TOPIC: Surgimend

Hi all,

Long time lurker, first time poster!

I met with Dr. Liu last week and he recommended Surgimend (which wasn’t a surprise given some of the threads on it here….). Has anyone here done Surgimend? If so, how was the surgery and recovery period, and, have you been happy with the results?

skiman wrote: Hi all,

Long time lurker, first time poster!

I met with Dr. Liu last week and he recommended Surgimend (which wasn’t a surprise given some of the threads on it here….). Has anyone here done Surgimend? If so, how was the surgery and recovery period, and, have you been happy with the results?

It's one of two surgical procedures I personally am comfortable recommending, the other being FFT (free fat transfer). What makes Surgimend appealing is that it's a dermal graft matrix, meaning it will integrate with your tissue, "becoming one with your penis." This is superior to say something like a rigid silicone implant which is not going to bend or shrink when your penis goes Flaccid.

Another excellent characteristic of Surgimend is that it avoids the pitfalls of fillers known as nodules and lumps. Because the graft is precision cut, it adorns the the shaft uniformly and cannot migrate through the skin like a filler would. This makes for a very natural result.

What's important is not to go overboard with too many dermal sheets - the penis needs to vascularize with the graft for a successful and long-term result. Only Board Certified Plastic Surgeons can perform this procedure, including Dr. Victor Liu.

I'm also interested in this procedure, but I am hesitant due to the lack of information surrounding it. I'd love to find some specific reviews and before and afters if anyone has them on hand.

Can you be uncircumcised? Is it done completely under the skin, which would resolve the accordion effect?

Surgimend, AlloDerm, Belladerm, MegaDerm and dermal fat graft use different materials, but the concept is the same to use a dermal implant.

Surgeons performing the different procedure each say the material they use is superior. Surgeons in Korea will say MegaDerm is the best, those using AlloDerm will say it is the best, and those using dermal fat graft will say it is the best.

In reality, I believe they all have the same pros and cons. As mentioned, a big advantage is that there is no risk of granulomas, nodules or lumps.

Supposedly the result will be more aesthetically-pleasing, and because there is no rigid silicone implant, it will feel natural.

Unlike silicone implants, the risk of infection is minimal, while with silicone implants I believe it is very high-risk.

ioannis519 wrote: Can you be uncircumcised? Is it done completely under the skin, which would resolve the accordion effect?

That would be my thinking... the accordion effect involves filler into the penis skin which can mobile and for some create that effect. I can't see how or why this issue with manifest itself with a matrix graft like Surgimend and why I believe it can have excellent aesthetic results when successfully implanted.

I'm waiting to hear back from Dr. Liu and Dr. Solomon, but of whom perform this procedure and will ask them about it.

Because I had dermal fat graft, I tried to understand the differences between the various options. From what I can tell, the possible complications are pretty much the same, with the pros and cons being of marginal difference, and some say one or the other is better; however, in reality I think they are all so similar that it depends on the skill of the surgeon, and what is convenient for each person, based on their location and budget. For that reason, anything that I cite here where specifically AlloDerm, Surgimend or dermal fat graft are mentioned. I assume it largely applies to all three procedures, with some minor exceptions.

The notorious Dr. Elist wrote on his website: "Dermal Fat Grafing (DFG) Penis Enlargement procedures are best compared to a combination of fat injection and AlloDerm (cadaver skin) placement into the penis. There is a claim, however, that Dermal Fat Graft procedures are superior to AlloDerm or fat injections because of increased initial thickness and durability. A large number of plastic surgeons utilize Dermal Graft or Dermal Fat Grafting (DFGs) for penis widening procedures. While the success rate of Dermal Grafts is described as superior when compared to AlloDerm and fat injections, the complication rates are also widely understated. It is true, however, that the initial gains with Dermal Fat Grafts seem to be greater when compared to AlloDerm, and more homogenous when comparing to fat injection".

Of course Dr. Elist ends by promoting his own notorious silicone implant, which according to him, naturally is superior to everything else. The complications he does list however, are pretty much the same I read elsewhere, both for Surgimend, AlloDerm and dermal fat graft.

Specifically, for dermal fat graft he lists: absorption of the dermal fat graft, shrinkage of the dermal fat graft and subsequent aesthetic deformity, fat tissue fibrosis (reported 8 weeks after surgery), rejection of the graft, Necrosis (death) of the graft, persistent penile edema (Phimosis), penile asymmetry due to fat tissue.

Dr. Whitehead writes on the supposed advantages of AlloDerm over dermal fat graft: "The advantages of Allograft Dermal Matrix Grafts (Alloderm) over autograft dermal fat or autograft Dermal Grafts for penile Girth enhancement are: it eliminates the need for incisions and scars at the donor sites "because there are none", and resulting pain and possible infection; and it significantly reduces the length of surgery."

I read that AlloDerm has a higher chance of being rejected by the body, and it seems it is less likely to integrate with the surrounding tissue, and presumably this might make it feel less "natural" compared to dermal fat graft.

