TOPIC: Questions for Doctors

I have a legit question discussion for doctors and experienced users - why isnt the filler procedure done more often when the patient is Erect? I think I saw a post about @dr Leonardo doing one like that and the results were great - assuming the logistics of getting hard while numb was doable - wouldn’t the results be significantly better and more evened out?

It seems like the challenge is that when you’re hard there isn’t as much empty space to put the filler in. I do agree that just doing it soft also presents challenges . I like @Rejuvall dr Carneys technique where he stretches the penis out while he does it. It seems to give very uniform outcomes.

Yeah it seems its injection when you're soft and wait for the surprise when you're erect haha - I've seen somewhere in the forums Dr Leonardo perform one when the uncut guy was erect which allowed him to do an A+ job on evenness etc. I'll try to find the link to confirm.. Would love to also get input from @Avanti_Derma @PhalloplasticSurgeon_DrLiu @Dr_Sullivan @LeonardoMedicine

Whether injection of filler for augmenting the penis when it is flaccid or erect depends on many factors:
1. Experience of the doctor doing the injection,
2.Any previous surgery? Circumcised? Any existing scars?
3. Original shape and contours of the penis.
4. Type of filler used,
5. amount of augmentation desired,
6.It is true that when injection is done with the penis flaccid, there is a rare possibility that irregularities can show up when the penis is erect. However, the reverse is also true i.e., when the injection is done with the penis erect, irregularities may occur after the the penis becomes flaccid. Whish is worse? to have irregularities when the penis is flaccid or when it is erect? After all, the penis is flaccid most of the time! For most humans at least.
Personally, I inject when the penis is flaccid. The occasional times when unevenness occurs, it is a simple matter to correct by minor injection. I do not charge the patient when this is required. Very often after seeing the good improvement of the first injection, the patient"wants more" In that case, I will charge the patient for the extra injection but not the injections for the revision.
For further info, please contact me. This email address is being protected from spambots. You need JavaScript enabled to view it. 650-697-8888

It’s not a horrible idea, but the mechanics of it aren’t very practical. It would be tough for someone to maintain an erection for the entire procedure, especially in a clinical setting and with the penis being numbed. While we could give a patient Caverject (a medication that induces an erection), it’s just introducing another unnecessary step. After enough experience, you learn where to inject so that the results look even and symmetrical when erect. Erect or not erect patients will occasionally need a little correction a few weeks after the procedure. During the procedure the flaccid penis is pulled or stretched to get a pretty accurate idea of how it will look when erect. As a side note, it’s not uncommon for some men to get an erection during the procedure, even though they’re numb, just due to the manipulation involved. @Sullivan

@Woodworking714 Thank you for mentioning me. My apologies for the late reply, I was away and came down with Strep Throat, then Halloween, then another business trip. I thought I had posted about this topic on my own page but apparently I did not. I didn't want to give you a quick empty reply so I waited to give you a more detailed explanation. I will post this on my own page as well.

PERFORMING AUGMENTATION ERECT VS FLACCID:

Bottom line is the end result should look great flaccid and erect. The penis can look completely different from one state vs the other. Some guys have concerns about their appearance when erect. For example, they may have a curvature or tapering that bothers them. It’s best to see them erect while filling these areas of deficiency.

I inject Trimix (a combination of 3 vasodilators) via a tiny needle to induce the erection. The response and dose is variable based on any underlying ED, level of anxiety, and appropriate placement of the medication. It should be injected into the corpus cavernosum. Sometimes there is misplaced administration.

Assuming we achieve an erection, it may last for the duration of the procedure or longer. Overly aggressive dosing may lead to priapism which needs to be reversed with phenylephrine or drainage by large gauge needle aspiration. Some providers may not be prepared to handle this. If an erection does not ensue, we can still proceed with treatment. Although, It may take a little more guess work in terms of where to fill volume deficient areas.

Other reasons I prefer erect augmentation? It frees up my non-dominant hand. I don’t have to hold the penis in constant tension throughout the procedure. It allows me to pinch the tissue while I advance the cannula to deeper planes without worrying about keeping the penis stretched. I inject as deep as possible to sandwich the product between 2 connective tissue layers: Buck’s Fascia and Dartos. Anything too superficial leads to product viability, contour irregularities, and a spongy blister-like appearance. It allows me to place the product throughout the entire length of the penis in long linear threads. It allows me to palpate the cannula tip to determine the exact location again without having to keep the penis in tension. The cannula also glides better under the skin when the penis is at full length. I use my non dominant hand to pull the skin in the opposite direction I want to advance my cannula and the cannula just glides without bunching up in the tissue plane. Upon completion of the procedure, I perform a light massage and roll the penis between my hands to even out the texture. This really allows the product to smooth out between the connective tissue layers.

