I’m in my early 30s and based in Southern California. Stumbled across this site a few years back and only recently (past few months) have I decided to commit to getting a procedure done. Have been doing my research and was hoping some of you more experienced and knowledgeable members might be able to assist in my decision-making process. Please and thank you
Since I’m extremely risk averse and safety is my top priority, I’ve elected to go with an HA filler for shaft enhancement. I’ve so far had consultations/brief discussions with the following physicians. Here are some comments, questions, and feedback on all of them. [The TL;DR questions are at the bottom]
Dr. TJ Tsay, Orange County, CA (Phalloboards Sponsor):
Overall impression is that he’s an experienced practitioner (couple hundred patients is what he told me, and he said he’s never had any material complications) and obviously the fact that he’s a site sponsor helps. He does both fat and HA filler injections, saying that the former is more permanent and firmer, but a bit more invasive (the fat harvesting part; not the injections part, which is not very different from HA fillers).
The fact that he also does glans enlargement is somewhat of a red flag, since my understanding is that it’s much riskier than shaft enlargement, and the fact that a doctor would do that concerns me as he’s potentially putting patient safety second to other factors. But that’s just me – I have a very high standard when it comes to doctors (sadly, a lot of doctors view themselves more as businessmen than as true fiduciaries, but I digress…).
$100 initial consultation
$890/syringe, 1 syringe = 1 cc = 1 mL, so $890/mL; Juvaderm
$750/syringe bulk, so $750/mL
Dr. Josh Gonzalez, Los Angeles, CA (an affiliate of the PhalloFill clinic, who referred me to him and who I understand are coincidentally as of very recently also Phalloboards Sponsors)
Dr. Gonzalez is a young doctor and much less experienced than some of the other doctors (as of December 2021, he had only done about 20 procedures, including those he did as part of his training at the PhalloFill Clinic). However, I was pleasantly surprised with his knowledge, candor, and “patient first” vibes. Additionally, it bodes well that he’s actually a urologist, not a plastic surgeon, so he has a far better understanding of penile anatomy than most others in this practice. Additionally, he worked under Dr. Irwin Goldstein, one of the top urologists in the country and who was coincidentally my doctor for some unrelated ED issues I had (I reached out to Goldstein and he gave a glowing recommendation of Gonzalez). But maybe this is an unnecessary qualification and wouldn’t be indicative of skills with HA filler injections?
Again, though, the lack of experience is something concerning me. He also touted the PhalloFill “technique” which uses a “special” method of “hydrodissection” to create more space in the penis to put the filler, an allegedly superior method. Not sure if there’s any merit to this technique or if it’s just a marketing ploy.
$5k for 10 units; 1 unit = 1.2mL, so $417/mL; Versa brand
$9k for 20 units, so $375/mL
Dr. Mark P Solomon, Los Angeles, CA (Phalloboards Sponsor)
I had a brief phone call with Dr. Solomon, as I understand he only does dermal grafts, not fillers, for which I understand the safety profile is not as great (please correct me if I’m wrong; he did tout a low complication rate). He doesn't believe in fillers “I don't put in fillers, I take them out”, as they don’t last and because he believes they just come out lumpy; says he has had maybe half a dozen complications in the 25 years he’s been practicing. He said that some of his patients have had ED but he also believes it didn't have anything to do with the procedure itself (i.e. when you take any random sample of men, over time, some of them will get ED).
Dr. Walter Kane, Los Angeles, CA
Also had just a brief phone call with Dr. Kane. The phone number on his site connects directly to his cell phone, an odd quirk for a doctor who wants to come off as professional (but I’m sure others would appreciate the approachability). While he does do HA fillers, he said he prefers silicone oil suspension using Silikon 1000, and that he’s done “thousands” of procedures using each. I was turned off by his use of silicone, as Phalloboards has taught me to steer clear of the material; but maybe there are different kinds of silicone?
Dr. Jason Emer, Los Angeles, CA
Dr. Emer is the only doctor I didn’t speak to directly, as his consultation is fee is very high (I don’t remember the exact figure but it was probably between $300 and $500). The only reason I’m adding him to this list for discussion is because his name is pretty well known. I have this trick of asking doctors the following question: “if you had to recommend any one doctor to do this procedure other than yourself, who would it be?” It’s a great way to 1. Test the doctor’s level of honesty and 2. Get a 100% unbiased and reliable referral (what could be better than a referral from your competitor?). Of the two doctors I asked this, interestingly, both said Emer. But it was hard to determine whether it was because they truly believed in his skills or if he’s just an excellent marketer. He also does every type of cosmetic enhancement under the sun, so I find it hard to believe he could be an expert in this field.
