer's get their data from). One could possibly extend this theory to fat (when done correctly), but I can't say for certain as far as the physiology is concerned. In other words, this is just a theory/musing. This would be a question best aimed at Dr. Carney.

Speaking of which, here is his direct take on the matter:

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I was rather surprised hearing that the sentiment on the PhalloBoards is that an FFT is not a permanent girth enhancing procedure. Fat tissue that survives the transplant process is a permanent outcome. However, as I thought more about it the next day and realized why lots of people might not feel that way.

Surgically-speaking, a penile FFT is considered to be a fairly simple procedure. However, as you’ll soon discover it’s deceiving in that regard.

I regularly perform organ transplants in the hospital that are considered dangerous and overwhelming to some surgeons. I can tell you with assurance that an FFT penile procedure is far more challenging to achieve a successful transplant than most doctors and patients realize.

An FFT is a “transplant”, and like every other type of human transplant procedure, there’s a lot of places it can fail since we’re trying to move a living organism from one location to another. When a patient gets an FFT and ends up eventually “losing it all”, that simply means the transplanted tissue eventually died and was reabsorbed into the body as waste.

To succeed in this procedure, your doctor must get six points just right. Shortcomings with any aspect will affect the final outcome.
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The Right Patient: Not every man is a good candidate for an efficacious FFT. A patient has to possess the right proportion of height and weight. He needs to be fairly healthy as patients addicted to potato chips and comparable junk food usually have fat that won’t transplant with success. Significant obesity usually triggers a poor outcome. Men who’ve had a previous girth enhancing procedure utilizing a permanent man-made injectable like PMMA or Silikon are not good candidates for FFT unless that material is first removed since the injected agent blocks the tiny blood vessels in the penile shaft necessary to ensure the transplanted fat cells stay alive. Likewise, men beyond the age of sixty-five will almost never get a good result – regardless of overall health – as human fat rapidly degrades to a more viscous state after a certain age. Such fat tissue simply won’t survive a transplant. Finally, this is a surgical procedure that requires mild anesthesia. If a patient has health contra’s for anesthesia, this procedure won’t be a viable option.

The Right Harvest: Improper attention to delicateness during the adipose tissue harvest is another source of failure. The fat cells must be extracted in a quantity that will provide a size increase worthy of a surgical investment AND they must be kept flourishing during that substantial withdrawal. Fat cells are rather fragile and although damaged cells can be transplanted, few will survive over the long term in such cases. Exactly “where” the tissue harvest occurs is another source for disappointing results. You can’t extract fat from just any location and expect it to succeed as there are variations in the quality of fat tissue in different parts of the human body. Likewise, some fat material has characteristics more akin to subcutaneous penile tissue compared to other more pliable fat that can leave patients with a distinguished “squishy” outer finish.

The Proper Treating of the Fat: Once harvested, the fat must be reconstituted in a manner that will make it suitable for subsequent reimplantation. We use an FDA cleared fat transplant filtration system to optimize purity, but I credit Dr. Morganstern and his many years refining these procedures with developing a novel shaping technology that optimizes the reimplantation procedure. Again, during this particular process within the treatment is yet another incidence where the fat cells can become damaged and/or die.

The Fat Injection & Placement: Finally, the harvested fat tissue gets transplanted into the penis. The most common mistake I’ve seen in this aspect of FFT is with doctors using the wrong needle for a particular patient. There’s no such thing as a “one size fits all” in any aspect of phalloplasty. Also, there’s an art form to the distribution technique that when poorly executed usually results in unevenness or lumps within the shaft several months down the line. Another common error is when the surgeon attempts to add too much fat into a singular procedure. We understand most men want the biggest possible outcome in a singular procedure but if you add too much at once, it increases the likelihood you’ll eventually end up relinquishing almost all of the transplant. One other mistake I’ve seen is where the doctor agrees to perform too many congruent procedures along with an FFT. Certain procedures are notorious for triggering excessive hematoma which prolongs any healing process. Living tissue transplants stand little chance of long-term viability if the time window for healing is overextended.

Survive the 72-hour “Tissue Vulnerability” Window: Assuming everything I just discussed was performed to perfection, the number one reason most fat tissue transplants will fail to live up to expectation is because of a 72-hour post-transplant assimilation period. For about three days after post-procedure, the transplanted cells will be unable to access any life-essential blood supply. Some of the cells will almost always die during this nutrient-starving phase. We pre-treat the penis before each procedure with a patented device that Dr. Morganstern developed that triggers endothelial cell production for healing penile trauma / Peyronie’s disease. We found this technology bridges the lack of blood flow nutrients immediately following surgery to a level that minimizes the loss of viable fat cells.


Following Prescribed Aftercare: Given the delicateness of the vulnerable cells during transplant and variations in how quickly healing occurs between one individual and another, it’s crucial to follow any prescribed aftercare program indicated by your surgeon to ensure long term success. Regardless of how capable your surgeon and how well your particular transplant procedure came out, it can fail quickly if you don’t follow recommended post-operative care.

Finally, in fairness to the skilled phalloplasty surgeons out there performing FFT, I’ve had more than one patient show up in our clinic claiming to have “lost all his previous FFT” with another doctor. However, upon close examination, we discover many of them actually retained a life-lasting portion of transplanted tissue.

How does that happen?

Following any FFT surgical procedure, there’s going to be a good bit of swelling and bruising. It takes months for all that swelling to completely subside. Some men confuse this loss of fluid – which can double the girth of the penis – with loss of fat tissue and lose sight of their pre-procedure width.

We very recently introduced a new non-surgical fat-tissue transplant procedure that will result in most patients adding about a half-inch of girth from a treatment. One of the reasons I was particularly excited to develop this new technology was so we could provide a less invasive and affordable pathway for patients to achieve that “post-surgical swollen girth” that many men adore and get depressed over losing once all healing is complete. It’s worth mentioning that this new procedure is NOT well suited as an initial procedure for men already over seven inches as we’re restricted in the amount of transplant tissue we can successfully collect from this pathway.

Another FFT complaint we sometimes encounter is patients were left with palpable fat “bumps or nodules” in their penis in the months or years following surgery. It seems some of you are aware that our clinic is able to redeploy the same technology we use to break up fibrosis and plaque in the penis that’s commonly associated with Peyronie’s disease to resolve these nodules since we’ve had a number of patients visit from around the globe for such repairs who indicated they heard about us on the PhalloBoards. However, I want to be clear that 98% of such nodules associated with an FFT are not from “fat tissue”. Rather, they’re pockets of excess edema which became trapped during the post-surgical healing process.

Most FFT surgeons recommend massaging the transplanted tissue for a period of time following your procedure to help reduce the likelihood of this unsightly outcome.