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 kill. 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.