TOPIC: Granuloma versus Nodule

I would like to ask anyone, DR C included, how inorganic granulomas just go away on their own. Granulomas, as Dr C eluded to, are a massive immune response to a foreign body. The macrophages cross talk and now have learned that your inorganic “biocompatible” filler is a foreign invader. Immune systems don’t forget, ever. So, u have a foreign substance that is being attacked interwoven into your own tissue. Yes, one may be able to shrink the inflammation caused by inflammatory cytokines with steroid. However, u can’t take steroid forever. This has side effects like thinking skin. If taken orally, it can cause diabetes etc. unfortunately, the filler substance stays forever. Forever, will one have to worry about inflammation, granulomas. All of which may be triggered by a bad cold or infection like a tooth abscess. The real problem is most everyone’s body will detect a foreign invader and mount a response. Unless u have an improperly functioning immune system. The only answer once PMMA is placed is having it surgically removed. The easier answer is just do not do PMMA as a filler. I know some will disagree and attack me. Oh well. I am trying to educate and warn. Dr C please correct me if I am wrong.

Toothman wrote: I would like to ask anyone, DR C included, how inorganic granulomas just go away on their own. Granulomas, as Dr C eluded to, are a massive immune response to a foreign body. The macrophages cross talk and now have learned that your inorganic “biocompatible” filler is a foreign invader. Immune systems don’t forget, ever. So, u have a foreign substance that is being attacked interwoven into your own tissue. Yes, one may be able to shrink the inflammation caused by inflammatory cytokines with steroid. However, u can’t take steroid forever. This has side effects like thinking skin. If taken orally, it can cause diabetes etc. unfortunately, the filler substance stays forever. Forever, will one have to worry about inflammation, granulomas. All of which may be triggered by a bad cold or infection like a tooth abscess. The real problem is most everyone’s body will detect a foreign invader and mount a response. Unless u have an improperly functioning immune system. The only answer once PMMA is placed is having it surgically removed. The easier answer is just do not do PMMA as a filler. I know some will disagree and attack me. Oh well. I am trying to educate and warn. Dr C please correct me if I am wrong.

Now you're just pissing me off. No one has or will attack anyone here. They will, however, have disagreements. Don't conflate the two.

And please drop the whole "educate" narrative, you're not a medical professional with intimate knowledge of filler and its associated complications. That's why I'm glad we have resident experts like Dr. C to fill in the necessary blanks.

You're someone who decided to get Bellafill (bovine-based carrier) by an unknown Dermatologist who clearly isn't a specialist in Phalloplasty (and its related techniques). You had an undesirable result, and I'm sorry to hear that. However, this continued antagonizing of a method that's worked for thousands of people in different parts of the body with relative success seems a bit... head-scratching. There are many men who've had life-changing implications by the results afforded by Ellanse & PMMA and the frequency at which they report Removal or major complication is the lowest we've ever witnessed compared to all other permanent options. Heck, Dr. C has witnessed only one true case of granuloma in the penis and his patients have been updating their progress reports for nearly a decade now.

So you aren't "warning" anybody, and you're on the cusp of fear-mongering (which you've been warned about in the past). I am all about learning potential complications (and how to go about resolving them), but doing so in an inquisitive manner--> asking the right questions, exchanging relevant and concrete information, seeking out the opinions and expertise of experienced practitioners, etc. There are a number of doctors and procedures out there that need real warning labels, and instead you're exhausting your energy on a proven method. I'd like to know why but I don't think that's going to benefit this discussion topic moving forward.

Thousands of men who lurk these forums are recipients of Ellanse or PMMA, many of them having done the necessary research. Despite some valid and important questions, your postings in general aren't always mindful or sensitive to that fact. I'm asking you be more mindful of that going forward, thanks.


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I apologize for the way I come across. My emotions are all over the place. This whole outcome has put me in a very dark place.
To answer your question I am a dentist ( 4 years at large highly regarded state school, 4 years dental, 1 yr hospital residency, extensive continuing education in fillers and I have had an extensive medical education. I have been in practice for 20 hrs. I have read, exhaustively, many medical papers and journals, about every filler out there, including complications. Unfortunately, I trusted a board certified derm in US that does many filler procedures and she told me she has done quite a few of these. I trusted her and failed to do adequate research. I just want everyone considering PMMA to know, and hear directly from someone suffering it’s ill side effects, that there is a real and irreversible risk. Furthermore, when the temporary “fix” of steroid shots for granuloma fails, surgery is only option. Surgeons in US that do this difficult work are very expensive and hard to come by. That is why I am a proponent of only HA, because it is reversible and natural. This site is very informative and I am thankful for that. I have contributed my money and journey for others education. I feel, however, that positive outcomes (albeit possibly short term) are praised and the negative outcomes tend to be glossed over. I am just presenting the other side of the coin. Shouldn’t a discussion board allow this? Please don’t attack me for openly and informatively expressing my medical opinion and my life experience. One can take what I say with a grain of salt. I have insulted and attacked no one. No one on this board has “pissed” me off either. I would like Dr C to comment on my last post if possible. Dr Oates, Dr Solomon?

