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Post by mikehok on Mar 31, 2011 15:18:37 GMT -5
Over the last few days I have exchanged several emails with Prof Lemperle who is the inventor of pmma and is now based in San Diego. I wanted to ask him about potential complications and I also asked for his comments on the report which was posted on this site several months ago which reports various cases of complications. His reply has given me more confidence to go ahead with the procedure, and he has given me permission to post it on this board, so here it is:
" I know this report very well (and the authors Ferreira and Gemperli) - since I had to peer-review it - and was shocked as you are. One has to know that PMMA is injected in Brazil by the pounds in probably millions of patients - because it is so cheap. over there. And it was (!!) not clean, e.g. caused a lot of granulomas.
The Brazilian doctors prevented granulomas by injecting bigger amounts deep under the skin, instead of into the dermis, as we can do it with our clean ArteFill or Artecoll - or now Newplastic. Everything in medicine is development - unfortunately often on the facts of side effects.
The described necroses , therefore, were eliminated by the introduction of blunt cannulas , which are introduced and used by Dr. Casavantes , since with sharp needles, one could hit an artery and fill it unnoticed with PMMA ...until a skin necrosis became obvious - hours after the injection.
So, since I collected all complications on PMMA worldwide since 20 years, I can assure you that a skin necrosis in impossible with blunt cannulas . Granulomas still remain a risk - but so far, they occurred all after intradermal injections (because the skin is the most sensitive organ of the body) - and not after deeper injections in the fat or for example between Dartos' and Buck's fascia.
Since I have been in contact with a few patients - and saw one in N.Y. - who had lumps after PMMA injections in their buttocks, I can assure you that also the "granulomas" described in the above article have been lumps, due to uneven injection or movement and dislocation by the buttock muscles. Pathologists call every foreign body reaction a "granuloma". What they call "inflammatory reactions" to PMMA. I would call a granuloma, if it occurs 1/2 to 5 years late, on all sites at the same time.
Still, even if I don't know of any case (In China , they have injected more than 500,000 patients - and report every side effect to me) the risk of the first granuloma in a penis remains....
Hope, that helps you ?
Best , Gottfried Lemperle"
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Post by Skeptical One on Mar 31, 2011 16:00:22 GMT -5
Thanks mikehok for this email, if you don't mind posting a copy of this email in the RESOURCES Forum, I'd greatly appreciate it (This thread can remain here for discussion).
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Post by sparticus on Mar 31, 2011 19:44:07 GMT -5
I agree that we should stay in contact with Lemperle, I want to email him as well. However, I recommend taking anything he states with a grain of salt.
"I would call a granuloma, if it occurs 1/2 to 5 years late, on all sites at the same time."
-Well, that is a convenient way to redefine the condition. A granuloma reaction doesn't have to form at all sites at once in order for one site to exhibit a granuloma. The studies posted had cases were one "bump" formed and were excised and tested by a pathologist, which confirmed a granuloma reaction, yet only 1 bump was noted and excised. Lemperle is not a pathologist, he is not the one in the lab with the specialized training to ID granulomas and other inflammatory reactions.
"because it is so cheap. over there. And it was (!!) not clean, e.g. caused a lot of granulomas."
-The majority granulomas reported were NOT sequela to infection, in fact I don't recall ANY STUDY we have posted stating infection was the primary cause. The studies indicated they were reactions to the pmma itself. In addition, not all of the people suffering granuloma reactions documented in the studies were injected in Brazil. "I can assure you that also the "granulomas" described in the above article have been lumps, due to uneven injection or movement and dislocation by the buttock muscles."
-A question we have asked before, how long is pmma vulnerable to mobility and migration? This is admittance that it can move, but how long until it is stable? Also, pathologist testing the tissue did not indicate them as "lumps" they were diagnosed as granulomas in the cases where they were excised.
"Still, even if I don't know of any case (In China , they have injected more than 500,000 patients - and report every side effect to me) the risk of the first granuloma in a penis remains...."
-At the conclusion of a study conducted by Lemperle, he also reported that no cases of adverse reaction to Artecoll/Artefill had been reported to the FDA since its first application and failed to mention the case studies indicating otherwise. This statement is completely disingenuous as there were plenty of reported cases and case studies indicating some people do have reactions even when applied correctly in the deeper tissue layers even if it is rare.
