Heard of PMMA (Medical Grade) OR Dr Casavantes?

[Skeptical One]

@alexbstn10

If you don't mind, the pics can be sent to my email at [e-mail]

I wasn't able to achieve 100% erections early on, it wasn't until a good 1 week out that my penis was comfortable with getting hard again. The procedure in NO way has impacted my erection quality in general and I believe my early erection issues were a result of my penis's response to mild trauma (just as we all vary with healing time, swelling, etc). I can also send you the only pic I have of myself at this moment in time. It is a Before & After in the procedural room so my AFTER picture is mildly swollen.

Good luck with your healing!

@forum

Email [e-mail] with "SO PICS" in subject, and I will respond with my Before & After (which is in a PDF format). You may not get the pictures same day but you should see them within 2-3 days max.

[bigbizo8]

S.O congrats buddy I've been gone for a minute but I'm happy ur doing good buddy

[hunkchunk]

WoW this is the mother of all threads leading to the mother of all results !


I'll be booking travel soon once I make the fated appointment. Thanks to all for this honest and truthful exchange of experiences which makes this decision a no-brainer.


The only thing I wasn't able to do was see any pictures except those of one member who posted his in a separate blog. His results are however a bit more enthusiastic than I feel comfortable in going, so it will be a godsend once there is a new forum with pictures again. Are there any pictures posted anywhere online we can see until then?


Thx.


HC

[Skeptical One]

hunkchunk

It was especially the Mother of All Threads when the pictures were still up. There were TONS of pictures, but unfortunately this site's host (PROBOARDS.COM) thought that these pictures were somehow obscene and had to be removed. Hence the migration to PhalloBoards Version 2.0.

Did you actually manage to read every page? I've been lucky to have been following it day-to-day so it wasn't like I needed to start from beginning-to-end. It almost seems that you would have to allocate enough time (like you were reading a short book) to cover this massive thread!

[dd72]

I read this massive thread ( and the rest of the posts) via lap top or iphone so much, friends and family started asking questions lol. Not to mention a huge crick in my neck.

[hunkchunk]

@so

Not only did I read it but I even tried to imagine what those pics must have looked like... ;D

Actually the only part that was difficult was to try to mentally reconstruct PE's lost posts from the earlier delete - the thread would be beyond 150 pages otherwise.


dd72

Good thing you've got good battery life, I was at it the better part of the day!


HC

[justabitmore]

6.75.......Monster!!! You should be happy!

Jun 5, 2011 0:31:40 GMT -5 bigbizo8 said:

S.O yeah he told me I could only get like another 5-7cc at most! In total I got 40cc and I'm really happy, I'm still about a 6.75 erect girth so I'm really happy with my two sessions

[justabitmore]

I corresponded with Wade and he told me the only complications has been in the very early days when they used too much and 30% solutions so he has probably good reasons not to try it again! He did say that the only complications were that patients could feel the material in when flacid but they were happy when erect.

Jun 4, 2011 20:54:40 GMT -5 Skeptical One said:

mrdeezy

Yea the early averages were 12-15cc's, but I think now that Dr. C has been doing a significant number of these procedures at a higher frequency, he's starting to learn what the penis can truly accommodate (safely) - and this may explain why injections are now averaging 15-20cc.

From the current progress reports, I think this 15-20cc range is a safe range to be in. If it were ever to move up in the 20-25cc range, I'd hope that would be on the maximum end. Dr. C has been pretty good at not over-filling, and I know he's even advised Bigbizo not to get any more done (unless it was for minor touch-ups).

My 1100th post, phew!

[hunkchunk]

Jun 6, 2011 11:06:40 GMT -5 justabitmore said:

I corresponded with Wade and he told me the only complications has been in the very early days when they used too much and 30% solutions so he has probably good reasons not to try it again! He did say that the only complications were that patients could feel the material in when flacid but they were happy when erect.

Hi Justabitmore,

This must be what I remember reading from an early adopter here, that he could feel what he called "rubber band" parallel strands a few millimeters thick stretching from the base to the gland all around the shaft. I figure that using more diluted solution allows the collagen to spread better, plus maybe Dr C added since those early days the massaging routine for the first two days?

