TOPIC: New HA filler claiming to last up to 5 years

Patients could use Teoysal Ultra Deep which is a very hard HA. I think a few patients from this forum have tried it though Androfill, but, it is hard to dissolve away (which negates the whole point of HA) and can only be injected a few ml at a time, and it is quite painful for up to 1 month (it wants to hold its shape).

Androfill wrote: For HA yes. From the first 1,000 we had:
- 7 granuloma
- 5 infections
- 1 allergic reaction
- 2 significant filler migrations

Thanks for the info!

Androfill wrote: It should not be squishy, if it is then it might not have been the right HA, or the filler injection or aftercare was poor.

Well, costa said it was, and you guys did his. He had it dissolved. The report of squishiness is \"not infrequent\" from all the cases I\'ve read about, and guys I personally communicated with who had it. And this is voluma. This was also the major complaint in the original korean HA study. Dunno about ultra deep. Why are so many practices using voluma if this is so good?

Androfill wrote: No problems from Ellanse yet but the sample size is tiny. At least 100 cases in a sample over 2-3 years... would that be reasonable.

Thanks again for the info. Combined with Dr oats almost 2 years experience plus morganster 7 months, so far so good it seems. I hope it continues to go this way, because I believe like @chester that it is superior in terms long lasting and feeling 100 percent natural when Flaccid and Erect.

Think.
[The only complication of Nodule formation and other irregularities can be overcome by an improved injection technique and better postimplantation care.]

It would be the postimplantation care (moulding) rather than the injection technique. A layer is being filled with a liquid that can move around until it stabilises. It is not the same as having filler in the cheeks where it will near enough stay in the same spot unless manipulated away from that spot.

[You\'re giving one single example, but you must have stats on how many patients you treated in total, and how many had this issue? I have not heard this before, and would like to know the stats. Everything has risk, but people decide to proceed or not based on statistics, not a single anecdotal case. If that were the case, people would read darkstaff\'s pmma experience and nobody would have it done!]

For HA yes. From the first 1,000 we had:
- 7 granuloma
- 5 infections
- 1 allergic reaction
- 2 significant filler migrations

We have subsequently had 2 more infections and one vascular occlusion where filler pressed into the blood vessel reducing the blood from outside the blood vessel and needed to be dissolved. Note: not intravascular occlusion.

[Yes, but he still does the procedure if patients request it, and has had good results (as has Dr Oats). Does he tell patients in advance that if something goes wrong he can\'t do anything? Or does he discuss with them what the specific odds are and actually have a some plan to treat possible outcomes?]

Yes so far the results are good. Dr Horn has refused a lot of patients Ellanse (some from this forum) and only agrees to go ahead if he thinks they fully understand the difference and have the capacity to make that decision (mentally stable, clearly understand the risk, preferably a repeat patient who has had HA before so they are familiar with the general aftercare back at home).

[Everyone knows that, but you\'re on a forum where for years guys are opting for pmma (which is permanent) on a daily basis, based on a long history of good and some negative outcomes.]

All the senior board members understand well, but in the UK because of recent BBC \'docu-torials\' (documentary/advertising lets say), there are many new penis filler patients probably coming onto this board, who don\'t understand the difference.

[Saying HA is safer is not going to convince a lot of guys to opt for it after doing years of research, and realizing that many guys spend a lot of money on HA and have it dissolved because it\'s \"squishy\" and feels like a \"padded dick\" ...]

It should not be squishy, if it is then it might not have been the right HA, or the filler injection or aftercare was poor. I know for example that Teoysal Ultra Deep is like wood.

[yes there are some lucky guys who are OK with HA]

How do you explain this? I think the unhappy ones might have had the wrong filler, or injected badly, or bad aftercare. I think Voluma or another firm HA filler injected with the method in the video above is not squishy at all when erect.

[but there are a lot of guys who are not, and in some locations guys are paying 10K USD for 15 ml ... which last 1.5 years, and which they may not be satisfied with.]

