TOPIC: Prednisone and pmma/ellanse

Hey guys - those of you that have followed my thread know I have had HA several times since 2021. I was planning to dissolve it and get pmma or possibly Ellanse in 2024 at @Avanti_Derma

HOWEVER- I have an autoimmune condition (technically auto inflammatory but I’m certain most here have never heard of that lol) that flares up a few times a year randomly. When it does it causes high fevers and painful joints . Basically, my body has a strong inflammatory reaction to …. Well that is a mystery but the rheumatologist believes it’s related to a bad case of mono I had 20 years ago. That said, when I have a flare up I have to take a steroid and it stops the flare up in its tracks. As I said I never know when these are coming and they aren’t predictable.

I spoke with Ian and he said Dr M thought that I’m not an ideal candidate for pmma because of the condition and possibility I would need to take a steroid. However, Ian suggested Ellanse.

Clinically, If there is little difference in the way collagen is formed, I’m curious why this option would be viable but not pmma? Perhaps I’m just not a candidate for the collagen stimulating fillers :/

I know this is a very niche question but I’d love to hear from others on the board with a medical or science background. Thanks in advance!

@Skeptical_One i always appreciate your input as well!

Not a doctor but I’ve taken auto immune suppressing drugs and biologics in the past. Prednisone will reduce inflammation but the course of treatment is short so I would think it would only be a momentary blip if anything during collagen formation.

PMMA is a permanent filler that remains in the body indefinitely. In cases of autoimmune conditions, there can be concerns about how the body might react to a permanent implant. The body's immune response could potentially be triggered or exacerbated by PMMA, leading to complications.

Ellansé, on the other hand, is a non-permanent filler that stimulates collagen production and gradually dissolves over time. The advantage in your case could be that if there is an adverse reaction, the effects of Ellansé are not permanent. While Ellansé also stimulates collagen, the substance itself dissipates over a period, usually a few years. This could potentially make it a safer option if there's a concern about how your immune system might react. HA's would of course be the safest.

Regarding the use of steroids like prednisone, it's true that prolonged or high doses can suppress collagen formation. However, the intermittent use of steroids to manage flare-ups may not significantly impact the effectiveness of collagen-stimulating fillers. The main concern with fillers in the context of an autoimmune condition and steroid use is more about how the immune system reacts to the filler material rather than the impact on collagen production.

Thank you @Dr_Sullivan . I think this should be discussed more. I didn’t develop my condition until age 40 so we never know when these things will creep up.

Pmma is definitely off the table for me. And given that Ellanse takes much much longer to degrade in the penis I’ll likely stick with HA.

Thank you Dr. Sullivan for your insight.

@Dickwhitman79 I'd love to impart advice in this regard however your medical condition and its association with dermal filler (irrespective of filler type) is beyond my purview. Since you have already tagged Avanti Derma, I will see if I can get Dr. Casavantes to provide a response as well, every professional prospective is useful.

Hello @Dickwhitman79
I absolutely agree with Dr. Sullivan’s response.
The longer lasting the filler, the more warnings it has.
A formal contraindication for PMMA are autoimmune (or collagen) diseases.
What I’d like to add (Ian never commented this with me) is that Ellanse is showing a longevity that is well beyond the one, two, three or four years that the manufacturers have found with facial implants, so do not rely on its longevity to get rid of a possible trigger for your condition.
Then, the most important factor to consider when it comes to cosmetic nonsurgical Phalloplasty is that being it an elective procedure, everything has to align before proceeding for long term, and especially permanent implants.
Regards,
DrC Avanti Derma

This is quite fascinating because I emailed Avanti back in the summer as I was gathering information and one of my questions was if PMMA had any contraindications for psoriasis which is an autoimmune skin disorder. I have psoriasis so this was one of my main concerns. I was told that PMMA has no contraindications for psoriasis.

Awful!
I’d like to see that thread.
Regretfully, I was absent from the forum settling my retirement and organizing this new phase of my life.
I am happy to be back again; I don’t see patients anymore but I like sharing my experience.
Avanti Derma’s policy is that only doctors respond to medical questions. If it was me, it was a horrible mistake if it was one of our non-medical team members, a new training session is on the way!
My response above is the correct one.
Thank you for your helpful comment.
DrC Avanti Derma

You are absolutely correct that psoriasis is caused by the bodies immune system and so technically "auto-immune" but it is different from connective tissue type autoimmune diseases so no extra risk as far as psoriasis and PMMA are concerned.

Right. Psoriasis is an uncontrolled growth of epithelial cells and collagen is not affected.
However, I would worry about the Koebner’s phenomenon (new psoriatic lesions in traumatized areas), psoriatic arthritis flare-ups, and especially psoriatic erythrodermia (generalized psoriatic flare-up) that even though there is no connection, patients with PMMA implants will panic and associate both things.
Information between parenthesis provided for non-medical professional readers…
Regards
DrC Avanti Derma

Thank you for the information.
I have asked our staff to go through this thread as part (beginning) of a new training course.
Regards.
DrC @ Avanti Derma.

Every psoriasis patient is different, but so far I’ve had 2 rounds of Bellafill (30 syringes total) and have not noticed any psoriatic issues or flare ups. No Koebner syndrome either. From someone who has had moderate/severe psoriasis diagnosis from when I was a teenager, I am very pleased and relieved so far. Hopefully for anyone with psoriasis, my experience will be encouraging when contemplating this procedure. There’s no guarantee they won’t be affected, but I do know a lot of psoriasis patients take a “screw it” mentality when it comes to their skin as we’ve already been beaten down by it for so long.

Yes. The implant doesn’t mean that the psoriatic complications will appear.
However, once PMMA is in, many patients associate any kind of issues with it.
Again, being a completely elective procedure, we go for it when everything aligns, and like in your case, when appropriate disclosure is observed and you accept the possible implications.
DrC Avanti Derma.

What about other relatively benign autoimmune diseases? I have self diagnosed myself with lichen nitidus, does this change my risk profile? Perhaps is there a way to test the PMMA on skin elsewhere and see if it develops a problematic reaction