TOPIC: Infections, Complications, Risks of PMMA?

@eqstudent
I would not be so sure of that. The choice of placing the product very near the ophthalmic artery can be a poor one. The material is indeed not supposed to move from the location where it has been injected but if it was administered very near the artery it is conceivable that some of it has reached it during the procedure; what if the artery happened to be fragile in that particular spot and broke because of the \"collision\"; old people (the deformed patient in the picture is 77 years old) often have damaged/fragile arterial walls. If this was the dynamics of the incident (cannot be ruled out), I would define the technique as poor. It is conceivable that Dr C is extremely careful not to inject close to the artery while operating in the glabellar region; you could argue that not every surgeon can master the art of bioplasty (what/where/how to inject); in particular, and it is just my opinion, the glabellar region looks more complex to work on than the penis. Can I ask you again: would you consider bioplasty to the penis using Artefill? Not that you would actually go now and have it. Rather, if you feel that it is a sound procedure to seriously consider. Or, on the contrary, if you would also equally and firmly reject it, at this point in time. As for me: I am willing to be exposed to a moderate risk of granuloma formation (and deal with it if such event occurs). On the contrary, I am not going to have the procedure if there is a moderate risk of migration: I need (scientific) evidence that suggests that such risk is neglibile (e.g. <0.001).

supa wrote: ... I would not be so sure of that. The choice of placing the product very near the ophthalmic artery can be a poor one. The material is indeed not supposed to move from the location where it has been injected but if it was administered very near the artery it is conceivable that some of it has reached it during the procedure;...

Are you saying one should not do work in the Glabella? Once you work in that area you are going to be near a blood vessel. All the arteries in that region have significant anastomoses. Look again at the Dr C. video, was he near a blood vessel? The technique is fine, the area is risky. A lot of well-respected surgeons will not put any type of filler in this area.

supa wrote: ...The material is indeed not supposed to move from the location where it has been injected but if it was administered very near the artery it is conceivable that some of it has reached it during the procedure;....

Thank you for bringing this discussion back to the central point. The Caldellas Newplastic study of 21 patients showed Macrophage phagocytosis in all 21 patients. If the PMMA particles are small enough to be eaten by a Macrophage they will move!

supa wrote: ...Can I ask you again: would you consider bioplasty to the penis using Artefill? Not that you would actually go now and have it. Rather, if you feel that it is a sound procedure to seriously consider. Or, on the contrary, if you would also equally and firmly reject it, at this point in time;...

If one must have PE then IMO Artefill, if it performs in the penis like it does in the face in the 36 month interim study, may be sounder than all the other PE alternatives. Having said that we should be clear that for every 10 people that have the procedure, at the 5 year mark it is likely that 1 or 2 will have some adverse effect including lumpiness, swelling and redness, lesions, treatable granulomas, and granulomas that will need to be surgically removed. We do not know how the higher volumes (10x) required in the penis will change the risks.

@EQ
1) (( If the PMMA particles are small enough to be eaten by a Macrophage they will move! ))
I have posted one paper before which shows that Artefill does contain < 20 micron beads in < 1% \" by the number \"
www.ncbi.nlm.nih.gov/pubmed/19787393
Is there a chance of movement of the phagocytosed small beads in Artefill or is it only the ones in Newplastic ???
It could be only the phagocytosed small particles in Newplastic will move but not the ones in Artefill ?? It could be I dont know??
2)(( If one must have PE then IMO Artefill, if it performs in the penis like it does in the face in the 36 month interim study, may be sounder than all the other PE alternatives )).
In you opinion would you still advise Artefill if one must have PE ?
If your answer is yes ,wouldn\'t you be worried about the small beads and their movement the one you have mentioned above ?

Why do we make things so complicated we have two products to compare Artefill and Newplastic :-
smaller beads carrier
Artefill < 1% bovine collagen
Newplastic > 1% ?? methylecellulose

The carrier difference has nothing to do with the serious complicatios , we all agree the it has to do with the beads and your body reaction to them, and both of these products have small beads of PMMA but one has a smaller amount than the other .
So if we suppose to have a serious complication from the movement of these phagocytosed small beads ---> wouldn\'t we have the same complication in both products but of course in Artefill will be lower than Newplastic.
At least one case from Artefill ????
But what we have in regard of Artefill there is no serious complication (i.e. from the movement of the small beads) so small beads have no serious effect on our health.
If somebody tell me it is dangerous to have small PMMA beads (in regard of migration) I will ask him to give me one case which has a serious complication (e.g. migration of distant organ) in the US from Artefill, (there are thousands of people in the US who had Artefill during the last 5 years)

@smartman - it really is sad when you can\'t leave well enough alone and start arguing against points that you made and claimed were clarified to you in an email from Dr Lemperle. Does this ring any bells phalloboards.websitetoolbox.com/post/sho...9208465&postcount=15 I suspect if you re-read your posts from Lemperle in that thread all your questions will be answered.

