TOPIC: Dr. Sullivan FAQs! Board Certified Dermatologist Answers Questions about Fillers

The following questions are in bold followed with answers authored by Dr. Sullivan:


How much girth/circumference can you achieve with girth
enhancement injections?

Basics:
The average flaccid girth: 3.5 to 4 inches and erect 5 inches. Most men are
looking to gain 1-1.5 inches.

Results:
A single session typically involves the injection of 5 to 15 syringes. Best results
for most patients come after 15 to 30 syringes over 1 to 4 sessions. After each
session, you can expect an increase in girth ranging from 1/4 to 1/2 inch. After
several sessions, total enhancement ranges from 3/4 to 1.5 inches. Some patients
may wish for more than 1.5 inches but be aware that as the girth increases the
naturalness of the look decreases.


How Many Sessions can a patient expect to achieve ideal results?

Most patients have great results after just one session, but 2 to 3 sessions may
be required depending on your goals. Some patients, thrilled with their initial
enhancement, opt for additional treatments. Spreading treatment over multiple
sessions allows for more fine tuning of the symmetry. It is important to avoid
over-filling during a single session. Stacking enhancements across multiple
sessions seems to produce the best results. Fifteen to thirty cc or syringes is
usually the optimal number for significant girth enhancement for the average-
sized penis. Remember your starting point matters. A man starting with a girth of
3 inches and achieving an increase of 1.5 inches has a 50% enhancement, if you
start with 5 inches and gain 1.5 inches there is a 30% improvement.


How long can filler injections take and what kind of anesthesia is used?

Typically, the procedure is completed within 30 minutes. The initial visit may be
an hour. This extra time is essential for completing patient intake paperwork and
conducting a comprehensive consultation.

I use a combination of topical numbing and a dorsal penis block. The dorsal penis
block involves administering a local anesthetic to the base of the penis, rendering
the entire penis numb. Patients experience almost no discomfort during the
procedure.


Can girth injections affect the function or sensitivity of the penis? What
complications are there to consider?

This is an important question. Most patients report either unchanged or
enhanced sensitivity with girth enhancement. Where does the enhanced
sensitivity come from? I believe some of it is from being more confident. So much
of sexual pleasure is mental, and feeling good about yourself is key to good sex.
Importantly with increased girth there is increased friction thus improved
sensation for you and your partner.

Potential Risks and Side Effects:
Bruising/Swelling - It is common to experience bruising and swelling post-
procedure. This may last for 1-2 weeks.

Discomfort - When the anesthesia wears off, there may be mild discomfort. This is
treated with over-the-counter anti-inflammatory medication.

Infection - Infections are rare, but as we are breaking the skin barrier and
introducing a foreign substance it is a potential risk.

Lumps/Unevenness – There may be lumps or unevenness especially in the first
few weeks. This usually resolves on its own. If it does not HA fillers can be
corrected using a small amount of hyaluronidase. Occasionally unevenness may
require an additional syringe or two. Some men have natural folds in their penis
due to how it is positioned in their underwear. This can cause the filler to kink or
crease. To mitigate this, we use dressings in the first week, but despite our best-
efforts creases can still form, necessitating a touch-up.

Delayed-onset Nodules - Delayed-onset nodules have been associated with both
PMMA and HA fillers. With HA fillers, these nodules can be dissolved entirely, but
PMMA nodules may prove more difficult.

Vascular Necrosis – This is where the filler is inadvertently injected into a blood
vessel. Although most affected individuals make a full recovery without lasting
scars it is an important possible serios complication. Girth enlargement is a
medical procedure and all procedures have possible serious complications.


How does a newly girth enhanced penis feel?

Great! It’s like driving a new car. The enhanced girth offers a sensation that is
amplified for many men. There's a subtle difference in how the penis feels
compared to before, but it remains discreet, detectable mostly only to yourself.
The injected area might be marginally softer, usually if larger volumes are used.
Usually, partners don’t notice a change in firmness; they do notice the change in
girth.

Consider many intimate toys have trended towards a softer exterior, for
enhanced comfort, a little bit of softness may be more comfortable for partners.
Also consider, the penis doesn't just gain in volume but also in weight, giving a
more noticeable hang when naked and in clothes. Most men really enjoy this
heavier feel and get a great boost in self-confidence.


How long can you wait before resuming intimacy or strenuous activity?

To prevent infections, it's advised that patients wait between 5 to 7 days after the
procedure before engaging in sexual activities. This period allows for adequate
healing and reduces potential complications. After 7 to 10 days sex and
masturbation are okay and might even assist in reducing any post-procedure
lumps. Physical activities such as the gym can be resumed after 3 days, but
caution should be taken to avoid any pressure to the penis.


