TOPIC: Infections, Complications, Risks of PMMA?

@ eq
thanks eq! sorry hard to read the paper on my black berry yesterday.

@EQ,
Thanks a lot for your 3 minutes research , I thought you still remember what was my Q. is about :- (( Any study about the Migration of the beads of the Newplastic or at least other products to a DISTANT ORGAN in human ---> distant organ disease or failure )), our argument was about the possibilty of the danger (e.g. migration) of the small beads migrating to distant organ, do you remember that EQ ??
In regards the 3 points you have mentioned above :-
1- 'The Polymethylmethacrylate Effects on Auricle Conchal Cartilage: Report of 21 Cases' by Caldellas et al
Is that a distant organ e.g. liver or lung ??? it is only a local (at the same area of injection) complication ???
Let us say this paper is 100% correct , the Q. is: Is this local complication due to the presence of small beads (e.g. in Newplastic) ?? If that is true why did FDA give the approval for Artefill i.e. it is safe ?? In Artefill there is <1% of the beads are smaller than 20 micron , I know it is low (<1%) but i.e. Artefill is not 100% pure, so is there any distant fatal organ damage after Artefill injection in USA, that will be a Q. for Dr. Cohen ( he will not answer me but of course we know his answer anyway).
www.ncbi.nlm.nih.gov/pubmed/19787393
2- 'Extensive facial necrosis after infiltration of polymethylmethacrylate' de Castro et al
I like that one , are you saying that the picture shown above is due to the product (e.g. Newplastic) ??? So do you mean if the same doctor used Arefill instead of (the Brazilian's product) wont happen this complication ???
First of all this complication can occur from injecting any product of PMMA directly into an artery ( in this picture is due to injecting PMMA into one of the branches of the Facial artery) which will occlude the artery---> necrosis .
So it is due to the TECHNIQUE of the doctor esp. by using sharp needle, and not due to the product per se .
Believe me EQ if you decided to have Artefill for chin augmentation (as you have mentioned before fft or Artefill) be careful esp. if your doctor use a sharp needle , he has to move it back and forth to avoid injecting the beads into your artery, otherwise the chance of having the same complication as in the picture is high.
BTW that is not the answer of our Q. it is not talking about migration of the beads to distant organ it is about the bad technique of the doctor by injecting the beads into an artery, as I said it can happen with Artefill also , correct me if I am wrong ?? i.e. the BEST product with a bad doctor ---> Disaster .
That was the opinion of Dr.Cohen ((the technique and not the product per se)).
So do you regard this case as a distant organ disease (e.g. liver) ??

3- 'Complications after polymethylmethacrylate injections: report of 32 cases' by. Salles et al
Again it is not a distant organ disease ?
5 cases tissue necrosis (acute complication) due to technique.10 cases granuloma (subacute complication) leave it or Kenalog injection.10 cases chronic inflammatory reaction in the same area were it is injected.Again they mentioned 10 cases chronic inflammatory reaction which is the same as above complication but in the lips (lymphedema).1 case of infection.
He mentioned one of the person who did the injection was not a doctor , I wonder which one was his patient ??
So are these the answer of our Q. in regard the possibility of small beads migration and the chance of distant organ complication ???

I think I did find the proof that skin necrosis complication depends mostly on the technique of the doctor more than the filler per se so it can happen with any other safe absorbable products :-
(1) I think most of us had or heard about Lidocaine 2% injection (a local anesthesia).
Did any one hear that this drug can cause tissue necrosis ??
jcp.sagepub.com/content/49/7/872.extract
So does it mean we should not let our doctors to inject us with any local anesthesia?? lol
(2) Did anyone hear that temporary fillers (biodegradable fillers) e.g Hyaluronic acid or collagen fillers can also cause skin necrosis ??
They said the nasal area, the perioral region and the glabella are the most dangerous areas .
a) www.cosmetic-medicine.jp/list/fillers.htm
also in this paper they mention Nasal Alar necrosis can happen and also they mention Granuloma formation can happen after the injection of temporary filler e.g. Hyaluronic acid :-
b) www.drdayan.com/pdfs/risk-of-alar-necrosis.pdf