$10k ('8,000) for 15 ml is about 2.5x the price in the UK for 15ml. I think Voluma and other HA fillers are very expensive for doctors to purchase in USA.[As long as there are alternatives like pmma or ellanse that last longer and feel more natural (I take this as confirmed), then people will opt for these over HA unless it is shown by reported / documented cases (with pics), clinical studies, and other real data that it\'s not worth the risk. Note that in Gary Alter\'s editorial comment on the pmma study, his main concern was what may happen \"a decade\" down the road ... at least for ellanse that\'s not a concern.]

Gary Alter\'s comments are quite bad. 50% irregularities - it depends on how bad the irregularities are. But again, with a big assumption that dermal fillers (HA/Ellanse/PMMA) have a similar propensity for irregularity, 4 years and no ability to dissolve is quite a problem?

[

www.jsm.jsexmed.org/article/S1743-6095(16)30328-9/abstractI\'m not arguing there is no risk, I\'m just asking you to contribute actual data and stats on those risks, if you have them.]Dr Horn is working on an article for a peer-reviewed journal.

Coming just from me, what I can tell you that I see from HA is, infection (very rare), granuloma (very rare), little bits of stray filler (maybe 5% of cases so quite common) (aside from the 2 major filler migrations, 1 caused the patient having anal sex 2 days after HA injection). No problems from Ellanse yet but the sample size is tiny. At least 100 cases in a sample over 2-3 years... would that be reasonable.

Yes, two entry points either side of the midline. It should be sufficient because the filler can diffuse through the layer although some areas may be difficult to reach. One entry point does not sound sufficient to get through both the left and right sides. How Ellanse is being marketed in the UK is a bit of a worry.

So he\'s switched to using a cannula and has now started using two entry points. You could say his technique is evolving! He wouldn\'t change things for a laugh, he\'s doing it to get better results. Technique and experience with the particular filler the Dr is using is clearly very important. With longer lasting or permanent fillers it\'s even more important than with reversible HA fillers.

biggy.

It would be nice to see videos of both Dr O and C procedures.

[Dr C divides the penis into 6 sections and uses a injection gun to more accurately measure the amount of filler being injected at each point.]

You can be as precise as you like placing the filler, however, it is a liquid and will diffuse around the layer it is injected into until it integrates.
No amount of precision when placing the filler can make up for the fact that it moves around for a few days on its own (assisted by nocturnal Erection, gravity, diffusion).
So this does not ring true to me that being super-precise when injecting filler into the layer means it will stay in place.

Regarding Moorgate, they are doing a lot of Ellanse injecting the filler subcutaneously. We have fix-up cases from Moorgate regarding HA frequently, but no calls regarding bad Ellanse results.

Androfill wrote: Getting the filler evenly into the correct layer is not especially difficult and I don\'t believe there is a special s or technique to it (but please feel free to disagree).

Dr. C believes there is, and gave it a name (EIT):

The senior author has presented this technique in medical meetings under the name Exact Implantation Technology (EIT). Using the EIT, the Buck fascia is easily identi?ed, and the PMMA suspension is deposited overlying the Buck fasciaat the level of the deep Dartos fascia. The PMMA suspension injected overlying the Buck fascia leaves the super?cial Dartos fascia untouched, and the alveolar gliding space is preserved, maintaining the gliding of the skinover the implant or of the implant over the Buck fascia.

from here:https://www.researchgate.net/publication/305664356_Penile_Girth_Enhancement_With_Polymethylmethacrylate-Based_Soft_Tissue_Fillers

You can\'t use that basic \"sausage filler\" technique with permanent or long term fillers! Otherwsie you end up with result like those on the Moorgate website. Why do you think so many of Dr N\'s patients don\'t look so great? She works alone, use one entry point and just molds the stuff. I know Dr Oates has his own technique that can\'t speak of, but Dr C divides the penis into 6 sections and uses a injection gun to more accurately measure the amount of filler being injected at each point. It\'s a much longer and more considered process than what is shown in the video above. It involves several entry points, requires an assistant and rolling instruments to smooth as he works. It\'s really not a case of making a hole, pumping it in and then molding it into place with hands.

