TOPIC: Dr Rupeka - New Website

Hey everyone, just wanted to come on here and say that I've been working on a new website with more I fo on how and why I inject like I do and basic info. I know that most on here almost know more about PMMA and phalloplasty than us providers, but I continue to try to coordinate info. The website is www.youthologyman.com .


Also, we made the ability to pay over time in monthly installments easier and I have info on it there. I'm going to post elsewhere as well about this because our prices will be bumping up a little bit starting July 1st (just an FYI).

Hope everyone is well! And I've been trying to bounce between here and Reddit in my spare time to answer as much as I can!

Hey @Dr_Rupeka how do you mitigate the accordion effect in uncut patients? Is it based purely off injection technique?

Hi, I place my filler deeper, so your skin and Foreskin should rub against the dartos layer just like it would naturally. As opposed to placing the product more superficially, directly under the skin, usually it will affect the skin that way. this is what's in my upcoming paper and I'm trying to draw a schematic of this so I can help explain it better. I'll post that when I have something I like.

What do you guestimate the timeframe for the PMMA carrier to be absorbed and the true final results to be realized? I use a pump, but don't want to damage your work!
Also what is the usual recovery time before resuming sex?
Thanks for being so forthcoming and helpful!

@Dr. Rupeka How do you avoid the pig in the blanket look where the glan is smaller than the shaft when you inject the fillers?

This is tough to say, if I injected a syringe of Bellafill into subcutaneous tissue along the jaw or in the cheek, I would expect the bovine collagen gel to get metabolized over the following 3-6 months and the neocollagenesis to happen over the the following two years with the most probably happening between 3-9 months after injection and then theoretically continuing on indefinitely. When you inject PMMA into the penis this entire process gets prolonged and a little hindered because of the space...there isn't the same fat, lymphatic fluid flow, etc there so the metabolism is going to get prolonged. Combing this point with the fact that we aren't using a syringe, but using a much larger volume of syringes will prolong this process. This is part of the reason why the irrégularités last longer in this are (that and anatomy and injection technique). You have to have a lot of patience with PMMA and allow the biostimulatory process take place.

I don't want you to pump initially because we are trying to not pull more inflammatory fluid into the tissue post-procedure, but you could pump normally after the product and tissue is healed and settled. I do encourage extending immediately after.

Hi, this would be essentially up to you. Generally speaking you would not get this look as long as you don't continue to try to increase the Girth over multiple procedures. I don't think I've ever really seen someone with this problem after the first or even second session, but again, that would just depend on the volume.

All that being said, my injection technique is deeper than most, this also reduces the risk.

Hello,
Had procedure done about a year ago now you did an amazing job happy with results ..Have 3 prominent nodules was just wondering would I have to get another procedure done or could the nodules just be removed

Thanks and we usually just inject them with a diluted Kenalog solution. We do also have 5FU, but generally the Kenalog solution will help degrade those. I have never had any patients (that I am aware of) have anything surgically removed from the face or body. Everyone that has had a Nodule or granuloma (even the ones that have been there for years), resolve with Kenalog injections…you just may need several rounds of them. If you can’t come in because you are far away or it just isn’t conducive for some reason, usually dermatological practices perform IKL injections. We do them all the time at Youthology as we mainly work with biostimulators on the body and face. You can always call and talk to Krista at my office as well (she is a trained dermatologic PA), she usually handles all of the phone calls.

I like to think of the nodules as having the consistency of a bath bomb. The Bellafill gets dehydrated and that bovine collagen gel hardens. Once you hydrate that “Bomb”, it should shrink or dissipate much easier. Again, sometimes you just have to inject them several times. I think I said it in another post, but that space that the product is in just doesn’t have the lymphatic flow and the fluid movement that most other areas we are injecting do (ie the subcutaneous fat in the cheek/face or the vagina).

Hey Dr Rupeka, would it be safe to get the Kenalog shot at the same time as getting more filler?

Would the Kenalog affect the new filler and possibly limit the gains from a new filler procedure? Or are you supposed to wait in between getting a Kenalog shot and going for more filler?

I keep thinking that the Kenalog will break down what is there so I opted out of getting it. I just figured the new filler would cover up the imperfections but the Nodule is still more or less there.

Yes, I do this all the time. I have the Kenalog in my injection room and on my tray with all of my follow up patients.

No, we inject it directly into the dehydrated ball of gel or the granuloma or whatever the lesion (this is exactly the same as we do cysts on the body).

This is true as well. Most guys that reach out with nodules, etc by the time that they come in for more PMMA, the Nodule has decreased enough to where it doesn’t bother them anymore and they just continue to wait out the metabolism.

I actually do this same thing when I do my lip injections with HA (I know this is off topic, but), whenever I see a girl and do her lips again, I may dissolve any migrated filler out at the same time. It sort of the same idea, if you keep the degrading product localized, you don’t have to worry about it affecting the newly placed product.

Dr Rupeka:

Is Volux offered by request? There's no mention of products outside of Bellafill on the new website.

Do you plan to offer the "new" bio-stimulatory filler HarmonyCA should it become FDA approved? Its non-permanence has piqued my interest -- just curious.

How do you generally handle the area of the Circumcision scar? Am I to understand that the Deep Injection technique completely obviates the need to avoid filling between the Circumcision scar & the head (as is nearly universally practiced currently); thus allowing for full shaft-length injection during the first procedure?

Hi, and thank you for your questions!

1. I do not inject Allergan products. To be honest, my practice is build on tissue regeneration, so I mostly use biostimulatory products. I do carry some HA to use in specific places, but not often. I inject Restylane products if I need HA. I do not like HA in the penis, which is why I don’t recommend it or have it on my website. I will add it though for those that want it, but I just don’t really recommend it.

2. I’m not familiar with HarmonyCA and I will have to look it up.

3. Correct. The plane that I inject into usually fuses around where the Circumcision scar is, so the Circumcision scar doesn’t really make a difference with my deeper injection technique. And, just my observation, I am not familiar with the deeper technique to be universally practiced. Most of what I see is very superficial injecting.

Issue of HA-products not being biostimulatory aside; what other reasons do you dislike HA products in the penis? Anything to do with the way they behave in the Deeper Plane or other complications? Very keen to know. Of the many HA-products available I'd personally only consider Volux for its high GPRIME while also non-permanent (a safety preference unique to me).

P.S. Here is a thread on this site discussing what's known to date of the not-yet FDA approved HArmonyCA -- some practitioners have chimed in there.
phalloboards.info/forum/general-discussi...-filler-product.html

Not really, basically, the patients that I have seen that have had HA done, didn’t like the way that it made their penis feel “squishy” when they were fully Erect. I have had several that didn’t mind either way, but their significant others didn’t like the way that it felt.

Also, I have had Youthology for about 10 years, and have based my practice on biostimulators, even before I was injecting penises. I have always believed in those products over a filler that doesn’t do anything to improve tissue health.

Obviously it is ultimately your body, so you should definitely put whatever product you are comfortable with in there. And, thank you for the link!