TOPIC: What is a Hyaluronic Acid (H.A.) Dermal Filler and are they all the same?

From my observation from speaking to Girth enhancement patients and reading posts on PhalloBoards, it seems to me that most of the men researching Phalloplasty or penile Girth enhancement through the application of dermal fillers such as liquid silicone, PMMA, or Hyaluronic Acid (HA) dermal fillers, have the perception that HA dermal fillers are all the same. This isn’t necessarily true. I want to explain what could make "adverse events" or "complications" related to dermal fillers different from one H.A. filler to another.

First, it may be surprising to know that Hyaluronic Acid is simply groups of sugar molecules suspended in water. And what’s even more fascinating about Hyaluronic Acid is that it’s found in almost every tissue in the human body. You can think of our bodies as a pool of Hyaluronic Acid. Even more fascinating is that Hyaluronic Acid can hold 1000 times its weight in water. So it’s a sponge that can actually expand and gain volume once injected into the body. For this reason most of us don’t have reactions to Hyaluronic Acid.

It’s important to understand that not all H.A. dermal fillers are created equally. (Neither are all men…. Praise be to Girth enhancement!). Hyaluronic Acid Dermal Filler in its natural state would absorb very quickly once injected into the body. In order to give H.A. dermal fillers longevity, the dermal fillers must be “cross linked.” Cross linking of Hyaluronic Acid gives the filler it’s “thickness”, flexibility, and it’s longevity.

Typically each brand of H.A. Dermal Filler has its own patented and trademarked cross linking technology. This is what could make one technology of “cross linking” preferable for one Dermal Filler application over another. For instance in the face the injector might choose a thicker and more flexibility Dermal Filler for the lips and a thinner more malleable Dermal Filler for around the delicate tissue of the eyes.

I decided to write an article on this subject this past week after I corrected a patient from another provider (not on PhalloBoards). I was forced to use hyaluronidase (the enzyme that "melts" Hyaluronic Acid) to dissolve the majority (90 - 100%) of the HA Dermal Filler that was injected into this man’s penis for Girth enhancement. He was impossible to correct with additional H.A. Dermal Filler because this product used in him caused some inflammatory responses and left his with nodules and granulomas.

The patient was treated with an unknown (unknown to to him) H.A. Dermal Filler 3 weeks prior. The following day after the procedure the patient woke up with an incredible amount of inflammation, swelling, and tenderness. After being prescribed an antibiotic by a different physician, 3 days later there was no change. At this point he began to feel self described “knots” otherwise known as granulomas in his penis. He contacted PhalloFILL - Dallas and we suggested he see a local physician to exam him for inflammation. A course of anti-inflammatory steroids were prescribed and the inflammation itself was resolved in about 5 days. He was left with golf ball sized lumps on all sides of his penis from the base to the glans on the entire length of his shaft.

Now I get to my point of the post. When choosing your provider for Dermal Filler it’s important to understand the differences in the H.A. dermal fillers that will be injected into you. I’m going to present you non-biased, factual information taken directly from the FDA. And I will conclude with a graph with references.

Primarily when researching H.A. dermal fillers in the US you will find 3 generally accepted H.A. dermal fillers in the Girth enhancement community. Galderma products often known as the Restylane line of products, Allergan products often known as Juvederm line of products, and Revanesse which has one product called Versa. All of the Galderm/Restylane and Allergan/Juvederm products are 1.0 mL syringes. Revanesse/Versa syringes are 1.2 mL.

The graph I’m going to show you presents what we refer to as “events of interests.” Events of interest are important to understand when selecting your H.A. Dermal Filler because they do happen in real world. They include granulomas, hyper-sensitivity, inflammatory nodules, and non-inflammatory nodules. Other "events" that would not be considered of interest would be things like swelling, bruising, soft tissue injury, or improper injection technique.

Now to the good stuff. This graph took the last 595 total events reported to the FDA on Restylane Refyne, Restylane Defyne, and Restylane Kysse. The next section is Juvederm Vollure and Juvederm Volbella which also has the same exact cross link technology as Juvederm Voluma. And the 3rd section which is only one product is Revanesse Versa. The last section is 3 dermal fillers from a company called Teosyal which we don't see discussed much. I'm not sure I've ever seen Teosyal mentioned on this forum.

The most important column in this graph is the 2nd column. It shows how many “Events of Interest” were documented for each product in the last 595 total "events" reported to the FDA at the time this research was compiled.

The data from the FDA shows the following "Events of Interest" out of the last 595 reported for each product:

Restylane Refyne = 5
Restylane Defyne = 10
Restylane Kysse = 0
Juvederm Vollure = 145
Juvederm Volbella = 24
Revanesse Versa = 0

It should be noted again that Juvederm Voluma uses the same Vycross “cross link” technology as Vollure and Vobella.

I hope that this helps you understand that the potential Girth enhancement patient should ask more questions of their potential provider than just the price, the number of procedures performed, and how many syringes will be injected per treatment. Be an educated researcher and know your H.A. dermal fillers.

Thanks for this comprehensive bit on H.A. fillers! It's one of the newer fillers being discussed, so any and all background is appreciated.