Consultation: $300 to $500 (can be applied to procedure if done)
$750+/syringe, so $750/mL; Juvaderm
Buy 3 get 1 free, so $563/mL
So that’s my summary of my physician visits and discussions. The questions I have (to those who are kind enough to offer answers) are:
Of these doctors, who would be your recommendation?
Are there any other doctors in SoCal I should be contacting?
For Dr. Gonzalez: does being a urologist help at all, or is it more important to have experience with the sculpting and injecting?
For Dr. Gonzalez: does only 20 procedures of experience give you pause?
For Dr. Gonzalez/PhalloFill: is there any merit to this “hydrodissection” technique?
For Dr. Tsay: does him doing glans enhancement give you any pause about his integrity?
Is there any difference between the Versa and Juvaderm brands? Am I truly comparing apples to apples by listing the pricing on a dollar-per-mL basis of the filler, or am I missing something?
Taking it a step back, I just want to be 100% sure I’ve done all my research: are there any material risks associated with HA fillers, assuming I’m in the hands of a good physician? I use the word “material” because we can all agree that there are risks with anything you do; but is the safety profile as high as it’s purported to be?
My other concern is that I might get the “pig in a blanket” effect, since one of the lingering complications from my previous ED is that my glans doesn’t engorge the way it used to. (Maybe I should be more open to glans enhancement than I previously thought?)
Thank you all so much!
Unless you're willing to travel to further south into Mexico or up to Northern California, no not really.
Injecting & sculpting are as much an art as they are a science. This would make Plastic Surgeons and Dermatologists experienced with dermal fillers at the top of the list, Urologist third. Being a Urologist is a plus however. Unfortunately, I don't know much about this particular physician.
His sample size is not optimal but it isn't a disqualification either. These guys have to start from somewhere; besides, I have to imagine PhalloFILL saw something in him worth bringing him onboard as an affiliate.
I'm waiting for PhalloFILL to provide me their marketing materials & visual aids to shed more light on the hydrodissection technique, and for now I can't add anything unfortunately.
Not at all. Almost every PhalloBoards Sponsor offers glans enhancement or has offered glans enhancement. The issue with glans enhancement isn't so much complication risk (unless you are dealing with a bad injector), but that gains are often negligible for the price. However, since men ask for it, the service is available. Dr. Tsay is a pretty upstanding guy from my impressions, and arguably the most personable I've dealt with among all my Sponsor physicians.
Not all HA formulations are created equal. Firmness, longevity, and cost seem to vary between brands. Which is the best for penis enlargement? That's up in the air and is something this site hopes to monitor if & when patients continue to progress report. That said, I'd go with an experienced physician's choice of HA versus an inexperienced one. The experienced physician will have the sample size to know whether or not the HA he's using is legit.
Your research is very solid and you seem to have put together a good list here. And yes, all procedures aren't without risk. Obviously, every procedure under the sun comes with risk of infection if treatment site isn't kept sterile and clean but that is an obvious one. This is generally a non-issue in a professional Clinic and when protocols are followed. The other risk is a granuloma complication. The good news is that these are rare, treatable, and aren't a threat to the function of the penis, but more of a nuisance in my opinion. HA occurs naturally in your body, and all they've done is cross-linked it so that it can act as a Dermal Filler and plump up the skin. It's arguably the safest filler outside of your own fat/tissue.
This is why I recommend Girth enhancement in layers. Sure it may be costlier, but if you treat increasing Girth like layering bricks, you can mitigate the pig-in-the-blanket look. Also express this concern to your doctor so that they don't overfill. Also, being a Grower lends more to pig-in-the-blanket than the show-er types.
As for the remaining doctors not mentioned in your question list:
Dr. Emer - I can't speak for his Phalloplasty skills but his Marketing team has certainly made him SoCal's "premier guy," except I'm not so sure he is. His Marketing Team also notoriously stole Dr. Oates Before & After photos (PhalloBoards Sponsor) in their advertising material, which they later took down upon Dr. Oates request. I doubt Dr. Emer approved or encouraged this himself, but he holds some responsibility regardless. Even so, that was years ago and there is no ill-feeling with me and their Clinic anymore. I would also like to mention that his "Hollywood" aura is a bit of a turn-off for me personally. The high consultation fees and how it can be hard to get a hold of him as a patient (which one had reported) comes off as a bit snobby. I could be reading too much into it, and heck who knows maybe one day he'll be a PhalloBoards Sponsor, but for now that's all I got.
