TOPIC: Fibrosis and future filler

I was wondering how people who have had many treatments have had to deal with the issue of fibrosis, where the filler is encapsulated by the body, causing fibrosis. I find that this literally can make it impossible for cannulas or further expansion of filler because it puts the area into a state of "lockdown." How did your doctor deal with it? I have noticed some doctors use needles, but I don't like this option as the amount of veins in the penis and the actual body of the penis makes it seem unsafe. Apparently, some fibrosis is permanent and can even lead to some gains, but even if that is the case, how did your doctor or surgeon manage to get those extra milliliters (ml's) in there?

The annoying thing is that sometimes a doctor will only inject 10 ml's and there has to be a time limit between sessions, which can lead to further fibrosis. What is the maximum a doctor can safely inject in one session? I am looking forward to hearing from people who have had many long-term sessions about their experiences. What were the approaches (needles or cannulas), the amounts injected, the techniques used to overcome fibrosis (I guess some people are more prone to it), and who are the best doctors for many sessions to achieve the biggest gains?

I'd be interested to know what filler your talking about. I’ve never seen the kind of fibrosis you’re describing occur with hyaluronic acid fillers. I have seen it with PMMA (Bellafill) or in patients who’ve had silicone or other permanent materials that can trigger granulomatous reactions. But its a granuloma not fibrosis. You’re absolutely right that in these cases, the filler tends to flow around the granulomas, filling adjacent softer tissue but not penetrating the dense area. Reactions to Dermal Fillers

To manage this, several strategies can help:
• Needle injection rather than cannula – this allows precise placement and, when done correctly, is perfectly safe. There’s no strong evidence that needles carry more risk when the injector understands penile anatomy and uses the correct plane.
• Mechanical disruption – fibrosis or granulomas can sometimes be manually broken up using a cannula or by performing controlled subcision before injecting.
• Medical treatment – in some cases fibrosis can be softened with medications such as ILK (intralesional kenalog) or other anti-inflammatory injections.

As for injection volume, 10 -15 mL is reasonable for most men, and in those with significant length up to 20 mL can be performed safely by an experienced injector.

Xanacer wrote: I was wondering how people who have had many treatments have had to deal with the issue of fibrosis, where the filler is encapsulated by the body, causing fibrosis. I find that this literally can make it impossible for cannulas or further expansion of filler because it puts the area into a state of "lockdown." How did your doctor deal with it? I have noticed some doctors use needles, but I don't like this option as the amount of veins in the penis and the actual body of the penis makes it seem unsafe. Apparently, some fibrosis is permanent and can even lead to some gains, but even if that is the case, how did your doctor or surgeon manage to get those extra milliliters (ml's) in there?

The annoying thing is that sometimes a doctor will only inject 10 ml's and there has to be a time limit between sessions, which can lead to further fibrosis. What is the maximum a doctor can safely inject in one session? I am looking forward to hearing from people who have had many long-term sessions about their experiences. What were the approaches (needles or cannulas), the amounts injected, the techniques used to overcome fibrosis (I guess some people are more prone to it), and who are the best doctors for many sessions to achieve the biggest gains?

This isn't uncommon with fillers that stimulate collagen growth as the core part of how it achieves volume (and by extension, Girth); PMMA (Bellafill or Linnea Safe), Ellanse, and Radiesse (CaHA) are among some popular and viable fillers for the purposes of Girth augmentation (avoid silicone fillers however), and they have been known to create fibrotic tissue amongst the surrounding collagen and elastin, but in an "inadvertent scaffold" (i.e. encapsulation). The degree of fibrosis likely varies patient-to-patient.

Don't let the word "fibrosis" alarm you, it shouldn't be confused with pathological fibrosis (think "disorganized scarring"). Instead, when you hear or read about it in context to dermal fillers (namely PMMA, Ellanse, and Radiesse), we're dealing with a more "controlled fibrosis" by way of neocollagenesis (the mechanism by which the fillers are generating new collagen). It's relatively safe in the volumes used in penis enlargement by all accounts, but no elective procedure is without risk.

This fibrotic tissue can make follow-up procedures a bit more challenging for the Injector because it's like trying to "get into a pie or pizza with a needle starting first at the edge of its more rigid crust." I'd know, over a decade ago my PMMA was remarked as being higher in fibrotic tissue than the normal patient, requiring a bit more of a rigorous & strategic approach -- I turned out fine in the end and remain both aesthetic in results and complication-free.

It can be done, and it would take the likes of someone who deals with both the use & subsequent re-use of the same bio-stimulating fillers in the penis. This would present you with the best chance of a productive and effective follow-up round of injections. Dr. Sullivan who made a comment prior to mine is definitely one of those qualified with the requisite knowledge & skills to approach this head-on if you wish to consider (1) more gains and/or (2) Revision for aesthetic purposes.