Well considered and I agree with a few points including the last point.

Regardless of how well the Ellanse is placed (the s of the doctor), it still moves around for a few days once the patient gets home. What the patient does afterwards is important to the final result and is out of the hands of the doctor, aside from providing adequate instructions.

I would rather have a reversible product when the nature of the procedure is that it relies quite heavily on the patient, back at home.

Below is a link to the technique preferred by Dr Horn. It takes around 20 minutes including local anaesthetic block.

I suspect it is very similar to the procedure carried out by Dr C or Dr Oates but I have not seen videos of their procedures.
If it differs, what is the crucial difference (there is always the possibility to improve)?



- Are any of these aspects materially contributing to a better / more even result? Or put another way, what is missing from the Androfill procedure in the Youtube link above that is done by Dr C or Dr Oates. Are their procedures filmed and put online anywhere?

Getting the filler evenly into the correct layer is not especially difficult and I don\'t believe there is a special s or technique to it (but please feel free to disagree).
The filler can/will move around after the procedure regardless of how well is it placed in this layer, and as long as it is placed evenly, it is less important to the final result than what happens after the patient leaves the clinic.

I think there is more to it than safety profile (where HA is safer) or suitability for penis enlargement (where PMMA/Ellanse are better). You also have to combine the right clinic/Dr with the product. I don\'t think Androfill is the right place to get a longer term or permanent filler. That\'s not a slight on Androfill or Dr Horn, but I\'m simply pointing out that with a non reversible product you need to to spend much more time with the patient and though it\'s technically non surgical, you pretty much go into theater. When I had PMMA, it was a 2 hour appointment. I had to get into a surgical gown, you get local anesthetic, Dr C has an assistant and it\'s done in a surgical suite. I think it\'s a similar situation with Dr Oates. It\'s because they have to get it right as the stakes are higher. They spend years honing their techniques. Whilst HA is just a case of applying some emla cream, then jumping on the table in a office and being done in 10 mins. If it doesn\'t go well it can easily be fixed. So the different types of products are more suitable to different business models. If you mix the the wrong product with the wrong business you end up with the type of Ellanse results you see posted on Moorgates website.

Androfill wrote: Filler migration is one specific risk in the penis that happens not infrequently.A patient called me after 1 year saying that a piece of HA had \'broken off\' and moved to the underside of the shaft and was now causing him pain during sex, so he had just stopped having sex. He asked if anything could be done and was relieved that the HA could be dissolved away, as he thought he had to wait until all the HA went on its own.

You\'re giving one single example, but you must have stats on how many patients you treated in total, and how many had this issue? I have not heard this before, and would like to know the stats. Everything has risk, but people decide to proceed or not based on statistics, not a single anecdotal case. If that were the case, people would read darkstaff\'s pmma experience and nobody would have it done!

Androfill wrote: I hope Dr Oates does write more about addressing complications. I don\'t think Dr Oates is a Urologist, but I see one Urologist and a surgeon on the Morganstern website.

I hope he does as well.

Androfill wrote: I already know Dr Horn\'s view that Ellanse is high risk.

Yes, but he still does the procedure if patients request it, and has had good results (as has Dr Oats). Does he tell patients in advance that if something goes wrong he can\'t do anything? Or does he discuss with them what the specific odds are and actually have a some plan to treat possible outcomes?

Androfill wrote: HA = safe (in large part because it can be dissolved), Ellanse / PMMA = less safe (in large part because you are stuck with some of the same problems, but this time they can\'t be dissolved). The distinction is obvious but worth repeating ad nauseam.

