TOPIC: Total removal of PMMA....

Is somebody going to ask Dr.C what he has to say to Dr. Daniel Cassuto's recommendation not to take permanent fillers on penis and the horrors of laser?I can do it but just thought if someone all ready did so they don't need to answer to ten similar emails..

cogent logic JBM!

Let me add that candidates need to think about raising their financial capital base. Dealing with complications would cost, both medical and logistic wise; e.g. laser and surgery by Dr Cassuto do not come for free unless you are an Italian insured taxpayer (+ flights + accommodation ...)

Dr Casavantes' procedure is clearly affordable for most (for the time being). However, if you do not have (or plan to raise) a financial cushion to deal with potential later problems, as unlikely they may be, from a risk management perspective you might just want to pass.

@jec - that's a great idea, i would be interested to hear his response, and also to know whether he is familiar with Cassuto and this paper. I think it should be someone who has already corresponded with him, as I get the impression that their office is starting to be flooded by our requests! Any volunteers...?

Btw, I also just found this abstract of a paper by Dr Cassuto - I wonder if this is the same process he uses to remove PMMA? Perhaps the more science-minded can comment on its potential applicability to the penis (eqstudent?)? I've also just sent Cassuto an email asking for his thoughts.

Advanced laser techniques for filler-induced complications [My paper] Daniel Cassuto, Ovidio Marangoni, Giorgio De Santis, Lise Christensen Department of Plastic Surgery, University of Catania, Catania, Italy. This email address is being protected from spambots. You need JavaScript enabled to view it. BACKGROUND: The increasing use of injectable fillers has been increasing the occurrence of disfiguring anaerobic infection or granulomas. This study presents two types of laser-assisted evacuation of filler material and inflammatory and necrotic tissue that were used to treat disfiguring facial nodules after different types of gel fillers.

MATERIALS AND METHODS: Infectious lesions after hydrogels were drained using a lithium triborate laser at 532 nm, with subsequent Removal of infected gel and pus (laser assisted evacuation). Granuloma after gels containing microparticles were treated using an 808-nm diode laser using intralesional laser technique. The latter melted and liquefied the organic and synthetic components of the granulomas, facilitating subsequent evacuation. Both lasers had an easily controllable thin laser beam, which enabled the physician to control tissue damage and minimize discomfort and pain.

RESULTS: All 20 patients experienced reduction or complete resolution, the latter increasing with repeated treatments.

CONCLUSION: Laser-assisted treatment offers a successful solution for patients who have been suffering from disfiguring nodules from injected fillers-often for many years. The procedure broadens the range of treatment options in cases of untoward reactions to fillers, in line with surgical Removal but with lower morbidity and less cosmetic disfigurement.

Cassuto's email is F@CKING SCARY. But it is of paramount importance that we hear all relevant opinions on the matter. So, well done ttar. Thank you for posting.

I agree - I was kind of disappointed to read that email! I still haven't been able to access the full article, which would be interesting to read as it details the actual procedure. Maybe we could then get a better sense of whether it is at all possible to perform on the penis.

@dd71

Great thread thank you!

@ Smartman

Thanks again for sourcing great information!

@ Supa and everyone

Yes its scary and anyone considering this would do well to scare themselves a little bit before making this decision....

However I am no more scared than before...perhaps even a little less!

Here is why.

Consider how many 100,000's of people are having this treatment and multiple treatments running in the millions. I still think its seems that the complication rate it low.

Also PMMA (artecol not the newer ones) accounted for five cases not every case despite being a very popular filler.

We know that complications are more likely due to improper technique and we know that DR C is very good.

We also know that Dr C is advocating 10% and will only inject amounts that he feels are safe.

We also seem to have agreed on that new plastic at 10% is likely safer than older and more concentrated versions.

I would like to know if the 5 cases of artecol injections were all done using the micro canula and in sensible amounts. Further more would these complications have occurred using a 10% New plastic product.

The answer to this might be yes!

In which case I will take comfort in having just read that if worst case happens there is another option before surgery.

That said I refer to my first statement....Reading blogs (like mine) hearing of others success and happiness makes it all very tempting. And yes right now I feel great but in order to feel great I am taking a risk that I feel I can manage. Can you?

Just got this back from Cassuto...

Dear Sir,
thank you for your message. All I can do is try to discourage you from having PMMA or any other permanent substance in your penis or elsewhere in your body. There's always a risk of something going wrong so don't play with such a dear part of your body. The procedure I've published is painful and causes downtime. It may also cause permanent scarring.
Please diffuse this answer among your friends and forgive me if I won't answer you anymore due to lack of time


Daniel Cassuto

Hoddle, your memory serves me better than mine lol. Although I think it was the way he spoke about it (as if he's done it or prescribed it) then it was knowledge of the Allopurinol that impressed me.