(3) Some people said that FFT is the safest technique and has no serious complications , actually there are serious complications from this technique (liposuction & fft injection) :-
Acute Respiratory Distress , central nervous system , skin and retina
www.scielo.br/scielo.php?pid=s1806-37132...=sci_arttext&tlng=en

I am not trying to frighten anyone about these complications from these products I just want to prove for everybody that the Technique of the Doctor is the most important and the area ( e.g. Glabella)
There is another paper which prove that :-
onlinelibrary.wiley.com/doi/10.1111/j.15...006.32052.x/abstract
injection necrosis is a rare but clinically important potential complication caused by interruption of the vascular supply to the area by compression, injury, and/or obstruction of the vessel(s).

In conclusion :- These papers prove that skin necrosis if it did happen (reported esp. in the face) it can happen with any products and not only with Newplastic .

@ justabitmore- It usually occurs if it did happen approximately between12-72 hrs post injection and not before 6 hrs .

smartman wrote: @EQ,
Lets say the migration of these small beads is true :-
...
So from these points ( it is like human experiments and not animal experiments ) wouldn't be enough to show at least one ill-patient???
EQ I am only trying to get the truth as all of us from the whole thing, Dr. Cohen will make it easier for us if he can show us at least one patient , could you help us to get this information from him or from other doctors , I have tried but he unfortunately didn't answer my Q. (i.e. our Q.) .

@smartmanI was not sure if you were serious implying that there were no studies recording serious issues with (PMMA) Newplastic. Here are 3 I quickly found on the web. I suspect Portuguese speakers could find a bunch more fairly quickly'The Polymethylmethacrylate Effects on Auricle Conchal Cartilage: Report of 21 Cases' by Caldellas et alhttp://www.ncbi.nlm.nih.gov/pubmed/20601571'Extensive facial necrosis after infiltration of polymethylmethacrylate' de Castro et al www.scielo.br/scielo.php?script=sci_artt...lng=en'Complications after polymethylmethacrylate injections: report of 32 cases' by. Salles et alhttp://www.ncbi.nlm.nih.gov/pubmed/18454007 That's 54 cases after just a 3 minute search!!

@ eq

Most definitely! The second factor in DR C opionion is the amount of procedures and volume you jack up with. He really is respectful of the material. One guy who he sent away after he felt enough was enough went somewhere else and ended up with 12 session !

Choose the best surgeon ask for his opinion and say you want safety and aesthetics first Girth second.

Stick to that and you give yourself the best chance of a good result.

EQ reality checks are always welcome. More than that, reasonable people cannot do without.

The chances of having a chunk of our unit removed are to be factored in/estimated, within our decision making process.

Boys, how depressing is reality, sometimes.

The Rt. facial necrosis in the picture is due to a bad technique (the doctor has injected pmma into an artery (branches of the facial artery)) esp. if the doctor used a sharp needle for the injection, they usually advice in pmma injection is to use a blunt cannula or if the doctor used a sharp needle he shouldn't inject the pmma at rest he should move the needle back & forth and the injection should be done during the movement to avoid any direct injection of pmma into an artery.
It has nothing to do with the amount of pmma it is due to the technique e.g. :-
A small volume of pmma injected by a sharp needle into an artery ----> a chance of necrosis.
A large volume of pmma injected by a blunt cannula and not into an artery--> no necrosis.
A necrosis of a tissue from an arterial embolism is not a long term complication it is an acute short term complication hours after the injection.
But if the injection was into a vein ---> possibility of pulmonary embolism
BTW the volume injected in the butt (around 500 cc) is 10 times more by volume than typically injected in the penis (around 50 cc in total) and I have never read any report of skin or tissue necrosis of the butt.
I agree with supa that there are other products beside pmma if you injected them in an artery---> embolism---> serious complication.
e.g. injecting steroid into the inferior turbinate (inside the nose) (used to be one of the treatment for chronic nasal block (allergic or vasomotor rhinitis)) can cause blindness
archopht.ama-assn.org/cgi/content/abstract/97/1/79
My doctor in Brazil used a micro-cannula during the injection of Metacrill but in some area of my penis he wanted to use a sharp needle (back & forth technique) but I refused even he told me he has a long experience of using a sharp needle. So I am sure some brazilian doctors still sometimes used a sharp needle beside the micro-cannula (so it is not a 100% a bioplasty technique (a blunt micro-cannula) what Dr.Almir Nacul has advised).
So the technique of the doctor is most important to avoid any serious complication and not the product per se.