Dr. Gary Alter wrote: "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. Alloderm has the advantage of avoiding the donor scar from the dermal fat graft, but it can also become infected or cause shortening and possible curvature."

Dr. Mark Solomon wrote: "Two successful procedures that widen the penis involve grafting procedures – AlloDerm dermal graft and the dermal fat graft techniques. Dermal fat grafts are usually taken from the patient's buttocks or groin and passed under the penile skin. The grafts are obtained from a scar in the donor incision site."

Dr. Jason Oates wrote: "Surgery with lengthening and dermal fat grafts can be successful, with the right surgeon. But is major surgery, very expensive (>$30K in Australia)."

My conclusion is that no matter the material, whether it is Surgimend, AlloDerm, MegaDerm or dermal fat graft, the pros and cons are very similar, including the complications.

ioannis519 wrote: Can you be uncircumcised? Is it done completely under the skin, which would resolve the accordion effect?

Yes, you do not need to be Circumcised, but if you are not Circumcised then there is a risk of Phimosis. In one study, seven out of 20 patients developed Phimosis: "Post-operative prepuce edema occurred temporarily (1–4 months) in seven patients."

In Korea where they do MegaDerm, I read that one clinic require everyone to have Circumcision, in Europe I saw one clinic only recommends it for DFGs, and when I had my surgery, I was told it is not necessary with Circumcision, but it might be possible for Phimosis to develop. Again, there should be no difference when it comes to AlloDerm or Surgimend.

So I was researching this some time back, but have we not had some disasters with grafts on this board?

Infections, grafts being rejected, shrinking a lot over time - the penis becoming twisted and consorted.

It seems super high risk to be honest. Because to be fair, if it were as good as claimed, with none of the filler downsides, plus permanent, why wouldn't more do it.

Yet there appear to be very few surgeons doing it, and the uptake is very small overall (compared to other options which don't cost 'that' much less)

karmaz1 wrote: So I was researching this some time back, but have we not had some disasters with grafts on this board?

Infections, grafts being rejected, shrinking a lot over time - the penis becoming twisted and consorted.

It seems super high risk to be honest. Because to be fair, if it were as good as claimed, with none of the filler downsides, plus permanent, why wouldn't more do it.

Yet there appear to be very few surgeons doing it, and the uptake is very small overall (compared to other options which don't cost 'that' much less)

Well yes, that's why I strongly recommended against multiple sheets of dermal graft matrices - the reason why these implants "shrink" (leading to shape irregularity) is because the graft itself failed to vascularize. This also happens with fat injections. When too much is placed in at once, the blood supply required to keep the graft alive isn't sufficient enough. This is why for example Dr. Solomon is very strict with how much he'll implant, based on these observations.

As for infection, this is a risk with all procedures in a clinical setting, no matter what you get done. People get infections in even the most cleanest of clinics undergoing the most benign outpatient procedures. That said, with a procedure like Surgimend which is surgical, you'll likely get an antibiotic course which will reduce these chances of infection. Again, anything that requires the breaking of the skin is going to have a risk of infection - this is why you don't go to back alleys for enhancement.

Few surgeons perform Phalloplasty period. It's not a breast job or butt lift. This still remains an experimental field performed by few, and even fewer who are any good at it. Ask your Primary Care physician about penis enlargement and they'll turn their head in confusion. Dermal fillers for penile application didn't really pickup steam until about 5+ish years ago. Furthermore, most doctors who perform Girth enhancement are not qualified Boast Plastic Surgeons and therefore CANNOT perform Surgimend on your penis either way. This may explain why you see very little of it discussed relative to non-surgical alternatives.

Dr. Solomon who has performed hundreds of repairs on penises from fillers to implants strictly prefers Surgimend for Girth. In my opinion, that's quite telling because he's a Doctor who's seen some of the most Repair jobs in Phalloplasty, so I imagine he knows what works and what doesn't. Dr. Victor Liu is Board Certified and has performed every phallo-procedure under the sun, including fillers, and he too prefers Surgimend as his "best looking results."

Personally in my opinion, if you are looking for modest gains (not monster sizes), aesthetic contour, permanence, and avoiding the accordion effect if you're uncircumcised, Surgimend is very much a viable option. Of course no procedure is without risk; I implore you to lookup statistics on breast implant complications, you'd think having been performed 10,000x more than penis enlargement they'd have figured it out by now, but even those procedures aren't without risk. You are artificially enhancing your penis, something guys dream of being born with, and it isn't without risk or consideration. This is why I say only those who are in a sound state of mind ought to consider this procedure, that includes budget and alibi, and all.

Dr. Solomon is often recommended for reconstructive surgery, for example Removal of Penuma implants, so I think he is a very good choice. I believe the reason why so few surgeons offer these kinds of procedures is because it is much more complex than injecting a filler. In Europe and Asia, the surgeons I read about who do it are usually reconstructive surgeons or specialized in gender reassignment surgery.

