TOPIC: PMMA infection

Is it possible the PMMA is just causing the inflammation and that needs to subside?

About Removal, there are docs here in US that are more familiar with it. Dr Mark Solomon, Dr Joe Gelman, and Rejuval.

Although infection after filler treatments is rare, it can happen, and since fillers are foreign materials, eliminating the infection can be challenging. Infection can happen at anytime because bacteria occasionally enter the blood stream, ie after a dental procedure, while brushing your teeth. When this happens your body typically deals with the bacteria and no harm done however when you have a foreign material in your body it may interfere with the bodies natural clearance of the bacteria. This is because bacteria can form a biofilm. A biofilm is a protective layer of bacteria that sticks to a surface, such as a filler, making it harder to . These bacteria grow slowly and are shielded from antibiotics, making treatment difficult. The risk of biofilm formation increases in cases where a foreign body is present, especially when infections last longer than a week, antibiotics are ineffective, or when infections improve during antibiotic treatment but return once the treatment is stopped.

To treat a biofilm infection, the first step is draining any pus and removing the foreign body. For Hyaluronic Acid (HA) fillers, hyaluronidase is used to dissolve the filler, but with non-dissolvable fillers like PMMA, this isn’t possible. Antibiotic therapy is also crucial and may involve multiple antibiotics, either guided by culture results or chosen based on the most likely bacteria causing the infection.

Because of the concern that the infection could return, we may treat with antibiotics for an extended period, longer than usual, to ensure that all the bacteria are eradicated and reduce the risk of recurrence. I'm glad you seem to be doing well with proper care.

Dr. S

Doc, interesting post. So would u suggest then, that pts with PMMA should premedicate for dental procedures with an antibiotic, similar to premedicating for prosthetic joints? I know the current protocol most orthos go by is premed for 2 yrs after joint replacement, then u usually don’t need to premedicate.

Also, Dr S, have u experienced any infections with the Bellafill augmentation pts you have treated? Have any of them needed full Bellafill degloving and Removal surgery?

Thankyou for your time

Thank you Dr. S. of his infiormations, I have been on antibiotics for 14 days, the infection has not gone away and I only have small leaks of transparent liquid. If the situation becomes complicated I have to look for a surgeon who is able to treat PMMA, I would be willing to come to you if you can help me. Here in Europe I cannot find a Surgeon who is familiar with PMMA treatments. If you can also contact me privately. Thank you

I'm not sure we know this answer yet. I think it is probably unnecessary to premedicate and it has not generally been recommended with fillers- the difference here is that larger filler volumes are being used with this procedure. I have not had an infection requiring more than antibiotics thankfully!

While I can see residual swelling, I will say the most recent pictures have made notable and promising improvements from the prior uploads, and I suspect the targeted treatment of this specific infection may be the light at the end of the tunnel you were looking for.

I did reply to your PM with respect to getting additional opinions including some names of Doctors who can be of help in your specific situation. Thanks again for keeping us up to date, and I'm confident your situation will resolve in due time -- best of luck and as always, the Community is here to support.

@Toothman I read that there’s PMMA infused with antibiotics to prevent biofilm formation that is used during orthopedic procedures, like joint replacements. It’s odd that they don’t do it for penis augmentation too. I think there’s additional caution in the orthopedic procedures because the orthopedic implants are at far higher risk of biofilm formation because they have more surface area and are long, complex multistage open surgeries with so much more exposure. That said, I’d rather get a knee infection than a penis infection.

@Zep83 I would think the doctor having experience with similar procedures in the same area is more important than PMMA experience. Meaning, a urologist who has done many penile surgeries would probably be better than a general surgeon who has done many PMMA removal in other areas of the body.

If it was me, and I couldn’t find someone with specific experience in removing PMMA from the penis—which obviously would be ideal—I’d look for a urologist who has done penile reconstructions, corrective surgery for Peyronie’s disease, or possibly some that have experience in treating biofilms that can form on inflatable penile implants. Someone who has done reconstructions would have a good understanding of the complexities of the penis, but would also have an eye for the appearance and function. Again—I’m not a healthcare provider—this is just a “what I would do” kind of thing.

I’m not recommending these places. I have no experience with any of these; I just did some searching and found these coming up as leaders in the area.

German Center for urology and phalloplasty surgery, London England
Dr Ralph at St. Peter’s andrology center, Darmstadt Germany
Harley street urology, London England

Bradonline1984 wrote: I read that there’s PMMA infused with antibiotics to prevent biofilm formation that is used during orthopedic procedures, like joint replacements.

If I'm not mistaken, Avanti Derma (and many other Clinics) will prescribe antibiotics as a preventative measure post-op. It appears that Zep83 is dealing with a rarer bacteria and what comes off to me as more-or-less a freak infection. The antibiotic that is prescribed is likely a first-line defense with broad protection against the kind of infections generally considered most likely to cause issues after a procedure of this kind -- given that the bacterium was determined to be "enterococcus gallinarium," a pathogen that appears to be very rare in cosmetic procedures (i.e. Dermal Filler injections) according to some of my initial readings online, it isn't a surprise that a first-line antibiotic would have missed the bullseye... reaffirming my belief that this is a statistical misfortune (a nice way of saying "bad luck") than anything else (especially based on an abundance of sample size), but one that I also believe can and will be corrected now that more information AND treatment has come to pass.

As for the PMMA infused with antibiotics when applied to other procedures, you'll find that they are often times more invasive (e.g. joint replacement), and warrants the heightened precaution -- versus dermal fillers that are by & large relatively safe (and as I noted prior, an overwhelming sample size that confirms as much). I want to emphasize the word "relatively," as I don't want anyone to believe that 100% of procedures are 100% safe and/or effective just because they are performed by the very best Practitioners. The whole reason why I vehemently insist on men seeing the "best of the best" is to reduce the odds of these types of complications to the very minimum. In the end, all elective endeavors are calculated risks, albeit low risks in my honest opinion, but risks nonetheless.

