TOPIC: HYBRID FILLER LONGEVITY

This topic was imbedded within a conversation but thought it deserved its own post.

Most people think that hyaluronic acid (HA) fillers last only 6-12 months but there are facial ultrasound (US) studies that confirm HA filler actually lasts much longer, sometimes even 2-3 years after depending upon where it is injected. Often it is still occupying space but not doing its job quite as well as freshly injected. It may be subject to degradation, swelling, and migration.

There are facial studies that demonstrate the collagen formed from Radiesse is present in 40% of patients at 2yrs. This means it has dissipated in 60% of patients. As time goes on a small percentage of the 40% will continue to 2.5yrs and beyond.

I've had 3 patients return 32mos after penis filler with my Radiesse-HA blend. All 3 were still girthier than their baseline measurements. 2 of these patients were aware they were still bigger. 1 of the 3 thought it had all dissipated, however, his comparison measurements showed quite the contrary. Most guys over time will forget how they started and think it’s all gone because everyday is a new baseline. It’s important to keep photographs with measurements to be objective.

Not everyone will have this longevity. Filler is subject to mechanical breakdown from masturbation and intercourse. If it’s in more demand, naturally it will dissipate faster. Chances are you will top off before all the product has been fully absorbed. If budget is not an issue, guys will typically repeat anywhere from 4-12 months. “It’s rather addictive” is often heard at my office.

I've attached a few photo comparisons. Generally speaking for my before and after photos, If you see steri-strips (thin adhesive strips) on the penis, it is immediately after. If there are no steri-strips, then it is at least 2 weeks after procedure but dates have also been provided in a few of these samples.

Contact my office for more information:

info @leonardomedicine .com or 1-647-223-4436

A curiosity because I had HA back in November 2021 and nothing since - this isn't talked about a lot other than hearsay, seems you're actually done some fairly in depth analysis of this. Some guys have said with HA you do get a minuscule amount of permanent collagen, but I've not seen more than hearsay confirming. So, worth picking your brain.

What effect, if any, have you found for those who have let HA mostly or completely lapse without top-ups in terns of how well they handle subsequent Dermal Filler procedures?

In my case it feels like the skin is looser but thicker. Have you seen similar, do you have an explanation for it? Is that the less-effective HA still holding on by a thin thread?

Would the continually stretched skin make for someone who's able to handle more filler than they would have originally? Or would the degraded filler be wasting space that could otherwise be used by good fresh filler?
Would the "thickened" skin make subsequent injections more difficult?

@itgoesthud there are studies that demonstrate collagen production as a result of HA filler, but not anywhere close to what you achieve with Radiesse or Sculptra. I'd say it is pretty much negligible. My augmentations are predominately performed with a Radiesse blend. Rarely do I use exclusively HA. As such, I don't have much to say about their longevity. Those few patients have returned sooner than their anniversary. They still retained some volume but not all.

Skin will stretch and be able to accommodate more filler over time. It may be prudent to stage large volume augmentations.

Degraded filler is pretty much gone. The body clears it after the native hyaluronidase breaks it down unless it is trapped in a confined space. Often if an area has poor circulation, then their is less exposure to hyaluronidase such that HA may linger much longer compared to an area that is highly vascular like the penis.

I place product deep such that skin thickness is irrelevant. Repeat procedures may be more challenging due to fibrosis though. This can be a result of the natural response to needle/cannula trauma or as a result of the body's reaction to the product that was injected. Some repeat patients have very little fibrosis, while others may have more.

Hope this helps.

Very good info, thanks Doc!
The patients above are still substantially (to me) above baseline when they return for follow-on procedures, with great aesthetics suggesting no uneven degradation.
WIth my HA I'm still...maybe 1/8" above baseline 3 years on.
I guess these Radiesse microspheres themselves are sticking around longer VS just a quick hit of new collagen that stays indefinitely.
Whatever collagen lingers with whatever filler, sounds like if nothing else the stretched skin is going to make subsequent procedures easier after degradation IF, there isn't a ton of fibrosis. Not that you employ the Leroy Jenkins injection technique once you get added space from stretched skin regardless, but still, sounds like those of us who did a "test drive" with HA put ourselves in a good position for longer lasting fillers down the road, possibly, with the caveats around fibrosis.

I am very interested in Radiesse or Radiesse/HA blend. Say I have a Radiesse procedure/s done and then decide I want PMMA. How long would I theoretically have to wait. Would doctors avoid doing PMMA on me for years?

I don’t work with PMMA so I honestly don’t know. If someone has PMMA, I avoid Radiesse because I don’t know how it will react with PMMA. However, Radiesse eventually turns into your body’s own natural collagen after about 4 months. If there are no nodules and it feels like flesh, I would assume it would be safe, but again it’s just an educated guess.

The longer term collagen stimulation and safety is one of the reasons I'm now considering the Radiesse/HA. I first researched getting PE fillers about 5-6 years ago and my conclusion from that research at the time was that I would likely be going with something like Ellanse with Dr. Oates due to the fact that it was "temporary" but still had a longevity component to it. On paper it seems that Radiesse is essentially a 'more temporary' alternative of Ellanse: less longevity but safer with better bio-compatibility and more suitable for people that might have atypical immune reactions or want a higher chance of avoiding fibrosis/lumps. On paper it also seems Radiesse is supposed to last maybe about ~2 years while Ellanse is closer to 3 or 4 years. However there are quite a large number of anecdotal reports on here of Ellanse patients at the 6-8 year mark with some still keeping upwards of 75-90% gains which does not seem consistent with that timeframe at all. And if this is really the case, what would even be the argument for getting Ellanse over Bellafill/PMMA? Whereas it seems Radiesse is perhaps more true to its quoted number in that there is a clear loss of volume even if there does appear some long-term size retention?

What I'm wondering is, since @LeonardoMedicine is seemingly injecting about ~50% Radiesse by volume, if perhaps this was a higher % Radiesse if there would be more long term/'semi permanent' volume retention along the lines of Ellanse? Or is it in fact the HA portion leading to this retention past the time frame. I'm sure the answer is that both do contribute, but I wonder if one is disproportionately contributing to this more.