Dr. Solomon is fantastic but offers surgical options only. This means he prefers the use of dermal graft matrices (namely Surgimend) to create Girth. There are pros & cons to this. The pros are: since the Surgimend is precision cut, you get a very even, natural end-result with no ridges or nodules. It is also permanent. The cons are: it's surgical so therefore it can be more invasive which includes longer down-time. Also (this can be a pro OR con depending on your goals), the Girth is capped at around 0.75" or so, which is QUITE significant but means there is no "adding on" in the future. If you're of average Girth, a 0.75" is massive and quite frankly all you need from one go around. Another good thing about Dr. Solomon is that he's very experienced in correcting botched procedures from other physicians, so his understanding of the penis is (arguably) on par with Reconstructive Urologists.
Dr. Kane I don't know of but if you were to go with him, OPT for HA and not silicone. I have only ONE Sponsor here that happens to have silicone as an option amongst a variety (he's a Plastic Surgeon in Northern California), but the agreement was that he would NOT advertise his use of silicone in the penis on PhalloBoards, only his lengthening, scrotal enhancement, HA, and dermal graft matrices. This is how much I dislike silicone-anything in and around the penis. Silikon1000 is meant to be used in micro-droplet not large volume, and can be effective in many areas of cosmetic medicine - however it seems that silicone and the penis have a bad history. And I mean all iterations of silicone coincidentally, silicone oil AND rigid silicone implants, despite not being the same thing.
A PhalloBoards Sponsor. You might think that's easy for me to say, but it doesn't change the fact that they have a "public face" on this site that monitors their work, holding them more accountable and ensuring the highest standard of care. Sponsorship also means a higher degree of vetting and/or positive review status.
@Skeptical_One , thank you, as always, for your detailed and cogent reply. I was leaning towards Dr. Gonzalez but now it's a toss-up between him and Dr. Tsay. The latter is obviously the "safer" choice but his pricing is essentially double that of the former. Here are some follow ups to your post.
Sounds good, when do you think you'll be receiving their materials to give a proper assessment? Would you like to also ask about Dr. Gonzalez in your discussions with them? I'd also be curious to learn if they have any comments on their choice of Versa brand vs. Juvaderm/others.
I was under the impression that HA was safer than fat? Dr. Tsay does fat harvesting and injecting, so perhaps I should consider that as an option? Or is it that fat is theoretically safer, but HA is practically safer since it is more tried and tested and therefore there's more data out there on it?
Can you explain a little more in detail about the layer approach? I thought that I'd be doing it in layers of ~10 mL each spaced out by a few weeks or months and that the cost would go down because I'd be purchasing a package. Or are you referring to much longer-term layering done over years which is why it's costlier (i.e. because you can't buy packages like that)?
Last edit: by rayjamesmith.
(1) I'll be sending an email later today to acquire additional info, including in regards to Dr. Gonzalez.
(2) I suppose you could make an argument that HA is safer than fat since the harvesting process in it of itself poses risks (albeit low). Either option is viable, but will require periodic top-offs to maintain Girth & uniformity.
(3) The "layering" approach does also assume the individual has a larger budget: the idea of layering came from fat injections (FFT), where you'd inject smaller volumes to allow for the filler to vascularize with the surrounding tissue, and proceed to incrementally increase your Girth through multiple appointments. The same could be done with any filler, and it decreases the likelihood of aesthetic irregularity.
Think of it like a steak. If you cook it Medium Rare, you can always throw it back on the grill to get it to Medium, Medium Well, or even Well Done. However, if you overcook the steak, there is no way to bring it back to Medium Rare or Rare. Same applies to the penis --> if you overfill, you'll have to wait for the filler material to dissipate (which can take months or years). If you underfill, you can then better see what "areas need touchups" as you move along.
This is why I'd recommend against having anything in excess of 15-20cc's injected on the FIRST round. The only exception I'd imagine are very long shafts that may require additional filler.
Ray, I am the founder of the PhalloFill enhancement technique and I trained Dr. Gonzalez. He is a very skilled injector. He may not have the number of patient under his belt yet as some others at the time of this blog post, but he has a natural gift for aesthetics and definitely knows his way through the tissue of the penis from all of his time treating other diseases in urology and performing surgeries. He was a natural from the moment he injected his first patient with me over his shoulder. Our technique is so specialized with our hydrodissection alomg with our aftercare that there is a very high likelihood that you will be happy without any "tweaking". However because you were smart to research and choose HA dermal filler, you already know that we can model and sculpt anything that may arise that you aren't completely happy with. I do believe that our aftercare sets the stage for a very aesthetically pleasing outcome using HA filler.