Can you gain length from girth injections?

Unfortunately, no. However, there is the feeling that it is longer because the
increased weight of the penis makes it “hang” more. Girth injections increase the
thickness of the penis, not its length.


Question of Filler Migration?

After the filler is injected, a compression sleeve is provided to ensure the penis
remains extended. However, since the penis is not a static organ and can change
shape during various activities, some filler movement is normal. For the first 2-4
weeks post-procedure, any uneven distribution of the filler can be adjusted
through gentle massages. After a few weeks and after couple months, the filler
integrates substantially with the tissue, making migration very rare. One
advantage of using Hyaluronic Acid filler over other treatments like PMMA or fat
transfers is its adjustability. If any irregularities occur, Hyaluronidase can be
injected to dissolve the undesired filler areas, and additional filler can be added if
needed.

Although PMMA fillers, like Bellafill have the potential to move, following
aftercare guidelines can significantly reduce this risk. Abstaining from sexual
activities for a minimum of one week, using the provided dressing and avoiding
kinking greatly reduce this risk. As PMMA becomes part of the tissue and collagen
production, migration becomes highly unlikely.


Granulomas:

Granulomas are inflammatory reactions by the body to foreign materials. They
can occur when certain substances, like silicone, are injected into the skin. While
PMMA injections can cause granulomas, they are rare. If they do occur, they can
be treated, though they might not fully disappear. The chances of getting
granulomas are extremely low with HA dermal fillers. If granulomas do form from
HA, they can be easily managed hyaluronidase, which dissolves the filler if
required.


What to expect on the Procedure Day?

Before the Procedure:
- I will examine you and we will discuss your goals. Once we decide on the both
the filler to be used and the amount I will perform a dorsal penile block to make
sure you are numb for the procedure.

During the Procedure:
- I will carry out a series of dermal filler injections. The total volume injected will
range from 5 to 15 syringes on average (although some men may do more), based
on your individual anatomy.

After the Procedure:
- A dressing will be applied to the injection area, which you'll need to wear
continuously for the first 5-7 days. During this time, avoid sexual activities. We
will guide you on dressing care and provide the necessary supplies for a smooth
recovery at home.

Follow-Up:
- A follow-up appointment will be scheduled for you three to four weeks after the
procedure.
 

Blunt-Tip Cannula vs Needle?

Both the Blunt-Tip Cannula and Needle methods have their own advantages.
However, I prefer using the needle technique. The reason for this preference is
that I believe the needle provides more control and allows for precise fine-tuning
during the procedure. Additionally, by employing a nerve block during the
process, the procedure becomes extremely comfortable for the patient, reducing
any potential discomfort.


What makes a good candidate?

The best candidates are circumcised individuals without pre-existing scar tissue,
primarily interested in girth enhancement, and have realistic expectations about
the results.

While both circumcised and uncircumcised men can undergo the procedure,
those who are uncircumcised might need follow-up touch-ups.
 

Use of Platelet Rich Plasma (PRP) to Aid Gains?

While I perform this procedure for aesthetic purposes this will not increase girth.
If your goal is girth, you are better off investing in a filler procedure. If the
question is where to spend your money PRP or filler, filler wins every time.


 Best Circumcision for Girth Enhancement (Filler)

You do not need to be circumcised. We treat both circumcised and uncircumcised
patients. Male Enhancement injections can be performed regardless of
circumcision status. Patients need to understand that if uncircumcised they may
require a touch up and if they are looking for larger girth enhancement, they
would benefit from a go-slow multiple treatment approach.


Preference of filler and/or brand?

Juvéderm Voluma XC and Juvéderm Volux XC are the longest lasting HA fillers in
the U.S. They also have a firm feel. HA’s are safe and have been around for
decades. The results are very consistent and predictable. I also use Defyne, Lyft
and RHA-4 however Juvéderm Voluma XC and Juvéderm Volux XC are my
preferred fillers.

If a patient is looking for a more long-term option especially if they have already
had HA filers. I choose to use the bio-stimulatory dermal filler Bellafill. Bellafill
provides immediate, long-lasting results and can last 5 years or more.


Can Filler cause ED?

No, not routinely. However as with any medical procedure extremely rare
complications can occur. The likelihood of the girth enhancement causing ED is
extremely rare. This is because we do not enter the corpora cavernosum which
holds the blood for the erection, nor do we inject anywhere near the nerve
bundles that affect the erection.


Can girth enhancement injections be performed on a penis that uses an
inflatable implant?