HC

[supa]

Some PMMA related research and data. Have a look:



onlinelibrary.wiley.com/doi/10.1111/j.1524-4725.2009.01216.x/abstract (positive)

www.dralaindansereau.com/art_ref/article_2.pdf (positive)

www.abme.com.br/pdfs/Granuloma%20tardio.pdf (2003 article. Quite negative: please see excerpt below)


In recent years, several reports have described adverse
effects such as painful and disfiguring granulomatous
skin lesions weeks or even years after implantation
of PMMA microspheres.10-12 According to these case reports,
unsatisfactory cosmetic effects or visible, painful
nodules led to excision of the material. Subsequent histopathologic
and ultrastructural examination showed the
distinctive aspects of multinucleated foreign body giant
cells, which enclose round and sharply circumscribed,
translucent, nonbirefringent bodies that apparently correspond
to the implanted PMMA pearls. In addition, epithelioid
cells and a sparse lymphocytic infiltrate were
found surrounding these bodies embedded in a loose sclerotic
stroma.12
Similiar histologic findings were detected in the biopsy
specimen of our patient’s forehead (Figure 2). In
addition, the ultrastructural examination revealed microspheres
within the cytoplasm of giant cells and smaller
particles within the macrophages, which led to the supposition
of degradation (Figure 3). The histologic and
ultrastructural alterations were detected in the middle and
lower dermis as well as in deeper layers of the subcutis.
Several explanations for the occurrence of these nodules
have been considered, but the exact reason for a
granulomatous host response is still unknown. Some authors
interpret foreign body granulomas as a low-grade
chronic inflammation in the sense of a usual second response
to implantation, which would be clinically invisible
after strictly subdermal injection and only accidentally
diagnosed by histologic examination.12,13 In addition,
superficial intradermal implantation itself may lead to
granulomas.2,3 Furthermore, undesired dislocation of the
subdermally localized implant to more superficial skin
parts—especially of the forehead because of its frequent
muscle movement—should be discussed. Investigations
of intradermal models of guinea pigs demonstrated
transepidermal elimination that began as a movement of
thePMMAbeads toward the epidermis.3 Particle size analyses
in the same study indicated that some of the PMMA
particles were smaller than 35 µm in diameter and consequently
susceptible to phagocytosis and migration. The
presumption that degradation of the microspheres due to
local enzymatic activity or aggressive metabolites causes
foreign body granulomas requires further, predominantly
long-term, investigations. In addition, there may
be a correlation between the quantity of the implanted material
and the incidence of foreign body granulomas, as also
reported for augmentation with silicone fluid.14,15
Even if true granuloma formation after implantation
of PMMA is not very frequent, a reliable and easily
tolerated treatment is urgently needed. Intralesional injection
of long-lasting crystalline corticosteroid usually
has been the treatment of choice,16 but severe granulomas
occasionally require surgical excision.

[sheldon]

Jun 7, 2011 5:30:47 GMT -5 supa said:

Some PMMA related research and data. Have a look:



onlinelibrary.wiley.com/doi/10.1111/j.1524-4725.2009.01216.x/abstract (positive)

www.dralaindansereau.com/art_ref/article_2.pdf (positive)

www.abme.com.br/pdfs/Granuloma%20tardio.pdf (2003 article. Quite negative: please see excerpt below)