Speaking of memory, I might have to get my head checked because I've read virtually every thread on this forum, why something so specific as Allopurinol didn't ring a bell is alarming... I'm not that old!

Hi Guys,
While there may be valid cause to be more cautious when referring to PMMA directly injected under the skin in the face we must reflect on the safer use of Canulas to inject it in large size in the penis. I don't know that Dr Cassuto has done his research possibly thinking a blanket warning carries no risks. "Don't cross the street, and nobody can get run over." To me this is a medical cop out for not having a valid response.
HC

IMO most of the plastic surgeons and urologists will refuse to do any penile enhancement procedures ( injection with temporary or permanent products OR phalloplasty with other girth material ) even penile exercises they will tell you don't play with such a dear part of your body ( they are right it is better to have a healthy, functional, thin and short penis than to have a non-functional thick long penis ).
So Dr. D. Cassuto's reason for not having a permanent fillers injected into our penis is because of Foreign Body Granuloma formation and it's management.
The most important Q. is :- Is FBG a serious complication or NOT ?? If the answer is yes ---> it means also the other temporary fillers he listed them are also dangerous and they shouldn't be used in the body and not only in the penis , I would like to know why did he treat the temporary fillers ( e.g. collagen, Puragen-HA and Matridex) (some of them as we know will be absorbed completely within 6-8 months) with the laser which is painful and can cause permanent scarring, that was his words????
He might say that these are temporary fillers are safer than the permanent ones but he still used the same treatment (Laser with its complications) for both types ???
In fft injection you can have also FBG which if local treatment ( antibiotics and steroids) has failed, it has to be removed surgically ( they have mentioned also in this paper :- The fat has to be refined and the technique is very important (as in pmma) )
bjo.bmj.com/content/early/2010/11/01/bjo.2010.180547.abstract
BTW Dr. S. Cohen said the best treatment for FBG is just leave it it will resolve spontaneously.
The chance of having FBG in the worst pmma generation (Arteplast) was high (2.5 %) and since 1994 they stopped producing it. In (Artecoll) the 2nd generation the chance of having FBG is around (1:5000).
I think the worst thing about PMMA is if you decide to remove it totally for any reason (which can be only by surgery) ---> the chance of skin necrosis is high.
So anyone who decide to go for PMMA penile injection ---> he shouldn't go for a big volume.

I have received the full article from Dr. Daniel Cassuto :-
He used two types of lasers :-
1- LBO 532 laser :- to clear hyper-vascular reaction of the skin and for evacuation of material ( e.g. pus) from infectious or cystic lesions by creating drainage holes ( 0.5-1mm ).
2- 808 nm diode laser (Intralesional laser Treatment "ILT") through 200 micro-meter optic microfiber introduced percutaneously (1-8 mm depth) into the granuloma lesion with this microfiber it drills multiple small holes (the heat used 65-70C) the tip of this microfiber will be inserted into the Granuloma , the heat will any micro-organisms and will melt and liquify the micro-particles (only in the granuloma lesion).
He treated 21 patients ( 20 women and 1 man) all had facial injection :-
7 patients with Dermalive.5 patients with Artecoll (PMMA).4 patients with Bio-Alcamid.1 patient with Acrylate.1 patient with Sculptra.1 patient with Matridex.1 patient with Puragen- HA.1 patient with Collagen.
He mentioned also :- Until now, treatment of granulomas or infectious or cystic lesions from injected gels has primarily been medical--- antibiotics (before biofilm formation), steroids, fluorouracil, or hyaluronidase locally and systemically. From there, treating physicians have jumped to incision, but surgery with local anesthesia can be imprecise in an inflamed area. There is bleeding during the proce- dure, and some scarring is inevitable.
Therefore, if invasive or intralesional laser-assisted treatment proved to be 100% effective, surgery could be completely avoided.
In conclusion :- His method of treatment is only for localized (e.g Granuloma or infectious or cystic) lesion and not for total Removal of PMMA .
So the treatment of PMMA granuloma will be in this order :-
1- Antibiotic ( before the formation of bio-film).2- Kenalog / 5 FU intra-lesion injection (you might need multiple sessions) if failed3- 808 nm diode laser (you might need more than one session).4- surgery for Removal of the Granuloma ( the last option ).

This post right here is probably the scariest on the forum, hopefully in the years to come they come up with a better way to remove it if for some reason it needs to be removed!

A few lumps in the penis might be desirable for some Some men even go so far as to have beads inserted to create a lumpy penis, apparently the women love it !
wiki.bmezine.com/index.php/Genital_beading

Hi

If anyone has been to see Dr Cassuto in Italy please contact me. This email address is being protected from spambots. You need JavaScript enabled to view it. as I am due to see him shortly