Hello everyone, update after 20 days. I had the support of Dr. C. on a video call and he referred me to a Urologist he knew in Florence. I left immediately and it was assessed that my allergy to antibiotics containing penicillin limited antibiotic treatment from the beginning because the "enterociccus gallinarum" bacterium is more sensitive to these antibiotics which I cannot take. There are treatment alternatives but using more antibiotics (imipenem, linezolid, streptomy). My infection went on longer than it should have due to the difficulty in treating this bacterium. The Urologist in Florence immediately explained the situation to me, he is an expert in penile reconstructive surgery. He told me that in his opinion the infection had been treated correctly and the blood tests had returned to normal. The MRI excluded migration of the PMMA in other areas, Corpus Spongiosum, scrotum, lymph nodes. He assessed that a low Circumcision was still necessary to eliminate the area where the infection started from the Foreskin. I didn't want to lose my Foreskin but faced with an infection I had no choice, I only asked to cut off as little skin as possible. I had a very low Circumcision and he told me that with time and stretching I could restore a part of the Foreskin but this will be seen. Now I'm back home, after 20 days of hell and I'll have another month of hell between rest, medications, oral antibiotics (lighter) hoping that the infection is gone and won't come back. I'm still not sure I'm out of this. I just prayed not to end up having my entire penis destroyed in order to remove everything and reconstruct it, for now the choice of Circumcision has been evaluated and I hope that in the misfortune I had at least the Foreskin where it all started was an expendable part compared to to open everything. For now I will continue with the treatment and I will see what to do with the next tests.

Glad you're doing better Zep83. That is a scary story. I've also never waited to have unprotected sex for more than 2 weeks. But I will def wait longer this time. FYI, I use a prescription antibiotic cream to massage with for the first 3 days and the holes typically close after day 3.
But like I've said many times before on this forum, I am astounded as to the amount of PMMA product you guys have injected at one time. I've had a total of 6 rounds of Bellafil, over a 2 and half year period, and I'm up to 28 cc's plus or minus. Your more than double mine over a very short period of time. But as I've also indicated, I don't have nearly the real estate most of you guys are blessed with. So I can only take small amounts at one time. My personal opinion is, these large amounts of product injection at one time has to
increase the risk profile of overall outcome, healing etc. With much smaller amounts, the healing and aftercare process is relatively nominal. I just put that out there again for folks to contemplate. Prayers on your continued improvement!

I haven’t posted here in years. I got my procedure done in 2017 and was a member before that since 2014. I spent countless hours reading progress reports for years. I do not think you got the infection from intercourse 2 weeks after your procedure, I think you contracted that infection in Mexico and you were unaware it was happening until after intercourse when something didn’t feel right. People could disagree and even you could think otherwise, but I’d bet I’m 90+% right about it.

Well you cant just end the post there. 90 percent sure based on what? Did you have a similar experience in mexico?

I wanted to update you on my situation, 1 month has passed since the beginning of the infection, two weeks have passed since my tests returned to normal. I had a lot of time to think during this period and I consulted many doctors and surgeons in Europe and the USA. Yesterday and today I had my tests and another urological consultation. From what I understand, the infection could have arrived in different ways, but no doctor can be 100% certain. For my type of bacteria, unprotected vaginal sexual intercourse is actually unlikely, the situation changes with anal intercourse where enterococci are present, my woman has also had tests to exclude any presence of bacteria and is negative in all . I had not had anal intercourse with her for at least 2 weeks before the procedure and therefore 1 month had already passed since the beginning of the infection and this possibility was also excluded. It may be a coincidence that the infection arrived about two hours after sexual intercourse, it is not possible to know for sure. To date, my remaining strength after 1 month of hell is all for recovery. They decided to do a Circumcision as I had already written and removing the nodules where everything started was important but not the definitive solution. The Urologist clearly told me that a conservative choice was made given that all the values ​​had been normal for two weeks and that there was no trace of the bacterium in the urine, feces or blood during this period. He was very clear and direct about the high probability that the bacterium has attached itself to the fibrosis creating biofilm, this will keep the situation normal as long as my immune system remains active, if I were to have another infection I would risk septicemia and then sepsis. the bacterium has become resistant to antibiotic treatment and another course of antibiotics would have no effect. Surgical Removal was ruled out given the stable conditions and honestly the Urologist who is a reconstructive surgeon explained to me that with 69cc of PMMA it would be necessary to completely open everything to reconstruct an entire penile patch and it would be devastating as a procedure. on a surgical level, and mentally given the recovery times of over 6 months and finding yourself with a penis that is no longer even the one I had before the PMMA which honestly wasn't bad (17x13). My wife had a prolapse and I decided to take this path towards enlargement but it went badly. My future sexual life does not allow unprotected intercourse and I will have to use condoms at all times. I will have to watch out for any type of infection and if it were to wake up in the penis it would be the end. Now I still have some residual swelling, I have a 14 cm circumference and unlike everyone else I'm praying that it stabilizes at 13 13.5 cm which were the measurements I had before. When Erect the situation seems better, the swelling seems to disappear and the penis is quite uniform. I had the Circumcision 2 weeks ago and I can't force the stitches but I thought I would end up like a circus monster after the infection. From today I will take supplements to relieve the swelling which is also partly due to the Circumcision.

Omg. Thanks for the reporting! Definately makes me think.
All the best to you.

That all makes sense except for the need to use protection once everything is all completely closed off. The biofilm is already in there. I'm missing something I guess. I don't know what the risk is there supposedly.

NB: you might look into slamming massive amounts of serptase.