@EQ
Thank you very much EQ for bringing this point for me:-
In his e-mail was he talking about a serious distant organ complication from the migration of the phagocytosed small beads or he was talking only about the chances of foreign body formation from these small beads ??(which Dr.Cohen said the best treatment for FBG is to leave it alone for spontaneous remission).
He mentioned only that small beads can cause FBG . And the chances of FBG formation in the Brazilian products are higher.
So are you saying FBG is a very serious complication and it is the biggest fear for you.

have a read of this page
web.me.com/drcasavantes/PMMA_Monograph/Welcome.html

and this one
web.me.com/drcasavantes/PMMA_Monograph/C..._Brands_of_PMMA.html

and this is most relevant to this topic
web.me.com/drcasavantes/PMMA_Monograph/PMMA.html

(the friend who forwarded it to me said this site is still a work in progress)

FROM ARTICLE

Approximately 20 days after grafted, fibroblasts migrate to the area and start producing collagen around the micro-spheres. It is important to remember that the inflammatory response has two synergic phases: inflammation and Repair.
The first phase is intended to destroy, dilute or isolate offensive agents and affected cells; the second phase cures and reconstructs the harmed tissues.
The Repair phase begins simultaneously with the inflammatory phase, but ends when the offensive factor is controlled.
This explains why the micro-spheres of PMMA must be between 40 and 60 microns in diameter: if they were smaller than 20 microns, they would be phagocyted; if they were between 20 and 40 microns, they will be phagocyted, but the macrophages will die creating a chronic inflammatory process. If the particles were larger than 60 microns, they will trigger a foreign body reaction.
The picture on the left shows the distribution of PMMA ranging from 40-60 microns, 6 months after the grafting in human tissues.

@ eq and smartman

do we know how long after her injections her Necrosis started?

I think I did find the proof that skin necrosis complication depends mostly on the technique of the doctor more than the filler per se so it can happen with any other safe absorbable products :-
(1) I think most of us had or heard about Lidocaine 2% injection (a local anesthesia).
Did any one hear that this drug can cause tissue necrosis ??
jcp.sagepub.com/content/49/7/872.extract
So does it mean we should not let our doctors to inject us with any local anesthesia?? lol
(2) Did anyone hear that temporary fillers (biodegradable fillers) e.g Hyaluronic acid or collagen fillers can also cause skin necrosis ??
They said the nasal area, the perioral region and the glabella are the most dangerous areas .
a) www.cosmetic-medicine.jp/list/fillers.htm
also in this paper they mention Nasal Alar necrosis can happen and also they mention Granuloma formation can happen after the injection of temporary filler e.g. Hyaluronic acid :-
b) www.drdayan.com/pdfs/risk-of-alar-necrosis.pdf

(3) Some people said that FFT is the safest technique and has no serious complications , actually there are serious complications from this technique (liposuction & fft injection) :-
Acute Respiratory Distress , central nervous system , skin and retina
www.scielo.br/scielo.php?pid=s1806-37132...=sci_arttext&tlng=en

I am not trying to frighten anyone about these complications from these products I just want to prove for everybody that the Technique of the Doctor is the most important and the area ( e.g. Glabella)
There is another paper which prove that :-
onlinelibrary.wiley.com/doi/10.1111/j.15...006.32052.x/abstract
injection necrosis is a rare but clinically important potential complication caused by interruption of the vascular supply to the area by compression, injury, and/or obstruction of the vessel(s).

In conclusion :- These papers prove that skin necrosis if it did happen (reported esp. in the face) it can happen with any products and not only with Newplastic .

@ justabitmore- It usually occurs if it did happen approximately between12-72 hrs post injection and not before 6 hrs .

Smartman,

The site of injection and tool used (syringe vs cannula) can play a role in whether the injected product will enter a vein or artery when syringe is used. I\'m not sure who you are arguing against as the text becomes mashed together on page two leaving much of it unreadable. However, almost anything solid injected into a vein or artery can cause an embolism.
All procedures have risks, though FFT has been documented to have the LOWEST known risks of any current PE procedure.