We can all learn from each other.

Toothman wrote: I apologize for the way I come across. My emotions are all over the place. This whole outcome has put me in a very dark place.
To answer your question I am a dentist ( 4 years at large highly regarded state school, 4 years dental, 1 yr hospital residency, extensive continuing education in fillers and I have had an extensive medical education. I have been in practice for 20 hrs. I have read, exhaustively, many medical papers and journals, about every filler out there, including complications. Unfortunately, I trusted a board certified derm in US that does many filler procedures and she told me she has done quite a few of these. I trusted her and failed to do adequate research. I just want everyone considering PMMA to know, and hear directly from someone suffering it’s ill side effects, that there is a real and irreversible risk. Furthermore, when the temporary “fix” of steroid shots for granuloma fails, surgery is only option. Surgeons in US that do this difficult work are very expensive and hard to come by. That is why I am a proponent of only HA, because it is reversible and natural. This site is very informative and I am thankful for that. I have contributed my money and journey for others education. I feel, however, that positive outcomes (albeit possibly short term) are praised and the negative outcomes tend to be glossed over. I am just presenting the other side of the coin. Shouldn’t a discussion board allow this? Please don’t attack me for openly and informatively expressing my medical opinion and my life experience. One can take what I say with a grain of salt. I have insulted and attacked no one. No one on this board has “pissed” me off either. I would like Dr C to comment on my last post if possible. Dr Oates, Dr Solomon?

We can all learn from each other.

I sense that you are dealing with a lot and I genuinely hope you and anyone in a similar situation end up with the best case scenario. I've read all your posts on the old forum and am well acquainted with your past, so pardon me if my rebuke was harsh. I just wanted to to tone down the misplaced alarmist rhetoric. I also didn't appreciate the suggestion that anyone is being attacked because they disagree with you, or choose to defend the merits of PMMA, and I hope we can move past those kinds of remarks.

This forum is intended to be a place for all former, current, and prospective patients of Phalloplasty. I intentionally named a forum category "the Patient Support Group" so that men knew this was an anonymous online sanctuary to connect, share, vent, and learn. Presenting your side of the coin is not only welcomed, but encouraged. Half of the Moderation team were patients of botched procedures. I brought on Dr. Solomon as a Sponsor largely due to his work in fixing procedures that went wrong. I've spent years exchanging emails with lurkers (members who don't post publicly) about ways to fix their penile issues, who to see, and what to expect. Trust me, all sides of the coin are welcome here.

If I didn't want "negative" or "critical" reviews of PMMA I'd simply ban or delete the topics. Furthermore, I have no financial incentive in promoting PMMA as I have other Sponsors who perform alternative procedures like Ellanse, HA, fat transfer, and Surgimend. For full disclosure, I did have PMMA performed on me over 8 years ago and a few follow-up rounds in the years that followed. I've had zero instances of complication since.

As for glossing over negative reviews, we'll have to agree to disagree. What's truly glossed over is how the current generation of Phalloplasty candidates are mostly unaware of what came before them and how much worse things were in the industry. Up until this past decade, men were discussing either dermal graft matrices (still viable with proper technique and graft), silicone oil/gel, PLGA scaffolds, fat transfer, and a rigid silicone implant. The success rates were abysmal and the nature of the complications associated were severe (i.e. length retraction due to scar formation, nerve damage and loss of sensation, impotence, infection, and Necrosis). By comparison, PMMA (and similarly Ellanse) have exhibited considerably better complication rates, and the nature of those complications are relatively minor compared to complications of old. This may explain why there appears to be a "glossing over" of less-than-stellar PMMA reviews--> they're infrequent and seldom ever as severe as to warrant a threat to penile function and health.

That said, discussions of potential complications and the means to address them are always a relevant discussion topic, just as they have been since this forum's inception. I hope Dr. C continues to chime in, I'm also very curious about the idea that granulomas can "disappear." Is it possible they could disappear indefinitely or is there an inevitability of their return?

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Some really important messages here for guys considering this. Injectable Phalloplasty is not without risk of complications. The doctors commenting here are probably the most experienced in the world and yet we still have issues. Last week I refused a treatment on a patient who then became very abusive and promised to write how our treatments dont work (despite not getting it because he demanded 100% satisfaction). If you do find a new RV online from this guy could you PM me please.
I will try steroid/5FU in a Nodule with moderate expectations but I am excising a Nodule in the new year Not my injection , but could have been.

Has anyone had any success with FFT. I Just had the procedure done by DR Giunta.

I am sure some must have. Please keep us up to date with your progress, but it should be in its own thread. Do you have pre/post measurements and photos? How many ml?

@Dr Oates
He took your advice and started a report found here.

@Little DeeJay
Please be mindful of where you post. It's important that content stays on topic so that others can easily & efficiently research the desired information. If you have specific inquiries, post either to a relevant topic or start your own topic.

I ask we resume the "Granuloma vs Nodule" topic moving forward, thanks

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