And for just a big more information on the choice of HA fillers, for the application of girth in the penis we are primarily looking at firmness. When developing the PhalloFill enhancement we tried Juvederm Ultra Plus, Juvederm Voluma, Restylane Defyne and Refyne, and Versa Plus. I am attaching a diagram of off of the currently FDA cleared HA dermal fillers. You can find Juvederm Ultra Plus and Versa Plus on the graph with almost exactly the same firmness. You will see that the flexibility of Juvederm Ultra Plus and Versa are slightly different, but not much. They are very similar in consistency and inject about the same. Because the molecule has a little less flexibility I feel that it stays in place better, but we also considered the fact that the 1.2 ml syringe of Versa is better for the patient than the 1.0 ml syringe. Although because we price our syringes the same or less, it would have been financially advantageous for us to choose the 1.0 ml syringes and sell more syringes to the patient. That is of course unethical and we wouldn't consider something such as that. The 1.2 ml offer 20% more per syringe and the pricing is very fair.
One comment about layering. May providers (am I am not speaking directly about the providers on this board) sometimes offer more syringes injected per visit so there isn't as much "layering" of the product. In my experience of injecting, we have had much more success with the filler staying in place rather than migrating when we use less dermal filler. Another financial advantage for the provider would be to inject as many syringes as possible per treatment. This does two things. (1) It allows for the provider to sell more syringes. (2) If the patient is prepared to purchase 10 syringes, if you inject all 10 in 1 visit versus 5 in the first treatment and 5 in a second treatment, the provider saves time on their busy schedule. My point is in our opinion it's better for the provider to inject as many as possible per treatment, but we have found that injecting fewer syringes and doing more "layering" yields a more pleasing aesthetic result with more longevity in evenness and symmetry. And the comparison to the steak from "Skeptical One" is very accurate. We can get better symmetry and overall better aesthetics by injecting in smaller amounts. Patients should always be thankful when a provider suggests less syringes because that has been chosen for a better patient outcome. It definitely isn't really a benefit to the provider to inject less syringes, other than maintaining a happier, more satisfied patient.
As far as our marketing materials for PhalloFill, we do need to get more availble on PhalloBoards. This site is so informative that there are so many places for us to try to "catch up". I will say that we have no intentions of posting any diagrams of how we perform the procedure. We really believe we have something truly unique that yields such amazing outcomes. We currently have a library of 25 before and after's and I am sending 10 more to my webmaster over the weekend. We have the largest gallery of before and after's (to my knowledge) of any provider of girth enhancement in the world. We want to maintain our technique so that it isn't performed incorrectly so everything such as diagrams are for providers eyes only. You can learn more about our overall technique without details at our website. www.phallofill.com
Message back if you have more questions for me.
Last edit: by PhalloFILL.
Thank you @PhalloFILL for your response.
@Skeptical_One , I'm curious to get your feedback on their reply. Do you have any new thoughts on the following:
1. Their hydrodissection technique (I respect the fact that they want to keep their method proprietary, but can you provide any comments on this?)
2. Dr. Gonzales (not sure how you would have any new thoughts other than from your discussions with PhalloFill, but I hold your opinion in extremely high esteem, so if you have anything new to share, I'm all ears). Does he now have a new, upgraded status in your eyes because PhalloFill is a sponsor?
I also wanted to ask a little bit more about the mechanics of sponsorship, since PhalloFill so directly responded to one of my posts. How does PhalloBoards manage the conflict of interest between having the most recommended providers also being the ones who pay to have this position? Who is the owner of PhalloBoards, and do they profit personally from these sponsorships?
I want to be clear: In no way am I doubting your integrity. I've read many of your posts and you certainly live up to your name (a great alternative moniker for you would be @shillkiller ), and I certainly owe it to your diligence that I dodged the Elist bullet. But if you could provide some color on how you navigate this slippery slope, out of a commitment to openness and transparency, it would certainly only improve this already great site (if there's already a post in which this is explained, please let me know and I apologize). There's nothing wrong with getting compensated for your time, so long as it's disclosed and the conflicts managed properly, which I trust they are.
Last edit: by rayjamesmith.
1. I'm in correspondence with PhalloFILL to see if I can obtain some information on what separates their hydrodissection technique from the competition without compromising proprietary methods & techniques.
