Recklaw, Mr. Minhas had no issue injecting Xiapex into PMMA nodules? Or did you mean he had no issue using it for Peyronie\'s?
How is it obtained in England - I am not really familiar with the NHS but aside from the insurance system in the USA, the distribution channels for the drug are heavily controlled. The doctor needs to register and take an online course for the drug. A hospital pharmacy then needs to order it. Did he say how much he\'d charge for it beyond the base price of the enzyme?
It\'s just interesting to me - 3 years ago I am sort of wishing I could\'ve found someone to try it - but I just never knew what basic Nodule Removal would turn into (when the wounds wouldn\'t close etc).
TheifofNight is right about this. It\'s the collagen that would harden - not the PMMA itself. I had 2 successful rounds & very good results with no long-term hard spots (just one for 2 months that went away). The third round led to much different & concentrated hard nodules all over the place, many of which were surgically removed after trying every injection therapy under the sun (5fu, Kenalog, sterile water, saline, etc...) and some topical things like DMSO.
This was not calcification. Although the pathology showed tiny calcium particles (they show up based on a stain that is used), this was from the old PMMA from round 1 and 2 which never hardened - and again they were microscopic little fragments buried in there with the normally dispersed PMMA, causing no issue. You\'d find the same thing in your arteries, unfortunately....which is where it would cause a problem (and far more than in the PMMA-triggered collagen)
The only theoretical way to dissolve excess collagen is with collagenase. This enzyme has been around since the 70s or earlier, but it was recently patented by a company now owned by Endo Pharmaceuticals, and was $4000 for 0.57 mg, last I checked. One of the uses is for Peyronie\'s disease (where a collagen band forms on your tunica albuginea and impedes a normal, straight, Erection). The tunica is even deeper than where the PMMA is. No doctor that I know of would inject collagenase into PMMA because it is not very controllable, and it\'s still a new drug on the market. The nodules are also quite close to the skin which could lead to severe blistering (there are some bad side effects even for on-label use). The doc I was going to at the time (who did the surgeries to remove the PMMA and close the wounds) did use collagenase for peyronie\'s, but he absolutely would not use it off label. And insurance would not have covered it since it\'s off label.
Based on the slides / slices of the nodules I had, the 3rd round of PMMA was clumped together and then surrounded by collagen, rather than dispersed with collagen threaded through the beads of PMMA. You could see some of the \"old\" PMMA on the borders of the nodules, and it was normally distributed, leaving it soft and normal (which some still is, but the third round triggered the older PMMA to harden also in some spots - it\'s hard to tell one round from another).
Collagenase doesn\'t know when to stop & might have dissolved all of it - or dissolved it incompletely. But it would\'ve left the PMMA behind, so what would my body have done? Made the nodules all over again? Never replaced the collagen with anything? Nobody can say because it\'s not studied and far off label... but in theory, that\'s the only injection that could attempt to resolve the problem...sorta. You\'d still have the PMMA in there. Collagenase also triggers unusual antibodies to the enzyme and to other matrix metalloproteinases (nobody knows the significance of this yet).
If you have $4000 and can find a plastic surgeon or Urologist to do this off label (good luck) and have them inject a fraction of the dose, you can be the first guinea pig for this - but it\'s a scary proposition. Oh also - injecting into a hard Nodule is not easy. This is why a lot of doctors screwed up in the clinical trials and missed the plaques. They went too high because the plunger on the syringe simply would not go down when the needle was in the plaque. Of course, more experienced doctors can get the injection in place & Dr. C obviously knows how to do it with Kenalog - but in the clinical trials for collagenase, you had a handful of docs who were just in it for the money and didn\'t really care what happened. Many were great, but a handful were ass holes who had about 20 clinical trials a year (just for the easy money / no insurance to deal with / no patient follow up or personal liability). I know one of them in particular, whose patients also cannot stand him. He\'s the type who\'d inject it in you off label - but he\'d name the price... I\'d guess 6k or more. Surgery to cut it out is covered by insurance and you\'d have your co-pay or whatever.
I had Kenalog and 5fu quite early too, in an effort to stop this, but it did not work. It\'s all in my old posts. I have a whole thread just dedicated to nodules maybe 2 years old now.
The hardening of PMMA is interesting, but to be exact it isn\'t PMMA that is hardening, it\'s our own collagen. When first injected with PMMA the body reacts by forming granulation tissue, which is a softer type of tissue. After a few months that granulation tissue is transformed into type 1 collagen, which is a firmer tissue than granulation tissue.
Has anyone experienced hardening of their implant over the years?
Ideally we would maintain the texture of the type I collagen that is formed in our bodies a few months post op. However, if there is hardening of that tissue over the years it seems to be some sort of calcification of the tissue. I do not know why type 1 collagen would calcify and become hard. I have been meaning to email lemperle about this. But to make it simple, if we could maintain the original integrity of that type I collagen tissue, then we could prevent hardening.
I advise anyone with PMMA to be conscious of their diet, and to research what foods and supplements maintain the health of collagenous tissues.
Great thread Reklaw. Only thing I know about risks of FBG is the closer you inject material under to skin, the more risks you have. Deep injections have less risks. So it\'s very important how is qualified the physician who do this work.
TheifofNight wrote: Elimination of adverse health risks. The health risks aren't many. There are exceptions. I think our main aim should be to figure out how to make these implantations smoother for the sake of aesthetics. That's a good start. What 'reactions' and 'issues' are you referring to recklaw?
I was mainly referring to the minor issues which seem to be more common like irritation, swelling and hardening, for example I have a friend who's recently had PMMA who woke up one morning with a rather large lump, and then there was the guy on here recently who had PMMA for 5 years with no problems then had another round which triggered some kind of ongoing irritation/swelling.
It would be nice if we found some kind of universal technique which would solve all these problems including granulomas.
There is a poll somewhere about if people regret it or not. The large majority is happy. People that have PMMA and no issues do not spend their life in the forum. They live their lifes with a big/bigger penis. You have some people checking in, but a lot of the times their problems are general problems and not directly only PMMA related. Any issue with the penis like infections and STDs are blamed on bad reactions. Think the major risk is foreign body granuloma. They seem very rear and Dr Lemperle I think has claimed he has not seen a real case in the penis at all. It might be rear, but can still happen. Look at miracles post. His body is rejecting silikon. Your body might also reject PMMA. I think the best approach would be to have a small amount injected into your arm before injecting the penis. This way it is easier to see how your immune system reacts and it is just to cut it out. Much more difficult once it is in your penis.
Elimination of adverse health risks. The health risks aren't many. There are exceptions. I think our main aim should be to figure out how to make these implantations smoother for the sake of aesthetics. That's a good start. What 'reactions' and 'issues' are you referring to recklaw?