@ EP and all

I said I would expand on my comment how would you cope if it went wrong.

for some reason my edit didn't work so apologies. I must have forgotten to save it !

Basically I agree with HC that for him the risk reward makes sense and he explained why.

Similar I deal with risk all the time (trader) and I always look at worst case scenarios before engaging in a trade.

So my comment related to the fact I think everyone this should consider their response if things go wrong.

I imagined my wort case scenario to be: Lumps, deformity (from FFT), granuloma, inflammation. Treatments could range from Kenalog to Removal surgery and the very end result maybe my old size back with scar tissue and maybe looking a lot worse than when I started this journey.

I imagined this to be costly time consuming and that I would be unhappy and disappointed.

But

I knew I would be able to pull through and that my wife would support me all the way and that when all was said and done it the effect on my life would be only temporarily negatively affected. Knowing me I would make up a story about how a shark tried to eat my Cock and tell this everytime I had a beer lol

So for me I felt I could justify it.

However had I been in my mid twenties I would have had a different attitude as a scared penis (worst case,Removal etc) would be the last thing I wanted and the negative effect would have been amplified and perhaps caused me long term problems.

So I urge anyone to look not only at the positives in getting this done but also at how would you cope if things didn't turn out right. Have you got a strong relations ship that would help you through it ? friend or family or have you got a bullet proof ego that would allow you to be happy regardless of a less than perfect result? Can you afford the cost!

Now this is if you have an average or good sized penis.

If you are well below average and already very unhappy then the situation changes again as you could justify the risk better. Basically what have you got to loose might be your attitude (would be mine in that scenario)

Hope that explained my comment a bit better!

@smartman

Well done! An apples to apples comparison is what we are all after! Being aware of possible or foreseeable complications is always to our benefit as well as potential remedies. Thanks for the contribution!!!

@mikehok - that is a really great question. Since we know that antimitotics like 5FU are used to treat PMMA granulomas and reduce lumps it is reasonable to assume that the newer more powerful chemo antimotic products delivered systemically could deteriorate the encapsulating tissue.

supa wrote: ... I would not be so sure of that. The choice of placing the product very near the ophthalmic artery can be a poor one. The material is indeed not supposed to move from the location where it has been injected but if it was administered very near the artery it is conceivable that some of it has reached it during the procedure;...

Are you saying one should not do work in the Glabella? Once you work in that area you are going to be near a blood vessel. All the arteries in that region have significant anastomoses. Look again at the Dr C. video, was he near a blood vessel? The technique is fine, the area is risky. A lot of well-respected surgeons will not put any type of filler in this area.

supa wrote: ...The material is indeed not supposed to move from the location where it has been injected but if it was administered very near the artery it is conceivable that some of it has reached it during the procedure;....

Thank you for bringing this discussion back to the central point. The Caldellas Newplastic study of 21 patients showed Macrophage phagocytosis in all 21 patients. If the PMMA particles are small enough to be eaten by a Macrophage they will move!

supa wrote: ...Can I ask you again: would you consider bioplasty to the penis using Artefill? Not that you would actually go now and have it. Rather, if you feel that it is a sound procedure to seriously consider. Or, on the contrary, if you would also equally and firmly reject it, at this point in time;...

