TOPIC: Complications following Dr. N pmma removal (Photos Inside)

Skeptical One wrote: I second Hoddle's opinion. Seek out more than just one opinion, especially if you can get a hold of professionals acquainted with wound care (this doesn't appear to be a PMMA issue, although I could be wrong. It appears pathogens were introduced during or after Removal). Sorry if I missed it but whereabouts do you reside? Maybe I can get a regional Doctor to chime in.

In the northwest but I'm more than willing and able to travel to see that right specialists.

Toothman wrote: So after rereading original post, I would say the problem is delayed healing caused by both steroid and 5fu. Both of these inhibit both healing and collagen formation. The doctor should know that no incision or surgery should be done for at least 6 mos after last injection. I bet a million dollars that is why the incision not healing. That being said, if u keep area clean, I may just granulate in over time.

Indeed I've had several steroid and 5fu injections in the area but in fairness to the doctor that last was well over a year ago.

Toothman wrote: I had two spots the derm tried to treat my PMMA granulomas with steroid. Both spots ulcerated and wouldn’t heal. Ended up I had to have those areas cut out. Gelman said tissue was very unhealthy where PMMA was. It just wouldn’t heal. I think it was 8 weeks later. PMMA, despite what some studies say, never seems to allow healthy vasculature to form. It creates scar tissue. Imagine lymphatics and blood vessels forming through scar tissue. Ain’t gonna happen.
I would keep it clean and covered. Moist wounds heal better than dry ones. Bandage and bacitracin. Neosporin has neomycin which, in some, causes allergy. It over time may granulate in and heal.

Very good points indeed, I'll take your advice. Did your wounds look like mine does? Aside from the swelling and pain your experiencing did they at least heal over?

hoddle10 wrote: But from what i can see, this doesn't look like the incision not healing or re-opening. It looks like a hole has opened up in the skin near by. I can also see some skin peeling. I've never seen PMMA rejected snd open a hole in the skin, hence I thought it could be something else. But Dr N has never used silicone, so obviously it isn't.

It's probably just an opening in the incision and the PMMA granulation tissue is causing a problem with healing. But from the photo, it doesn't actually look like it's on the incision, but it could just be he angle and lighting etc. To me it just looks a bit like some bacteria got in during surgery and caused for the filler to be rejected. It's just I've not seen that from PMMA in all the time PB has existed.

Most of my PMMA and the nodules I had exercised were courtesy of Dr. N but I did go to see Dr. C for touchup sessions to correct the many aesthetic issue I was originally left with and silicone was part of that treatment. That said I'm almost certain that no silicone was put in that area. For one it wouldn't make any sense because it was always a 'high point'as there was way too much PMMA injected there to begin with. What I did have in that area is multiple Kenalog and 5fu injections in an attempt to reduce the Nodule. In hindsight it seems clear that the integrity of the skin was probably greatly weaken by these injections.

I don't think the PMMA triggered the reaction either because where the skin started to degrade there was hardly any left in that spot after Removal. However the skin was damaged there during Removal as indicated by the tiny holes oozing fluid immediately post Removal and black spots in there area (dried blood?), this spot was about 1cm away from the incision line. It could've got infected during surgery or while healing, the skin did heal over completely though after 1 month. But there was a large depression and a sharp ridge between the area where the PMMA was removed and the rest of the implant. I had wanted a smooth transition but that's easier said then done when it comes to Removal. Anyone considering Removal must consider this, the chances of having a smooth outcome is VERY UNLIKELY. When I moved the skin across this ridge it felt irritated by it. I did not have any sex, only light masterbation and that was one month post surgery.

Post Removal depression;
Attachment 1

The ridge is more noticeable when viewed like this;
Attachment 2

My areas of ulceration were in areas where I was having pain so derm used bleocyn and steroid to try to shrink the mass. What it did is ulcerated the tissue. First was not visible, then they both looked like pin holes, then grew to the size of a eraser on a pencil. 8 weeks went by and no healing. I could tell the tissue around ulceration wanted to close but the ulcer itself was just dead tissue. Wasn’t gonna heal.
Gelman removed some of my material but I think it’s made things worse pain and inflammation wise. I am currently booked with Alter to try to remove more however how much can my Dick take. I am really considering just removing all the skin and doing a split thickness graft. Very non ideal.
This PMMA is so inflammatory

Based on what you've posted today, I'm fairly confident it is a case of bacteria causing silicone to be rejected. When silicone is injected it can migrate and it gets everywhere. As soon as I saw your photos, I suspected silicone, but I thought it was done with Dr N, which didn't make sense.