Furthermore, it allows me to determine the maximum dose of filler. If I can no longer pinch the skin because it is too tight/full, I cannot possibly inject more volume safely. The penis has a confined space determined by the elasticity of the skin. Overfilling the penis may compromise blood flow, a phenomenon known as “compartment syndrome”. I have this reassurance when I’m injecting large volumes in one sitting. Imagine stuffing a flaccid penis with more product than what the skin is able to accommodate during an erection. It’s an unwelcome, dangerous surprise.

Yes the penis is more flaccid than erect during its existence but the point of augmentation is to improve the sexual experience. If it looks great flaccid but odd erect, that leads to embarrassment and perhaps performance anxiety. As such, I screen for shrinkage and pretreat the patient with Botox to limit shrinkage or drastic length changes. This helps mitigate contour irregularity from the product bunching up when flaccid and shrunken.

Those are my reasons for performing augmentation in the erect state. Again, it is not mandatory but it certainly facilitates the procedure and gives me various clues that I do not get when the patient is flaccid during the procedure.

Attached are photos demonstrating correction of a curvature and taper. There is another photo demonstrating the relaxation of the penis using Grotox (Penile Botox) such that it hangs longer in the flaccid state, thereby creating less length disparity compared to its erect length.

LeonardoMedicine wrote: @Woodworking714 Thank you for mentioning me. My apologies for the late reply, I was away and came down with Strep Throat, then Halloween, then another business trip. I thought I had posted about this topic on my own page but apparently I did not. I didn't want to give you a quick empty reply so I waited to give you a more detailed explanation. I will post this on my own page as well.

PERFORMING AUGMENTATION ERECT VS FLACCID:

Bottom line is the end result should look great flaccid and erect. The penis can look completely different from one state vs the other. Some guys have concerns about their appearance when erect. For example, they may have a curvature or tapering that bothers them. It’s best to see them erect while filling these areas of deficiency.

I inject Trimix (a combination of 3 vasodilators) via a tiny needle to induce the erection. The response and dose is variable based on any underlying ED, level of anxiety, and appropriate placement of the medication. It should be injected into the corpus cavernosum. Sometimes there is misplaced administration.

Assuming we achieve an erection, it may last for the duration of the procedure or longer. Overly aggressive dosing may lead to priapism which needs to be reversed with phenylephrine or drainage by large gauge needle aspiration. Some providers may not be prepared to handle this. If an erection does not ensue, we can still proceed with treatment. Although, It may take a little more guess work in terms of where to fill volume deficient areas.

Other reasons I prefer erect augmentation? It frees up my non-dominant hand. I don’t have to hold the penis in constant tension throughout the procedure. It allows me to pinch the tissue while I advance the cannula to deeper planes without worrying about keeping the penis stretched. I inject as deep as possible to sandwich the product between 2 connective tissue layers: Buck’s Fascia and Dartos. Anything too superficial leads to product viability, contour irregularities, and a spongy blister-like appearance. It allows me to place the product throughout the entire length of the penis in long linear threads. It allows me to palpate the cannula tip to determine the exact location again without having to keep the penis in tension. The cannula also glides better under the skin when the penis is at full length. I use my non dominant hand to pull the skin in the opposite direction I want to advance my cannula and the cannula just glides without bunching up in the tissue plane. Upon completion of the procedure, I perform a light massage and roll the penis between my hands to even out the texture. This really allows the product to smooth out between the connective tissue layers.

Furthermore, it allows me to determine the maximum dose of filler. If I can no longer pinch the skin because it is too tight/full, I cannot possibly inject more volume safely. The penis has a confined space determined by the elasticity of the skin. Overfilling the penis may compromise blood flow, a phenomenon known as “compartment syndrome”. I have this reassurance when I’m injecting large volumes in one sitting. Imagine stuffing a flaccid penis with more product than what the skin is able to accommodate during an erection. It’s an unwelcome, dangerous surprise.

Yes the penis is more flaccid than erect during its existence but the point of augmentation is to improve the sexual experience. If it looks great flaccid but odd erect, that leads to embarrassment and perhaps performance anxiety. As such, I screen for shrinkage and pretreat the patient with Botox to limit shrinkage or drastic length changes. This helps mitigate contour irregularity from the product bunching up when flaccid and shrunken.

Those are my reasons for performing augmentation in the erect state. Again, it is not mandatory but it certainly facilitates the procedure and gives me various clues that I do not get when the patient is flaccid during the procedure.

Attached are photos demonstrating correction of a curvature and taper. There is another photo demonstrating the relaxation of the penis using Grotox (Penile Botox) such that it hangs longer in the flaccid state, thereby creating less length disparity compared to its erect length.

Thank you so much for the detailed explanation - This actually explains a lot and your results speak for themselves. @Skeptical_One - This is a great explanation that might be worth pinning? In regards to performing the injections during an erect state vs flaccid for more desirable results.