PhalloBoards - An Online Community to Discuss Penile Girth Enhancement

First of all bone cement is absolutely different from any pmma tissue filler injections :-

Bone cements are supplied as a two-component system, consisting of a powder and a liquid, which are mixed and delivered to the implant site during the surgical procedure. The powder portion contains approximately 90% by weight polymer (PMMA) beads, the remainder is typically composed of benzoyl peroxide (BPO, free-radical initiator) and barium sulfate (BaSO 4 ) or zirconium dioxide (ZrO 2 ), both of which are radiopacifiers. The liquid portion contains three basic components: MMA (approximately 97 % by volume) monomer, N,N-dimethyl-p-toluidine (DMPT, free-radical activator), and hydroquinone (HQ, free-radical scavenger).

So with this conc. it has been used as we know in orthopedic surgery and dentistry.

So the only way if we need a harder pmma graft ---> the beads has to be closer to each other i.e. a higher conc. .

That was the reason why they made the highest conc. for pmma as a tissue filler 30% only and not higher than this - e.g. 40-45% pmma will be used for reconstruction of bone defect (e.g. frontal bone) :-


NewPlastic®, was developed in Porto Alegra, Brazil by Dr. Almir M. Nacul. Dr. Nacul is in clinical practice and is recognized as the inventor of Bioplasty (soft tissue augmentation with fillers) and has authored a medical textbook and many articles on soft tissue augmentation with PMMA. NewPlastic is the commercial name for a series of PMMA, products with microspheres of 40 to 60 microns, in different concentrations. These products are currently available as 2%, 10% and 30% concentrations of PMMA in a vehicle of 98% 90% and 70% methylcellulose, respectively. Dr. Nacul is also developing a 40-45% concentration for specific reconstructive applications where a denser implant is desired.

www.facialwasting.org/products.htm

As we know after few weeks post-pmma injection ---> our body will produce new collagen (i.e. scar tissues surrounding each bead) and the texture of the connections between these multiple scar tissues will be very important in determining the firmness of pmma graft .

So lets think about it this way e.g. 45% pmma conc. will give you a hard pmma-graft like a bone after few weeks i.e. the small multiple scar tissues forming around each bead are connected and fixed to each other so firmly like one piece and forming almost one big hard scar capsular tissue. So that means the connections and the bindings between these multiple small scar tissues are very important and the degree of firmness of the graft will depend on the texture of these connected fibrous tissues.


In regard of the other conc.\'s (2%,10@ and 30%) as a dermal filler will they become harder after a long period ?? I.e. will the connections and the bindings between the multiple small scar tissues surrounding the beads change in their texture and become harder later on and become almost like the 40-45% ?? The answer imo is NO ; the maturity and the end-stage of scar tissue formation is usually between 6-12 months in adults.


If you ask anyone who had penile pmma he will tell you the pmma feels softer in flaccid and firmer in erect and that is what my penile pmma (30% metacrill) still feels like after almost 4 years (actually this coming Oct. will be my 4th anniversary) and it had never changed or become harder.

@fran berlin,
We are very grateful that you have shared your story with us, and we are here to help and support each other, so your story and anyone else, IMO the negative results will be more important than the positive ones and they will be v. beneficial for all of us, so you should expect many people here in the forum will ask you many questions and to know more about your past-penile pmma history and that is normal and expected.
Thank god that you are happy now and I wish you the best in your future life.
If you don\'t mind fran and I will be v. grateful if you can share with me the following points (I think you have now fair amount of knowledge about pmma) :-
1- I read that your treating doctors in your big city (I expect it is Berlin) said pmma could cause cancer in your tissues (a pre-cancerous product??) :-
* We know that PMMA was used in our body since around 1940\'s e.g. Intra-ocular lens and also in bone cement for joint prosthesis so if it was really a cancerous product we should read about it long time ago, and it would never be used as a filler in our body. And I am sure (as you have mentioned before) your doctors know about PMMA and it was invented as a dermal filler by a german Prof. G. Lemperle in Frankfurt in 1989, so if PMMA can cause cancer ---> Lemperle would not have the approval from the german health authority for this product to be used in Germany 1989-1991 and the rest of europe / in 1990\'s in Canada and in USA- FDA approved in 2006.