2. I'm also vetting Dr. Gonzalez and their relationship with PhalloFILL in the same discussion with PhalloFILL.
As for the mechanics of Sponsorship, I'm glad you asked. I've Moderated this forum (including PhalloBoards 1.0 and PhalloBoards 2.0 ) for over a decade, as the sole platform for the discussion of male elective procedures (surgical & non-surgical). In that time it has largely been a volunteer effort on my part (for most of the past decade up until the last few years), and owned independently by ME and no one else. No Clinic has a share of ownership or revenue, nor do I make commission or bonuses from any referral on this site.
The core mission of this site was to be an information exchange on a topic that remains stigmatized in most medical circles, and too taboo for social word-of-mouth. Well, at least historically, I believe attitudes have and are changing in this coming decade. A place where men come to gain an edge, like they would in other areas of their life, via anonymity through a trusted source.
In these times I've learned that this industry also attracts "bad players" and unscrupulous methodologies. Fortunately this has been a dissipating trend, and I sincerely believe this forum and its amazing community has played a role in that. Over time it began to make sense to create a network of phalloplasticians my readership could rely on, instead of taking a gamble with an unexperienced practitioner or a malpractice-ridden quack.
How I generally vet prospective Clinics:
1. Positive Word of Mouth
2. Passing the 3 "E's" Test:
I personally take pride in providing this community with vetted Clinics providing quality work through skill, experience, and ethical medicine. If you have the time, go through the time-capsule known as PhalloBoards 1 & 2 to see how much I've invested in retaining this site's identity as one of integrity and good-will.
The mechanism of Sponsorship after said-vetting is as follows:
How the Readership Benefits:
I see myself as the Patient Representative: being a former recipient of these procedures, and not being a medical professional, I've essentially "been in your shoes." I've gone through what many of you will and have gone through here. This is why the forum continues to be a patient-driven site despite the presence of Sponsorships.
I hope this clears some things up
Thanks for the great response @Skeptical_One . Sounds good, I'll await your feedback on hydro-dissection and Dr. Gonzalez. Thank you.
Here is PhalloFILL's take on Hydrodissection technique:
The PhalloFill enhancement utilizes a technique called a hydrosessection in which a fluid pocket is created between specific layers in the penis. This allows the provider to evenly distribute the HA dermal filler while maintaining an even consistent outcome. In addition, the location of this pocket created in which the HA dermal filler is injected does not have the lymphatic drainage or blood flow which will cause the HA dermal filler to be absorbed by the body as quickly it would be absorbed being injected in other areas of the penis. This is the reason our patients see greater longevity with their girth enhancement procedure than with other techniques available.
As far as the newsfeed update on Dr. Gonzalez from PhalloFILL:
Dr. Gonzalez is the first additional provider to our network. We selected him because although he is a urologist with most treating mean and women, he specializes in Men’s sexual health. He is also a surgeon and does inflatable penile implants so he is really skilled at procedures and using his hands. We also do an test we developed that determines if they have an eye for aesthetics because being a medical doctor doesn’t make you have the ability to be a good injector. He checked all of the boxes and he has amazing bed side manner. I trained him in October. He spent two weeks with me. Most doctors when they train for this spend half a day and see 3-4 patients. He probably saw 6-7 per day. He is a very talented injector now.
Thanks @Skeptical_One . I guess here's my final question: what do YOU think? In my first post, you recommended I go with a PhalloBoards sponsor. Would you now put Gonzalez on the same level of Dr. Tsay now that you've gotten some feedback from PhalloFill? Of course, I take everything they say with a grain of salt, so I'm just curious what your unbiased perspective is.
Well I'd usually like to stay impartial when I can, and often point to a Sponsor within your region. Dr. Tsay would normally be my go-to for Southern California, and it was only until recently that I learned about Dr. Gonzalez. Playing tie-breaker would be a conflict of interest on my end, but I can provide some things to consider:
Dr. Gonzalez is a Urologist and also has performed inflatables which means he has a surgical background as well (this is a PLUS).
Dr. Tsay I have more acquaintance with, and he's much more experienced with injectables, which can be essential for Dermal Filler enhancement (this is also a PLUS).
You can see how both have advantages.
So in this instance, I would say your best bet is to contact both and see which one offers a better sales pitch, value, and information. Remember that this will potentially be a physician you see more than once, so no need to rush the vetting process for yourself. I hope that helps.
Thank you @Skeptical_One and fair enough. I'll give some more thought to this and decide what to do. Should I post progress reports here?
No problem, and you'll want to post your progress report here.
You probably got a good idea of how to draft a progress report if you've read enough on the forums, otherwise here are some extra tips.