In recent years, several reports have described adverse
effects such as painful and disfiguring granulomatous
skin lesions weeks or even years after implantation
of PMMA microspheres.10-12 According to these case reports,
unsatisfactory cosmetic effects or visible, painful
nodules led to excision of the material. Subsequent histopathologic
and ultrastructural examination showed the
distinctive aspects of multinucleated foreign body giant
cells, which enclose round and sharply circumscribed,
translucent, nonbirefringent bodies that apparently correspond
to the implanted PMMA pearls. In addition, epithelioid
cells and a sparse lymphocytic infiltrate were
found surrounding these bodies embedded in a loose sclerotic
stroma.12
Similiar histologic findings were detected in the biopsy
specimen of our patient’s forehead (Figure 2). In
addition, the ultrastructural examination revealed microspheres
within the cytoplasm of giant cells and smaller
particles within the macrophages, which led to the supposition
of degradation (Figure 3). The histologic and
ultrastructural alterations were detected in the middle and
lower dermis as well as in deeper layers of the subcutis.
Several explanations for the occurrence of these nodules
have been considered, but the exact reason for a
granulomatous host response is still unknown. Some authors
interpret foreign body granulomas as a low-grade
chronic inflammation in the sense of a usual second response
to implantation, which would be clinically invisible
after strictly subdermal injection and only accidentally
diagnosed by histologic examination.12,13 In addition,
superficial intradermal implantation itself may lead to
granulomas.2,3 Furthermore, undesired dislocation of the
subdermally localized implant to more superficial skin
parts—especially of the forehead because of its frequent
muscle movement—should be discussed. Investigations
of intradermal models of guinea pigs demonstrated
transepidermal elimination that began as a movement of
thePMMAbeads toward the epidermis.3 Particle size analyses
in the same study indicated that some of the PMMA
particles were smaller than 35 µm in diameter and consequently
susceptible to phagocytosis and migration. The
presumption that degradation of the microspheres due to
local enzymatic activity or aggressive metabolites causes
foreign body granulomas requires further, predominantly
long-term, investigations. In addition, there may
be a correlation between the quantity of the implanted material
and the incidence of foreign body granulomas, as also
reported for augmentation with silicone fluid.14,15
Even if true granuloma formation after implantation
of PMMA is not very frequent, a reliable and easily
tolerated treatment is urgently needed. Intralesional injection
of long-lasting crystalline corticosteroid usually
has been the treatment of choice,16 but severe granulomas
occasionally require surgical excision.

supa

Thanks for sharing these articles you found on PMMA with the forum. This is what I like about this forum - guys sharing information, knowledge, and experience.

[Skeptical One]

Jun 7, 2011 5:30:47 GMT -5 supa said:

Some PMMA related research and data. Have a look:



onlinelibrary.wiley.com/doi/10.1111/j.1524-4725.2009.01216.x/abstract (positive)

www.dralaindansereau.com/art_ref/article_2.pdf (positive)

www.abme.com.br/pdfs/Granuloma%20tardio.pdf (2003 article. Quite negative: please see excerpt below)


In recent years, several reports have described adverse
effects such as painful and disfiguring granulomatous
skin lesions weeks or even years after implantation
of PMMA microspheres.10-12 According to these case reports,
unsatisfactory cosmetic effects or visible, painful
nodules led to excision of the material. Subsequent histopathologic
and ultrastructural examination showed the
distinctive aspects of multinucleated foreign body giant
cells, which enclose round and sharply circumscribed,
translucent, nonbirefringent bodies that apparently correspond
to the implanted PMMA pearls. In addition, epithelioid
cells and a sparse lymphocytic infiltrate were
found surrounding these bodies embedded in a loose sclerotic
stroma.12
Similiar histologic findings were detected in the biopsy
specimen of our patient’s forehead (Figure 2). In
addition, the ultrastructural examination revealed microspheres
within the cytoplasm of giant cells and smaller
particles within the macrophages, which led to the supposition
of degradation (Figure 3). The histologic and
ultrastructural alterations were detected in the middle and
lower dermis as well as in deeper layers of the subcutis.
Several explanations for the occurrence of these nodules
have been considered, but the exact reason for a
granulomatous host response is still unknown. Some authors
interpret foreign body granulomas as a low-grade
chronic inflammation in the sense of a usual second response
to implantation, which would be clinically invisible
after strictly subdermal injection and only accidentally
diagnosed by histologic examination.12,13 In addition,
superficial intradermal implantation itself may lead to
granulomas.2,3 Furthermore, undesired dislocation of the
subdermally localized implant to more superficial skin
parts—especially of the forehead because of its frequent
muscle movement—should be discussed. Investigations
of intradermal models of guinea pigs demonstrated
transepidermal elimination that began as a movement of
thePMMAbeads toward the epidermis.3 Particle size analyses
in the same study indicated that some of the PMMA
particles were smaller than 35 µm in diameter and consequently
susceptible to phagocytosis and migration. The
presumption that degradation of the microspheres due to
local enzymatic activity or aggressive metabolites causes
foreign body granulomas requires further, predominantly
long-term, investigations. In addition, there may
be a correlation between the quantity of the implanted material
and the incidence of foreign body granulomas, as also
reported for augmentation with silicone fluid.14,15
Even if true granuloma formation after implantation
of PMMA is not very frequent, a reliable and easily
tolerated treatment is urgently needed. Intralesional injection
of long-lasting crystalline corticosteroid usually
has been the treatment of choice,16 but severe granulomas
occasionally require surgical excision.

