TOPIC: complication post pmma round 2 - open lesion with possible pmma material surfacing need advice...

Hi everyone,

I reported here in the past. I had my second round 12 days ago to gain more Girth and fix up multiple aesthetic issues I had after the first round the result looks very good except for one major thing. Around 25CC mostly of 30% PMMA solution was used. I was told I could expect another 0.5-0.75" after an initial gain of over 1" after round one

Near the base of my penis was a very mild scar from an old Phalloplasty procedure and at Avatni Derma they thought it would be a good idea to get a CO2 laser to smooth out that scar and make it less apparent.

The problem is that this procedure caused the scar to gape and even though I stopped stretching 11 days after the procedure (yesterday) it seems to still be drying up and closing up and then opening up again, becoming moist and white. That whiteness looks possibly like PMMA material that Dr C first tried to inject directly and superficially into the scar during the session. The area around that white repeating gape is specifically hard to the touch (feels like PMMA bunched up very close to the surface). Its confusing because it seems to close up every time and open on its own. I clean it every day and started to use antibiotic ointment but it does not seem to really improve things and stop the gaping and white/moisture 'cycle'.

I am attaching a photo of the scar in that location before the laser and what it looks like now you can see the moisture and whiteness on the left. I'm also attaching a photo of the result before they used the laser (trying not to get it Erect now..).

I assume the combination of laser to deal with a previous scar is not something that you guys have likely seen but perhaps some other instances of injuries with PMMA being exposed to the outside that you have read about here or elsewhere and what this can lead to. I'm worried the scar will not heal well. There is some pain at the location of the wet gaping spot as well.

Also - Dr C says not to stretch until it properly closes and I'm wondering what are the possible worst case implications of not stretching starting day 11.

I would really appreciate any insight into these questions.

Thanks a lot!

A laser essentially burns layers of skin and the wound in those photos looks how I'd imagine burned skin would. Obviously check with Dr C, but I think it looks normal. I seriously doubt it's PMMA related. It just looks like normal healing to me. Maybe keep it bandaged.

www.realself.com/question/what-good-afte...gram-laser-treatment

Thanks hoddle,

The penis skin is very thin and while some other scars in my body were treated and only 'smoothed' over, in the penis it really had a much deeper effect but I know they didn't expect it.

The issue is that it seems to heal and dry up during the day and then when I wake up in the morning it is gaped and moist again. I thought it may have been exacerbated by the stretching but its happened again without it tonight.

Dr C just emailed me to use betadine and antibiotic ointment twice a day and then leave it to dry during the day, but I checked out the link you provided and also from what I know, it is recommended to keep the scar moist, but I guess I should follow what Dr C says and hopefully it isn't PMMA.

The situation now is that I am not supposed to stretch until it is totally healed - can someone explain to me what the potential negative ramifications of not stretching starting day 11 could mean for my outcome?

Thanks!

I had a wound from an accident so pretty familiar with wound care. DO NOT USE OINTMENT!!!! IT slows down healing! Clean the wound with saline water ( boil water let it cool down, then add salt) When cleaning the wound use cotton bud and swipe it in one direction, throw it away swipe in one direction, the prevents an infection spreading. One of the most inportant things for wound healing is moisture ( also helps prevent scarring) then use an air permeable, self-adhesive dressing. clean the wound twice a day if it has pus otherwise clean once a day.

Drinking orange juice from carton can help speed up healing.

Thanks so not even antibiotic ointment? Dr C said to do that once a day - do you think it will delay healing?

re moisture - I don't understand what you mean what do I use for moisture if ointment is not recommended? Can I use a moisturiser for burns and cuts and would that not delay the healing?

and I'm not sure what self adhesive dressing is (I don't live in the states) they told me to leave it uncovered.

If you could clarify those points I would really appreciate it because I also read something about moisture that contradicts the concept of letting it dry.

Thanks.

Trust me in the past I used ointment and it significantly slowed down healing. I thought well it must be better than salt and water cause it anti bacterial e.t.c If you don't believe it read online about using ointments on wounds. What you need is a breathable dressing, google "Mepore" Go to your chemist and ask them for dressing self adhesive absorbent dressing for wounds. If there is hair around the wound you might need to gently shave around it. Start cleaning it with boiled salt and water (cooled down). Only trying to help.

ok thank I will try that. The trouble is that it seems to close and open up every morning again (perhaps nocturnal erections) looking white and moist and gaped. I'm concerned some PMMA injected very superficially into that scar is preventing it from closing. Meanwhile I can't stretch at all and I am concerned about the implications this will have as well...