If one must have PE then IMO Artefill, if it performs in the penis like it does in the face in the 36 month interim study, may be sounder than all the other PE alternatives. Having said that we should be clear that for every 10 people that have the procedure, at the 5 year mark it is likely that 1 or 2 will have some adverse effect including lumpiness, swelling and redness, lesions, treatable granulomas, and granulomas that will need to be surgically removed. We do not know how the higher volumes (10x) required in the penis will change the risks.

Re: The horror picture portraying a disfigured face.

It would seem down to poor technique; I read in the article:

" ... the PMMA microspheres were injected very near branches of the ophthalmic artery, which caused embolism in the vassel.2 We also know of complications also associated with the use of an autologous graft when the injection is carried out in the glabellar region.6
In this report, the complication mechanism was similar. PMMA was injected in the nasogenian groove, or directly into the right facial artery, or very near it. There was arterial embolism: right angular artery, right superior and inferior labial coronal arteries".

Not the product is to blame then, if we take the excerpt literally, but rather the location where it was injected.

Thoughts?

P.S.
I truly and deeply think that challenging info/doc/research documents are absolutely crucial for our long journey to a thorough assessment of PMMA. Thank you eqstudent for your contributions. Please, keep it up.

At the same time I did resent your patronizing attitude when replying to smartman. He has brought wealth of technical info to this forum on top of sharing his long-term experience with us: both extremely valuable assets.
I personally would welcome more imperturbability when objecting to points of view of a fellow forum brother. Rest assured that I still would avidily read your inputs. We are all here to learn and contribute. Btw, I confess, I do ignore the basic facts of biology, so I am happy to know more.

Final question: you "will not be using Artefill for chin augmentation" ... would you use Artefill for penis Girth augmentation?

supa wrote: Does anyone know the overall granuloma complication rate on Dr C.'s total number of patients (wrt PMMA to the penis)? After all, he has started PE via PMMA some five years ago.

I think I read he's only had one granuloma when injecting below the fascia on any part of the body. He doesn't think granulomas occur when injected below the fascia and this is why Artefill studies, which inject into the skin itself aren't really that relevant to us.

@eqstudent

Thank you for your insightful research into unexplored territory. We all assume the associated risk when undertaking a new medical procedure. FBG can occur from a plethora of injectables in various parts of the body. Sometimes, our bodies just don't agree with our decisions. Good advice to all considering augmentation with PMMA. The pathology is similar, however, there are many variables as you well know. Some may experience serious adverse reactions long term; others may not have any. Some will be treatable. Some will require surgery. It is unwise to recommend such a procedure without acknowledging ALL associated risks. Thanks for shedding some light on this subject. Especially to some of the "young guns" that come on board and (due to their youth/ignorance) hop on board the PMMA proverbial wagon.

@hoddle10

Nobody is to blame or is "at fault". You've done a great deal to help others. Surgical as well as non-surgical augmentation of one's "pride and joy" is not something that should ever be entered into lightly. I implore all considering PMMA or any other augmentative procedure to explore all possible methods/procedures and the corresponding risks. Each procedure has pros and cons and associated risks. I would advise anyone under the age of 25 to use this forum as an education center. SO, EP, Supa, EQ, smartman, myself and others have touched on this topic before. That being said... I personally see PMMA as the best choice/alternative for Girth enhancement at this point in time. Who knows, in six months, PMMA could be considered outdated and a barbaric attempt of the past to enlarge one's penis. To our younger members/guests, realize that the ramifications of surgery are real. Complications (though rare) DO occur. I'd hate to be in my teens/twenties and lose the use of my penis; the joy that it brings both myself and my respective partner. It is catastrophic; physically, emotionally and mentally. I know. I suffered from peyronie's for 15 long years. Think about it people. That is all.