* You have mentioned :-
I can answer here and give you the opinions of my doctors.The technique used is not the most important here. What is important: how does your body react to foreign product?For some people, it is well accepted, for others no. It is the same idea as an organ transplant... there is always a risk of rejection, but will not happen to everyone. The same with mammary prothesis, some womand reject it and 1 hour after the operation, they they to be opened again to take the prothesis off. So, the body reaction is what is important, more than the product itself (I cannot give you more details here, and I am sorry for this...)

The technique of the doctor and his experience in pmma injection are very important in regard of pmma complication than the product per se, that was the statement of many doctors who have great experience in permanent fillers e.g. Dr. S. Cohen and I have also posted in this thread a paper which prove that. They have always said the doctors have to be trained for permanent filler injection before they use it e.g never inject pmma superficially also use a blunt cannula and not a sharp needle and a funnel technique injection and never inject pmma while inserting the needle.
In regard of rejection of any implant in our body and not only in the penis there will be symptoms and signs for that (e.g. tenderness, diffuse oedema (swelling) over the whole implant i.e. Biofilm formation and not only localized in a small area and the rest of the implants ia normal , fever, redness of the skin over the implant and eventually skin breakdown and extrusion of the implant. And these didn\'t happen to you, please correct me Fran if I am wrong.
So if you had only nodules and lumps with different sizes with no pain, no redness of skin and no diffuse fluctuating swelling (fluid) of the penis-cellulitis and no high temp. ---> so you had only multiple nodules and different size-lumps ---> bad aesthetic result and asymmetry of your penis ---> due to clumping of the pmma beads in different parts of your shaft and not distributed evenly along the shaft ---> the reason for that is the technique of your treating doctor +/- you didn\'t massage your penis esp. if you did notice irregularities in the 1st 24hrs + the weak carrier (cellulose) of the brazilian products.

* Fran did your treating surgeon remove the whole pmma in your penis or only the bulges + the lumps ?

I am really happy for you now after you have mentioned that you are ok and fine.
SM

Complications After Polymethylmethacrylate Injections: Report of 32 Cases
Plastic and Reconstructive Surgery. 2008;121(5):1811-1820.Alessandra Grassi Salles, MD, Priscilla Helena Lotierzo, MD, Rolf Gemperli, MD, J'lio Morais Besteiro, MD, Lu's Carlos Ishida, MD, Rodrigo Pinto Gimenez, MD, Jorge Menezes, MD, Marcus Castro Ferreira, MD.
Over the past 15 years, polymethylmethacrylate (PMMA) injections have been used for soft-tissue augmentation. However, there are insufficient data relating to complications associated with dermal fillers containing PMMA.Salles and colleagues examined 32 patients (average age, 43.6 years) with complications following injection of PMMA fillers. Complications were classified into five groups according to the main presentation: tissue necrosis, granulomas, chronic inflammatory reactions, lip complications, and infections. Results:Five patients presented with tissue necrosis after injection: two male patients had skin and subcutaneous necrosis of the penis after injection for penile enlargement; one female patient had necrosis in the right ala and nasal tip after injection to improve nasal tip projection; two female patients had necrosis of the nasal alae, nasolabial fold, and superior lip after injection for nasolabial fold correction.
Ten patients developed severe granulomas starting 6 to 12 months after PMMA injection.
Ten patients had a chronic inflammatory reaction beginning 1 to 10 years after PMMA injection.
Six patients developed lip complications, including stiffness, lymphedema, and nodule formation after PMMA injection in the lips.
One patient presented with infection (hyperemia, edema, and pustule formation 1 year after injection).
The authors concluded that complications arising from PMMA injections are rare considering the number of successful cases noted. However, they emphasize that these complications are severe, permanent, and difficult
or perhaps impossible to treat. Therefore, safety guidelines1-2 should be observed when using PMMA for soft-tissue augmentation.

Link from above:

Complications After Polymethylmethacrylate Injections:
Report of 32 Cases
Plastic and Reconstructive Surgery. 2008;121(5):1811-1820.Alessandra Grassi Salles, MD, Priscilla Helena Lotierzo, MD, Rolf Gemperli, MD, J'lio Morais Besteiro, MD, Lu's Carlos Ishida, MD, Rodrigo Pinto Gimenez, MD, Jorge Menezes, MD, Marcus Castro Ferreira, MD.
Over the past 15 years, polymethylmethacrylate (PMMA) injections have been used for soft-tissue augmentation. However, there are insufficient data relating to complications associated with dermal fillers containing PMMA.Salles and colleagues examined 32 patients (average age, 43.6 years) with complications following injection of PMMA fillers. Complications were classified into five groups according to the main presentation: tissue necrosis, granulomas, chronic inflammatory reactions, lip complications, and infections.
Results:Five patients presented with tissue necrosis after injection: two male patients had skin and subcutaneous necrosis of the penis after injection for penile enlargement; one female patient had necrosis in the right ala and nasal tip after injection to improve nasal tip projection; two female patients had necrosis of the nasal alae, nasolabial fold, and superior lip after injection for nasolabial fold correction.
Ten patients developed severe granulomas starting 6 to 12 months after PMMA injection.
Ten patients had a chronic inflammatory reaction beginning 1 to 10 years after PMMA injection.
Six patients developed lip complications, including stiffness, lymphedema, and nodule formation after PMMA injection in the lips.
One patient presented with infection (hyperemia, edema, and pustule formation 1 year after injection).
The authors concluded that complications arising from PMMA injections are rare considering the number of successful cases noted. However, they emphasize that these complications are severe, permanent, and difficult or perhaps impossible to treat.
Therefore, safety guidelines1-2 should be observed when using PMMA for soft-tissue augmentation.

It could be Dr. A. Carruthers is using Silicon injection because it has a less serious complication or less frequent???? from FBG formation than PMMA :-
www.realself.com/question/are-silkion-10...used-butt-augmentati
They have mentioned FBG after silicon oil injection would be nearly impossible to treat.
The adverse effects of liquid silicone injections :- have included movement of the silicone to other parts of the body, inflammation and discoloration of surrounding tissues, and the formation of granulomas (nodules of granulated, inflamed tissue).
So Dr. A. Carruthers think silicon oil injection is safer than PMMA as a volume enhancer

---

> so could it be better to use it in penile injection instead of PMMA
@eq- you have said (( If you don't believe that granulomas is a serious complication just say so and move on.))

IMO if a complication like e.g. a foreign body granuloma from any filler is a serious complication --->e.g. from using the temporary filler (e.g. Hyaluronic acid) and esp. permanent fillers ---> so that mean the whole world should stop using them ???

Are we smarter than FDA in regard of FBG (as a serious complication ??)(e.g in Artefill which has the lowest chance of FBG formation but even that FBG had happened with Artefill) if it is so serious and untreatable would they give the Approval ??? Wouldn\'t we think they would remove it from the market if FBG was so serious ??

@eq
In this study he mentioned :-
Practitioners will need to learn how to use this exacting agent and will obtain excellent results with careful use.
Background. Polymethylmethacrylate microspheres/collagen has been used in Canada since 1998. A closely related product will probably be approved in the United States shortly. Concerns have been expressed about the use of permanent fillers such as this.Objective. This retrospective study of the authors\' clinical practice is designed to reflect their experience with this agent. In particular, the authors describe some of the problems they have seen.Results. Polymethylmethacrylate microspheres/collagen has behaved as a satisfactory long-term tissue augmenting agent in the authors\' practice. They have had the opportunity of managing any number of patients with Artecoll granulomas and describe these patients.Conclusion. When polymethylmethacrylate microspheres/collagen is introduced to the United States, practitioners will need to learn how to use this exacting agent and will obtain excellent results with careful use.
So he emphasized the doctors should be well trained for any permanent filler (e.g.PMMA) ---> to reduce the risk of any complication. As far as I remember he mentioned also PMMA granulomas disappear after 3-5 years by itself ! (Carruthers)
BTW he was talking in this study about Artecoll and not about Artefill
About what I have mentioned \"Silicon oil injection\"(a permanent product) that he is using in HIV-patients with facial lipodystrophy and also the chance of FBG formation from it , I think it is important point because he mentioned as you said FBG is a serious complication from any permanent filler.
So we know FBG can happen with any fillers (including pmma) so I am only wondering if FBG is a serious complication?? why is he using a permanent product which (not FDA approved for HIV-Patients as a facial filler) can also cause this serious complication as he stated.
I have never said there is no chance of FBG formation from PMMA injection , but the thing I and also most of us here want to know if FBG is a serious complication from a permanent filler (as you have mentioned before:-It's very clear that the medical community certainly considers granulomas a very serious complication of permanent fillers (PMMA). Even the staunchest proponents of Artefill considers granulomas a serious complication, some like Alastair Carruters who were amongst the leaders in championing Artefill have since done a 180 based on the number, severity, and treatment efficacy of real world granulomas. www.entrepreneur.com/tradejournals/article/135215598.html why is he using another permanent product which can cause the same serious complication?? Do you still think I should not bring the topic about Silicon oil injection he is using ??
And I think it is a great idea what you have mentioned :-\"I think it is a good idea to start a new thread comparing the risks and complications of the different enlargement methods if that is your goal. I would certainly be interested in reading any real data posted in such a thread.\"
I will do my search and I need your help and the others too --> to find a product (for penile girth enhancement) which has:-1-The lowest risk of any complication.2-Permanency.3-The best aesthetic result.4-Lower cost.

darkstaff wrote: Thanks for the support guys.