I wouldn't consider the above quoted article as being that negative. It seems to be making observations as to why granulomas may come about with PMMA, not that it always will. It concedes that it is rare and treatable, and that only severe ones require actual surgical intervention.

In past debates on the topic, one "school of thought" has it that technique has a considerable effect on granuloma formation. More specifically, the use of a blunt cannula performed by a skilled physician, avoiding extreme quantities, and using high-grade PMMA (and proper concentrations) as ways to minimize (or eliminate ??) granuloma formation. When I brought granuloma formation up with Dr. C & Wade, they made it seem as if it were non-existent (or low in occurrence) with their practice of many years.

For me, the biggest concern the above article lays out is the ability for granuloma formation to happen years later. It's a risk we assumed (like risks we assume with any phalloplasty method), but it's a risk I hope that has been minimized greatly via the Dr. C route. The above article also concedes that the actual reason for granuloma formation is not defined or well understood, and thus a doctor's experience (of many years) could prove useful in this conversation.

[justabitmore]

and on that note I am booked in on Wednesday next week!

As I had fft done I have had several chats with Wade who has been uber helpful. they have analyzed pictures I sent them and they were very impressed with the fft job. Wade said its the best he have seen in 6 years. He also sad they would pretty much ignore it and that there was no reason to avoid any of the fat. They would simply do as usual which would break some of that fat up but possibly also make some of it survive longer due to the new blood supply that pmma formes.

I had 5 inch Erect Girth before FFT

with FFT I currently have an average of 5.5 with 5.4 before the glands and 6.25 at the base (measure right up to the pubic bone avoiding the sack).

I am hoping for an average of 6.25 after the final treatment with 6 before glands, 6,25 shaft and 6.5 at base.

Thanks for all of your posts I will start a progress thread in the new forum and post before and after pics.

Take care

JAM

[Skeptical One]

@jam

Good luck! I actually got off the phone with Wade myself about an hour ago or so. He is most definitely helpful and both Wade & Dr. C are very pleasant to be around in person.

Are you flying in or do you live in Southern California?

[gamecock]

The article below posted by supa deserves a good read by everyone. It hits a lot of major and minor points that we have discussed about the PMMA procedure. It reaffirms some of our beliefs and also offers slightly contrasting advice about others, which may help improve our aesthetic results overall. Of course the article is not about the use of PMMA in the penis, but a lot of the information will apply nonetheless.

www.dralaindansereau.com/art_ref/article_2.pdf


Here are the major points of the article that really caught my attention and my take on them.


"Generally speaking, tunneling (or line threading) is the method recommended for most
indications. Following this technique and using different patterns such as fanning or
crosshatching (to name a few), the initial implant is deposited slowely (~0.3 cc/min)
and deeply intradermally (ie, into the reticular dermis just above the junction between
the dermis and the subcutaneous fat). A trained injector will know exactly where that
plane is. The rate of injection is also critical to minimize bruising and pain and to
ensure accurate product placement."

I think it was a post by Smartman that brought up how the PMMA feels like threads along the length of the penis. This seems to line up with their recommended method of injection, called tunneling.

The real questions here are around the "plane" in which the PMMA is injected along with the rate of injection, which are both stated as crucial.




"Since PMMA is a bioactive implant (ie, it is a host-tissue growth stimulator), it is
necessary to wait approximately 3 months between injection sessions to adequately monitor
the progression of the correction and to achieve superior results."


This was comforting to me, in realizing that PMMA is classified by the FDA as a "host-tissue growth stimulator" and not a volumizer. Also they recommend 3 months before a second session.



"Based on the experience of the group, areas of thin skin or areas requiring a placement of
the implant in the upper dermis, such as crow's-feet, superficial lines, or neck lines,
should be avoided."

It's been stated here that the PMMA is injected into the fascia of the penis. Are we talking about underneath the superficial fascia mixing with the areolar tissue just prior to the deep fascia (buck's fascia). Can anyone confirm?




"After the injection, the area should be gently palpated, not massaged, to feel for the
presence of any lumps. If a lump is found it should be flattened or sculpted to avoid
future bumps."

Not sure why they don't recommend massaging the PMMA. This may be specific for applications in the face and could be inaccurate advice for penile injections.


"It is necessary to instruct the patient to minimize facial mimicry for 72 hours following
injection to avoid implant displacement."

Don't let it turtle for 72 hours.