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Post by sparticus on Apr 1, 2011 1:32:40 GMT -5
Also, I just remembered something:
A member on this forum posted that he knew of one of Dr. C's patients that had several lumps form and had one removed from his penis after pmma. Dr. C knows how to do the injection properly, so how would Dr. Lemperle explain that incident?
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Post by mikehok on Apr 1, 2011 2:18:55 GMT -5
Tell me something Sparticus, since you seem negative on pmma, what are you hoping to achieve for yourself from these discussions ?
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Post by Skeptical One on Apr 1, 2011 3:18:08 GMT -5
I'm certain that any procedure that requires sedation/anesthesia will, out of 10, 100, or 1000, be susceptible to post-op complication (minor or major). You just have to hope the procedure's complication rate be 1 out of a thousand (or better), versus say 1 out of a hundred or 1 out of ten. I can't imagine any elective surgery or bioplasty procedure being complication-free.
With that being said, I should point out that I highly doubt you will find a procedure to increase your penis size to be 100% safe. At least this is true in the foreseeable future of phalloplasty.
When one researches PE methods, one must realize that if they are going to commit to a surgical option that they are in fact rolling a dice...so one must feel confident that the procedure they elect has the best odds in their favor. This is true for all elective procedures, which include breast implants, nose jobs, and even procedures of liposuction. These are commonly practiced, board approved procedures that experience a variety of major & minor complications year after year, even in light of all the technical advances made.
And as for the suggestion that Sparticus has been "negative," I disagree. Sparticus has opened this forum to an assortment of quality data/resources on PMMA that was not available to us before. This data has in some ways been both pro and anti PMMA. He's also been objective and thoughtful in the debates, regardless of whether one agrees with him or not. I think what some perceive as his negativity is really just intense skepticism.
Sparticus, your skepticism has brought balance to the PMMA discussion, but I am interested in your response to Mikehok's question. If even PMMA, arguably the most successful short-term procedure seen to date (long-term obviously lesser known) is deemed too questionable for you, what do you suspect you will gain from the overall research here other than just pure phallo-knowledge? This question isn't meant to criticize you, but I am curious.
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Post by mikehok on Apr 1, 2011 8:34:42 GMT -5
Let me try to clarify my comment. I wasn't suggesting that Sparticus is necessarily biased in the arguments he puts forward, but it seems his view on pmma is not sufficiently positive for him to go ahead with the procedure. And that being the case where does he hope to go from here ? Does he think it's possible he may change his mind ?
As you say SO almost everything in life has a risk. We often forget that when we book a routine cosmetic procedure. I had a bletharoplasty with no complications, but there are many people out there with undesirable results. There is the risk of side effects and the risk of poor result.
I am in agreement with those who place more emphasis on the aesthetics of their enlargement result. I don't want an odd looking penis. But at the same time I accept that in order to gain size there probably will be some minor irregularity or slightly unusual shape. For example a gap behind the glans or a flaccid penis which is fatter midshaft. I wish to minimize this so I probably will compromise by having less pmma injected. It's each individuals choice.
But of course it's healthy to be sceptical, and we need to be cautious about anybody's comments including pro Lemperle's. I will say though that 2 years ago before I had scaffold surgery, he warned it was a waste of time, and he was right.
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Post by envisionmore on Apr 1, 2011 17:35:35 GMT -5
I posted once about Dr C removing a lump but this was NOT one of Dr C's patients to begin with the guy had the injection somewhere else and went to Dr C to have it fixed which Dr C's Plastic Surgeon handled. Dr C said it was due to Major overfilling!
Mikehok is right all procedures have possible complications. I just heard this morning on the radio a lady had (eyelid surgery) last year here in the states and could no longer close her eyes and sued the Plastic Surgeon and won a little over $100K which she thought was too low.
With (all) PE even manual I have heard of complications. I have been waiting since 1998 for a complication-FREE PE!!! There isn't one!