I\'m concerned that my doctor has no idea what PMMA is, and has no capacity to include a related cause within the scope of his diagnosis.

The good news is that I have no issue with my penis ... it seems to be fine... so I\'m hoping there is no relation... and instead is just a crazy coincidence that my health went south a few months after my procedure in June.

I had a CT scan with contrast about a week and half ago ... the complaint was pain in my abdomen, and pain when I took a full breath of air (pain on my left chest wall) ... it came back clean.

I got a copy of the CT scan, and it showed the penile area, and guess what ... I didn\'t see anything that would indicate PMMA ... is this normal? .. does PMMA not show up on CT scans? (Anyone know?)

Thanks!
Dark

The actual beads are a small percentage of the new tissue. It\'s not like silicone or other fillers. PMMA is particulate, so it probably wont show up.

But don\'t go getting this stuff removed. It will be a nightmare to cut out and even then I doubt they\'ll remove it all.

Also, given that only 3% of the beads are even smaller enough to theoretically migrate, then that means at the very most, 0.06 cc of PMMA could have migrated. Obviously that wont be the case, as not all that could have would have. In fact it\'s unlikely any has. When you consider all the other particles that get moved around the human body, I still don\'t get the worry of PMMA migrating. Obviously if it\'s injected directly into vessels at the point of injection, then we\'ve seen this can have tragic consequences, but the chances of this are close to zero when using a micro cannula. I just can\'t imagine the CIA have PMMA beads in their arsenal for assassinations.

IMO most of the plastic surgeons and urologists will refuse to do any penile enhancement procedures ( injection with temporary or permanent products OR phalloplasty with other girth material ) even penile exercises they will tell you don\'t play with such a dear part of your body ( they are right it is better to have a healthy, functional, thin and short penis than to have a non-functional thick long penis ).
So Dr. D. Cassuto\'s reason for not having a permanent fillers injected into our penis is because of Foreign Body Granuloma formation and it\'s management.
The most important Q. is :- Is FBG a serious complication or NOT ?? If the answer is yes ---> it means also the other temporary fillers he listed them are also dangerous and they shouldn\'t be used in the body and not only in the penis , I would like to know why did he treat the temporary fillers ( e.g. collagen, Puragen-HA and Matridex) (some of them as we know will be absorbed completely within 6-8 months) with the laser which is painful and can cause permanent scarring, that was his words????
He might say that these are temporary fillers are safer than the permanent ones but he still used the same treatment (Laser with its complications) for both types ???
In fft injection you can have also FBG which if local treatment ( antibiotics and steroids) has failed, it has to be removed surgically ( they have mentioned also in this paper :- The fat has to be refined and the technique is very important (as in pmma) )
bjo.bmj.com/content/early/2010/11/01/bjo.2010.180547.abstract
BTW Dr. S. Cohen said the best treatment for FBG is just leave it it will resolve spontaneously.
The chance of having FBG in the worst pmma generation (Arteplast) was high (2.5 %) and since 1994 they stopped producing it. In (Artecoll) the 2nd generation the chance of having FBG is around (1:5000).
I think the worst thing about PMMA is if you decide to remove it totally for any reason (which can be only by surgery) ---> the chance of skin necrosis is high.
So anyone who decide to go for PMMA penile injection ---> he shouldn\'t go for a big volume.

www.realself.com/question/penile-girth-enhanced-ha-fillerBad experience with other fillers makes everyone gun shyThere was an article in Plastic and Reconstructive Surgery several months back about use of another filler, Artecol, in the manner you described in South America. The complications were disasterous. Skin loss, extrusion of the product, I don\'t think I need to go on...You are 100% right, we have changed our philosophy on the tear trough but, it took a long time to do so. Whether its autologous fat or an off the shelf filler, no surgeon wants to deal with the potential complications this presents.