As I understand it, infections are much less likely with dermal fat graft, but it is more common that they shrink. It seems that AlloDerm on the other hand can cause infection right after the surgery, or long after the surgery, and I assume Surgimend and MegaDerm are the same. With both dermal fat graft and AlloDerm/Surgimend/MegaDerm it seems very important that the result right after surgery is good.

With AlloDerm/Surgimend/MegaDerm it would seem that infection after insertion of the grafts is the most worrying issue, where the body rejects the graft, however it would seem even long after there is still a chance of infection. The idea is that the graft will integrate with the tissue and vascularize. Those materials do not come from your own body though, and even much later, it would seem possible with infection.

Dermal fat graft on the other hand, it comes from your own body, so infection or rejection would seem very unlikely. Immediately after surgery, there is risk of fat tissue fibrosis. Gradually the dermal fat graft should integrate with the tissue and receive a blood supply. Later on, instead of infection, the risk instead is of the graft dying due to loss of sufficient blood supply.

There are quite a few large studies that have been done on AlloDerm, dermal fat graft, and also Belladerm. I am not sure about MegaDerm or Surgimend. You could look up those studies. Some of them were done in China, Serbia and the USA. Considering that you live in the USA, then Dr. Solomon would seem to be the best choice, both because of his reputation and because it seems there are extremely few surgeons performing such surgeries in the USA.

"]With AlloDerm/Surgimend/MegaDerm it would seem that infection after insertion of the grafts is the most worrying issue, where the body rejects the graft, however it would seem even long after there is still a chance of infection. The idea is that the graft will integrate with the tissue and vascularize. Those materials do not come from your own body though, and even much later, it would seem possible with infection."

@Screen2584
What leads you to believe that there is chance of infection much later after the procedure? It would seem to me that once fully integrated the chance of infection would be very low. @SO, have you heard anything on this?

skiman wrote: "]With AlloDerm/Surgimend/MegaDerm it would seem that infection after insertion of the grafts is the most worrying issue, where the body rejects the graft, however it would seem even long after there is still a chance of infection. The idea is that the graft will integrate with the tissue and vascularize. Those materials do not come from your own body though, and even much later, it would seem possible with infection."

@Screen2584
What leads you to believe that there is chance of infection much later after the procedure? It would seem to me that once fully integrated the chance of infection would be very low. @SO, have you heard anything on this?

I base my assumption solely on having browsed different galleries of reconstructive surgeries, and when it comes to AlloDerm it usually say it was removed due to infection, while when it comes to dermal fat graft it will say it was because of shrinkage. AlloDerm should usually integrate, as it is natural, however it is not your own tissue. As you say, there is chance of infection, although it is likely to be very low. This is in contrast to for example the Penuma implant, which is a totally foreign material, so the chance of infection would presumably be very high.

There are so many different dermal graft materials, and different surgeons in different countries will say one material is the best, so it is very hard to know which one is truly best. All these materials are supposed to integrate with the tissue and vascularize, so the concept is the same. It is just that one surgeon who uses AlloDerm says it is the best, another one who uses Surgimend says it is the best, and someone else says MegaDerm is the best, and so on.

Personally, I do not really think it matters. It is not that someone from Korea should travel to the USA just because AlloDerm is available there while only MegaDerm is available in Korea. I believe these materials are not so different like fillers, for example PMMA and HA. The two fillers are obviously very different, but I believe this is not the case if comparing for example MegaDerm and AlloDerm.

I'm assuming the gallery @Screen2584 browsed of reconstructive photos didn't provide timeframe or context to the infection. In other words, what I suspect was an infection introduced from the procedure and eventually worsened to the point of requiring a corrective surgery. I haven't heard of a late onset infection with dermal graft matrices, but I also can't rule out that it's ever happened. Unfortunately the vast majority of PhalloBoards traffic (as my statistics show) choose not to post. Also, many men who have had this performed don't require top-offs or additional rounds, and are usually on with their lives, making the use of PhalloBoards a bit less necessary.

Surgimend is a sterilized collagen so you typically have added protection here.

Note* many times antibiotics are sufficient in controlling minor infections, so simply having one isn't a sentencing for your health or your penis. Also Note* men have acquired infection from non-surgical settings as benign as breaking the skin with a needle. Both very low when performed in a professional clinical setting with world-standard cleanliness.

In other words, if your fear is infection, the risks are low - however if your risk threshold isn't very good, phalloplasty may not be for you, regardless of procedure type. If you understand the risks as it pertains to elective surgery -- then Surgimend is a great option for men who want a "one-and-done" enlargement of probably 0.5" to 1.0" in circumference (which is quite significant), and a aesthetically uniform & natural result.

Thanks SO. I actually hadn't given infection too much thought until Screen2584 brought it up, and inclined to agree with you that it would be highly unusual. The one and done is a nice concept for sure, although given that it is surgery there is a 4-6 week recovery period with no sex. One thing Dr Liu did tell me is that if you do want more Girth beyond what you get with Surgimend, you can add filler as well. I'll be making a decision soon about what to do, but am leaning towards having it done.