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Post by sparticus on Apr 1, 2011 18:04:17 GMT -5
Mikehok
To be honest, yes it may be possible that I change my mind about getting the pmma procedure, its the reason why I am still researching it. However, I am not convinced yet that it is safe in the long term and I personally feel the long term risks are understated by those with interests in the procedure. I am very skeptical of anything regarding PE as I have seen so many scam artists. I have a medical background and am able to assess the procedures and claims from a prospective that may be different than other members on the forum. I share what I find because I would want someone to do the same for me, so that I could make an informed decision. I probably sound anti pmma, but I am really not, I am pro safety. The reason I talk about pmma the most is because it is the only procedure I am actively considering. I have thought about scaffolds as well, but given the negative stories I have heard from infection and most cases have little to no gains I am not fully considering it at this time. The rest of the procedures are completely unattractive and far too risky: Bella/alloderm (most get little gain, long time for body to convert to tissue, doesn't cover full shaft, risk of infection, and shortened length), Elist (implant sounds very unattractive, heard many horror stories and loss of length), FFT (heard too many horror stories and seen too many lumpy outcomes after re-absorption, even if all goes well top ups are required and I will not do that).
I try to be as unbiased as possible, but I do error on the side of caution. For example, I was using Dr. Arnold Klein as a source until SO pointed out he may have had financial ties to Artes Medicals competitors, so I stopped using him as a source. I have not stood up for any procedure over another as I feel none are proven to be safe or effective. I have hope for pmma, but given the current evidence I am not comfortable getting it and I have shared my reasoning with others.
SO I understand that other procedures are even more dangerous. However, my perspective is not coming from one where I am going to get PE and am seeking the safest procedure. My perspective is I am uncomfortable about my size and will consider PE if it is reasonably safe, effective, and the aesthetic quality of my penis remains near normal. Maybe this is why my criticism of these procedures seems so harsh, it may not be in sync with the perspective of many other members on the board that have already made their mind up about getting a PE procedure and are here to make their final choice. That obviously not why I am here and if no procedure comes that meets my personal standards then I just won't get one and will live with what I got.
Envisionmore I had thought you stated the man going to Dr. C was a former patient of his. If I misinterpreted that then it was my mistake. EP mentioned a guy receiving a lump and said he was yet to come forward. He used the term "brother", so I assume he was a Dr. C patient, but maybe I am wrong on this as well. You obviously won't find EP's post, but I believe I responded to it and that should still be present in the thread.
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Post by mikehok on Apr 2, 2011 5:10:56 GMT -5
Sparticus, it seems we agree on a number of things. Pmma is the only possible option as far as I am concerned. I did consider FFT but there seem to be mixed reports, with absorption and as you say continual top ups. On top of that the fat feels soft, not like penis tissue.
As for the Elist implant, I personally wouldn't consider it in a million years. In my opinion that thing is going to feel awful.
I am also very sceptical of enlargement procedures in general. I've had two myself , neither worked. One was scaffolds and the other a temporary injectable. The difference with pmma is that it definitely works, as in you will get permanent gains. And we've now seen several reports and photos from people who have had this done. There have been some minor irregularities but overall I'd say so far they have been pretty successful.
So there are some slight aesthetic issues which I am a little concerned about, more so in the flaccid state. I want to avoid having a penis that looks too fat in relation to my glans. And that's reason I plan to receive a moderate amount of pmma and not the full 20ml. I will have to discuss this issue with Dr C at the time.
I can't be 100% certain of course that lumps won't form long term. I know someone who had it 3 years without any problems. Ok that's only one example but weighing it all up I think it's probably worth it to get relief from this size insecurity that many of us have to deal with.
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Post by biggerbob on Apr 2, 2011 17:02:57 GMT -5
@ Mikehok
Where did the guy that has had the PMMA for 3 years get it done? Was that though Dr. C? Any chance of getting him to join this site and give us his story?
@ Sparticus, personally I appreciate your input on the PMMA discussion. I have been weighing my options for awhile. I have dismissed many of the procedures as too risky for myself. PMMA is the only procedure that I am considering at this time. The level of risk with that is much more acceptable to me currently.
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Post by mikehok on Apr 3, 2011 5:31:09 GMT -5
biggerbob, he is already a member here, his name is Smartman. Just to be accurate, I checked with him when he had his first pmma procedure, it was Oct 2008. No it wasn't Dr C, it was a Brazilian doctor, can't remember the name.
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