Forget about stretching! The one thing that is different about this wound is that it is basically a burn. Lymph fluid builds up during the day makes a half ass scab and you disrupt it during the knight. Everyone has seen the scab that lymph makes, it not as good as blood. So i think there is a lot of good advice here, but it is a burn and most likely need to be treated as such. Express to the doctor exactly what is happening , take pictures etc. I do know that Hoddle knows his shit and I believe Michael is correct with ointments ( but more applicable to cuts etc) . But remember this is a burn, no bleeding, and burns generally suffer from dehydration. Normally why you put ointments on to limit the dehydration of cells and prevent infection. But and a big but, we are not Doctors and make sure you only use us for ideas and help, follow the doctors advice.

You make a very good point. In fact I saw a laser specialist back home (when it was still closed and a lot better than now a week ago) and updates him. I only told him I had laser not The PMMA part though.... He said to keep it moist with anti burn cream like you suggested. Dr C, however, says only to use antibiotic cream during the morning and then to let it dry up during the day so I am conflicted. I know that when I take a shower the deeper white lesion seems to absorb the water very quickly and expand, making it appear to even more gaped so I am not sure what the right thing to do would be. Also I'm still concerned that some PMMA that was injected very superficially into that scar may be preventing it from closing as it does not seem to improve. If that is the case, I wonder if there is a way to ?clean' the wound from any such substance. On a side note, after recovering from CMV virus a few weeks before this happened, I am starting to develop a fever again (about 100F now) with some stomach symptoms and a blood count that I had done yesterday shows signs of an infection. I think it is more related to my stomach because the burn/scar does not appear infected but it has begun to hurt and I don't want to take unnecessary chances with this. At the very least, I think my body is not at it's best to heal at this point in time. Any additional advice or ideas re what to do if PMMA is blocking this from healing would be very welcome. Thanks again to all of you!

Whether you take Dr C's advise or go with the other options, I don't think it will matter, as it will heal over in a week or two. At the end of the day it's just some very superficial layers of skin burned away. If anything PMMA would help it heal, so I'm sure the fact it's still sore isn't PMMA related. It's simply down to location. It's at the base of your penis, where the skin naturally stretches due to erections and so on, so it's hard to "seal" as is constantly gets stretched. But eventually it will heal. Even if you kept it constantly stretched it will heal. Sometimes after infections guys are left with huge gaping holes, where the tissue has died, yet the body is an amazing thing and even they heal eventually. So a surface wound like yours is nothing to worry about and your PMMA related concerns are misplaced in my opinion.

Thank you hoddle, you make a a strong and reassuring argument and you are probably right and I should give it time. I did receive some advice to try growth hormone for a more profound effect of this procedure (I have so much internal scarring that my next round will only be touch ups I know it already so what I gain now will have been it... ). If I go ahead with HGH (whether it works or not for the Girth..) I wonder if it would make a thicker less aesthetic scar where the gap exists now by making thicker collagen or whether the face that it is superficial will not mean that much of a difference for the scarring. Any opinions on this point?

And another question - the scar seems improve a bit during the day and after 1-2 hours of sleep when I wake up it looks as bad as before. This prevents any kind of true healing. I guess one assumption could be PMMA in the way but it is more likely my nocturnal erections - I just noticed one and woke up but it was too late, an hour into my sleep and everything is gaped again. I recall that before my initial Phalloplasty surgery, I received Finastride for at least a week before the procedure to prevent erections. Does anyone know the recommended dosage for that and how long it would take this to act?

Thanks again

Double blind studies have showed Fin doesn't really effect nocturnal erections.

If I were you, I just let nature take it's course. It might take a while, but it will heal, even with the erections seeming preventing things from ever settling down. PMMA stimulates collagen, which would aid wound closure.

Really it doesn't effect it? Another myth sold to me by Dr Solomon?

THe question if PMMA has settled in those lesions, if has the same impact in triggering production of collagen as when it is inserted underneath the skin. PMMA can lead to the the creation of totally unsmooth collagen surfaces the skin if it is not evenly distributed - who knows what some random PMMA particles can create inside an open scar if they are there (is that what you meant?). I may end up with a thick and uneven scar if this is the case and PMMA takes over healing.

I think 'deep' PMMA underneath the skin that is evenly distributed (not what was injected into those scars) will have no baring on the scar that develops as they have explained to me that the entry point PMMA goes a lot deeper.

I have no idea how it will close except if I remain awake for the next week and not allow myself to fall asleep. Even after surgery there are stitches keeping these things in place, in this case there is nothing 'glueing' the top layer of the skin together....

Should I go and see someone who deals with PMMA perhaps they can examine the wounds to make sure nothing is 'stuck' inside?

Just what I needed after all of the issues I had in the past...