Everyone knows that, but you\'re on a forum where for years guys are opting for pmma (which is permanent) on a daily basis, based on a long history of good and some negative outcomes. Saying HA is safer is not going to convince a lot of guys to opt for it after doing years of research, and realizing that many guys spend a lot of money on HA and have it dissolved because it\'s \"squishy\" and feels like a \"padded dick\" ... yes there are some lucky guys who are OK with it (and have the $$$), but there are a lot of guys who are not, and in some locations guys are paying 10K USD for 15 ml ... which last 1.5 years, and which they may not be satisfied with.As long as there are alternatives like pmma or ellanse that last longer and feel more natural (I take this as confirmed), then people will opt for these over HA unless it is shown by reported / documented cases (with pics), clinical studies, and other real data that it\'s not worth the risk. Note that in Gary Alter\'s editorial comment on the pmma study, his main concern was what may happen \"a decade\" down the road ... at least for ellanse that\'s not a concern.

www.jsm.jsexmed.org/article/S1743-6095(16)30328-9/abstractI\'m not arguing there is no risk, I\'m just asking you to contribute actual data and stats on those risks, if you have them.

Ellanse may or may not be more likely to cause complications than any other Dermal Filler.
But dermal fillers do cause complications.

Filler migration is one specific risk in the penis that happens not infrequently.

A patient called me after 1 year saying that a piece of HA had \'broken off\' and moved to the underside of the shaft and was now causing him pain during sex, so he had just stopped having sex. He asked if anything could be done and was relieved that the HA could be dissolved away, as he thought he had to wait until all the HA went on its own.

Had it been Ellanse, I would not have felt good reminding him that there is nothing that can be done for 3 more years.

I hope Dr Oates does write more about addressing complications. I don\'t think Dr Oates is a Urologist, but I see one Urologist and a surgeon on the Morganstern website.

Dr Ralph in the UK would be an excellent Urologist to ask because he does a lot of work removing fillers from the penis (mainly self-injected paraffin but also other substances), and he has no penis enlargement business so he should be impartial. I will write to him asking specifically for his views (I already know Dr Horn\'s view that Ellanse is high risk).

A fundamental problem I don\'t see a clear solution to is how some of the basic issues associated with dermal fillers, of any type, can be dealt with when the filler can\'t be dissolved. Hyalase is a useful safety net for many of these problems, but only with HA.

Further, most of the discussion and formal study of Dermal Filler complications is in the context of small volumes, and not in the penis. But the context here is 10-30ml in a sensitive organ which no one wants a problem with. To be able to dissolve away many of the complications changes the risk profile significantly.

HA = safe (in large part because it can be dissolved), Ellanse / PMMA = less safe (in large part because you are stuck with some of the same problems, but this time they can\'t be dissolved).
The distinction is obvious but worth repeating ad nauseam.

Androfill wrote: The difference between HA risk and Ellanse risk is my focus, and not explained well in some of the marketing to new patients.

You make the risk clear on your website. But aside from it being non dissolvable, I am just trying to understand exactly what the risks are and what the incidence / likelihood of adverse reaction is based on any available data, not hearsay.

All we have to go on at this point is that dr oats has been using it for almost 2 years (I don\'t know how many patients he\'s treated, maybe he can tell us) and that Morganstern in atlanta, who are top notch urologists and have been doing PE and research on it a long time, has been using it for about 7 months. If either of them discontinue its use then I\'ll pay attention for sure!

[Right. The exact same considerations as with PMMA requiring good technique, multiple sessions with small amounts, detailed after care instructions, etc... and guys are reporting PMMA results on a daily basis...and a 10 year history.]

Yes I agree, similar considerations to PMMA.

I would have Ellanse over PMMA myself because I know where Ellanse is made and that it is eventually fully bioabsorbable. That said, I would not take the risk of either, personally.

Both are much higher risk than HA. The difference between HA risk and Ellanse risk is my focus, and not explained well in some of the marketing to new patients.