I don\'t think the major concern with PMMA is Necrosis from injection as cannulas are now used, rather the concern is the possible effects from migration.

Sparticus,
So we agree now it depends on the site of the injection and the technique of the doctor and NOT on the product per se (e.g.Newplastic) in regard of Necrosis.

(( I don\'t think the major concern with PMMA is Necrosis from injection as cannulas are now used, rather the concern is the possible effects from migration )) .

In regard of migration, I agree with you we should talk about it, but I have some points I need somebody to help me in answering these Q.\'s :-

We have read that the migration could happen with the small beads, correct me if I am wrong??
1- As we know the worst PMMA product was Arteplast (1989-1994) it had the highest number of small, irregular and electrostatic charges beads, correct? So it was injected in people around 22 years ago. I had never heard of one case of distant organ disease ( I am not saying there is NO proof of migration of these small beads what I am saying if it did happen--> there is no serious illness from this ). BTW I have mentioned before that Dr.Cohen said about Arteplast it has only 2.5% a chance of FBG formation and the best treatment for it just leave it it will go away by itself, and he did not mention about migration or serious illnesses of these old products.
In my opinion If I want to check for any complication (e.g. migration and its complications) for any product , it\'s 1st generation will be my best material for any research, sure it will have the worst complications, I hope we all agree about this point ??
2- If it was true that Artefill contains <1% small beads (<20 micron).
Why don\'t we have serious ill-patients from it during the last 5 yrs ?

3- Many ladies (not only from the US) travel to Brazil and Mexico for Butt\'s enhancement (each one has e.g. > 500 cc of Brazilian product in her Butt) 10x more than the penis.
So why there is no one case of serious ill-patient (e.g. lung or liver) in these ladies (e.g.in the US) I am not talking about lumps or FBG.

4- Also many HIV-patients with lipodystrophy from the US and from other countries travel to Brazil and Mexico (as you know they are immunocompromised patients so they are more prone to serious complication).
No serious organ disease in the US has been shown from any migration of the small beads.

5- Believe me I dont need any proof for that , I just want to help the others about PMMA ((the bad and the good informations)) .
In our Forum there are guys who have PMMA for few months (short period) and I have it for 15 yrs (I think it is a long period) I am still healthy (no liver or lung problem but in regard of my brain ?? I dont know, lol).
Of course I understand if somebody says I dont believe you SM that you had Artecoll 15 yrs ago, I will tell him I agree with you absolutely and I cannot prove it for you but do you believe that there are patients did have PMMA injection in 1989 ???
I will always like and support healthy discussion and I will never argue and force people to believe my points, I think you do remember sparticus when I have mentioned before about the need of an antibiotic for PMMA injection and I said actually you dont need it (that was the words of Lemperle) you did disagree with him (you said as far as I remember it is a serious statement and he shouldn\'t say that) and I didnt argue with you that time, I said he is right he should be worried about a risk of infection, and then you asked me if I could ask Dr.Cohen (who is affiliated with Artefill) directly, I accepted your request and I did ask him the same Q. his answer was the same as Lemperle.
Everyone should know the truth about any product and it\'s possible complications (i.e. complications due to the product per se and not the technique) and then he should decide what is the best for him.

I really enjoy having discussion with everyone in this forum, actually I feel we are like brothers helping each other.

Justabitmore wrote: ...do we know how long after her injections her Necrosis started?

within 24 hours re the de Castro paper\"Approximately 24 hours before she had been submitted to a cosmetic treatment on her face, a bioplasty with PMMA, performed by an experienced plastic surgeon. \"

@ eq
thanks eq! sorry hard to read the paper on my black berry yesterday.

Smartman,

I\'m not stating there is 100% proof that the beads are making it to distant organs and that they are causing major problems. I am stating that it is a potential problem that needs more investigation. I think we need to dig further before we conclude that there are no cases. EQ was able to find a study recently regarding migration in humans when many were stating there is no evidence for that happening in humans. Since migration has been shown in both animal and human models now, we really do need to consider the possibility of these beads making their way to organs. I understand your point that no studies that we currently have found show this as a major issue, but will this change when this stuff is in a body for longer than the studies have tracked? Some people may have this stuff for 70 years if they get it while young. I think we need to do more research into the possible consequences of bead migration to organs.