In my layman opinion, this looks like a typical silicone reaction. I've never seen this from PMMA and I researched PMMA complications for years before finally getting it done. I've seen it happen with silicone several times. Yet, somehow, unbelievably I got S1000 myself, despite telling others not to!

Obviously take what I say, with a massive pinch of salt, as I have no medical training whatsoever and speak to a Dr with experience in dealing with complications from fillers.

Have you contacted Dr C? He may be able to recommend someone in the US.

So even when using the microdrop technique there's still the possibility of migration?? Jezz talk about a ticking time bomb, meaning anyone who's had it done can suffer the same consequences should the penis suffer physical trauma.

On a more positive note and I hope to god this is not just my imagination but I think I'm starting to see the start of re-epithelialization! It's hard to believe that things can change so suddenly but there is noticeably an increased amount of white tissue built-up inside the hole from just yesterday. And it's not just slough which was easily washed out this seems to be solid tissue;
Attachment 1

Now I'm not sure if I should proceed with the silver nitrate application? Would it interfere with the healing process or would it help?

wemustbecrazy wrote: So even when using the microdrop technique there's still the possibility of migration?? Jezz talk about a ticking time bomb, meaning anyone who's had it done can suffer the same consequences should the penis suffer physical trauma.

On a more positive note and I hope to god this is not just my imagination but I think I'm starting to see the start of re-epithelialization! It's hard to believe that things can change so suddenly but there is noticeably an increased amount of white tissue built-up inside the hole from just yesterday. And it's not just slough which was easily washed out this seems to be solid tissue;
[PHOTO]

Now I'm not sure if I should proceed with the silver nitrate application? Would it interfere with the healing process or would it help?

If I'm not mistaken the micro-droplet technique is intended to prevent migration. I think Hoddle may have been speaking in generality regarding silicone, I'm not sure (?). I think what he's speculating is that the Removal procedure exposed an infection to the surgical site which in turn induced a foreign body response to the silicone you already have inside you.

I don't know if this is silicone-related at all but it definitely appears to be associated with something that happened during or after your Removal procedure (namely an infection). I'm curious to see what test results of the bacteria culture come back as.

Skeptical One wrote: If I'm not mistaken the micro-droplet technique is intended to prevent migration. I think Hoddle may have been speaking in generality regarding silicone, I'm not sure (?). I think what he's speculating is that the Removal procedure exposed an infection to the surgical site which in turn induced a foreign body response to silicone you already have inside you.

I don't know that is silicone-related at all but it definitely appears to be associated with something that happened during or after your Removal procedure (namely an infection). I'm curious to see what test results of the bacteria culture come back as.

Yes that'll be interesting to find out. Should know the results in 3-4 days, though if the wound is actually healing would there be anything to report? On that note I misworded the last post, it's not the start of re-epithelialization which may never properly reform but rather granulation tissue, lest I hope.

It's intended to, but it doesn't. Mine has moved over time and Miracles got into his skin.

You are correct about what I'm speculating. @wemustbecrazy thought because the silicone wasn't injected in that spot that it seemed strange it would come out there, but it does move.

A final follow up report on the situation. The wound did indeed finally started to heal once I finished off the antibiotics. Clearly it was infected, the bacteria culture came up negative but they were after I had been on the antibiotics for a bit. Seems to me that when an open ulcer like this forms on the shaft skin it's because you're deal with an infection otherwise things would heal up normally without complications.

It was interesting to see the granular tissue fill up the wound from the center/base of the wound and grow upwards. Eventually the skin around the wound started to contract and shirk the wound area, the resulting scar is probably slightly less than half the size of the wound at it's maximum, I'd say 8mm long by 2mm wide. The granular tissue filled up about 80% of the wound depth, there is a slight depression but it's not really noticeable. However the skin was not fully able to grow over the new granular tissue and reconnect. Instead the skin is attached to the edges of the scar tissue. Basically its no longer able to move freely over the shaft in this one spot. Thankfully because of how small the scar is and it's location, more towards the underside of the shaft, this seemingly hasn't result in any really noticeable issues. Though I haven't really been able to test things yet so it may still prove problematic in the long term. In any case I'm just happy that I no longer have a fucking hole in my Dick or that the ulcer did not turn into something much worse - skin Necrosis or larger ulcerations!

How have things been?? Healed up ok?