In most cases yes. Rarely, it would not be possible. For example, if an implant was
inserted and there were complications such as infection or scar tissue then girth
enhancement with filler might not be optimal.

Why are silicone injections regarded as the least safe option as a girth
filler?

Even when medical-grade silicone is used and even with the correct technique
(the microdroplet technique) its use is complication prone. The mechanism by
which liquid silicone works involves the formation of foreign body granulomas,
which can lead to firm nodules. These nodules may not only be challenging to
remove but can also erode the skin, resulting in ulcerations. This complication can
occur immediately or years later. It is unpredictable. I have seen this complication
many, many times and for this reason I do not use silicone. It is also very
important to consider that many providers using “silicone” are not even using
medical grade silicone. There are so many safer options that are very long lasting
so why take a chance?


Are there any solutions for glans enlargement?

Hyaluronic Acid (HA) fillers like Vollure can safely be used to increase the size of
the glans (head) of the penis. I take a go-slow approach here only injecting a
limited volume at one session. I keep the number of syringes injected here to a
minimum (I only inject a maximum of 2 mL of HA) and ask the patient to come
back to add more product later. Although I know it is said that the results are not
long-lasting due to the vascularity of the glands, I do not necessarily believe this is
true. Consider the lips another very vascular area, filler typically lasts 1.5 years
here if the correct filler is used. Filler may not last as long in the glands as the
shaft, but it is certainly long lasting.


Can you describe your experience with cosmetic medicine and the
importance of injection technique? How does this benefit girth
enhancement?

Injection technique is extremely important. I have been using dermal fillers since
they first became available in the U.S. two decades ago. I have used all filler types
including hyaluronic acid (HA), PMMA (Bellafill), calcium hydroxylapatite
(Radiesse), poly-lactic acid (Sculptra) and silicone. I have injected almost every
anatomical location including the face, lips, hands, neck, chest and of course the
penis. I have used both needles and cannulas. This experience allows me to safely
inject for girth enhancement.


Do girth dermal filler injections adversely impact blood pressure or
increase risks of hypertension?

No.


If I had other treatments for penile enlargement (fat injections,
Penuma, Surgimend, etc.) and am not happy with it, can I have still get
filler injections?

Yes. Filler injection after a person has had surgical insertion of devices such as
Penuma is safe and do-able. It can even be used to correct problems with the
device. If the device is visible or palpable, its appearance can be improved with
filler injections. Unevenness after fat injections can also be improved by injecting
filler.



getmoregirth.com

Hello Dr. Sullivan,:thank you for your introduction and the detailed information about yourself, and the procedure your are offering. I noticed you have remarkable experience with different sort of fillers. I made some research regarding Ellanse filler. Some doctors recommend this filler especially for penis enlargement. Are you familiar with this filler? I had 20 units injected into my penis a year ago. I was extremely happy with the results. I literally had no problems. However, I lost most of my gains by now and I am wondering if an alternative filler would be the solution.

It's important to note that this specific filler is not currently available in the United States, and as such, I do not have personal experience with it in my practice but I am aware of it.

Ellanse is similar to other biostimulatory fillers such as Radiesse, Sculptra, and Bellafill, in that it stimulates your body to produce its own collagen. This process can provide longer-lasting results compared to some other fillers. Like Radiesse and Sculptra, Ellanse is eventually absorbed by the body, but it tends to have a longer duration before being reabsorbed. On the other hand, Bellafill is more permanent compared to Ellanse, as it does not completely reabsorb over time.

Given your positive experience with Ellanse and the natural absorption over time, exploring alternatives that are available in the U.S. could be a viable option I would suggest considering Bellafill.

Best regards,

Dr. Sullivan

Dr_Sullivan wrote: It's important to note that this specific filler is not currently available in the United States, and as such, I do not have personal experience with it in my practice but I am aware of it.

Ellanse is similar to other biostimulatory fillers such as Radiesse, Sculptra, and Bellafill, in that it stimulates your body to produce its own collagen. This process can provide longer-lasting results compared to some other fillers. Like Radiesse and Sculptra, Ellanse is eventually absorbed by the body, but it tends to have a longer duration before being reabsorbed. On the other hand, Bellafill is more permanent compared to Ellanse, as it does not completely reabsorb over time.

Given your positive experience with Ellanse and the natural absorption over time, exploring alternatives that are available in the U.S. could be a viable option I would suggest considering Bellafill.

Best regards,

Dr. Sullivan

I'm very aware of Radiesse being used by some for Girth augmentation. What about Sculptra? Could it possibly suitable vs Radiesse?