PMMA Injections for Penile Enlargement
NOTE: The Male Enhancement Centers and Dr. Elist do not perform polymethylmethacrylate (PMMA) Penile Enlargement Procedures. The following material is solely for information purposes. Complications reported in this section are based on phalloplasty revision surgeries performed at our facility due to previous PMMA procedures and associated complications.
PMMA Injections History:
Polymethylmethacrylate (PMMA) – For more than half a century plastic and reconstructive surgeons and dermatologist have been using medical degree PMMA mainly to fill up small wrinkles in the face (cosmetic soft tissue augmentation). Artefill, one of the best known names in PMMA technology, has been approved by the FDA for facial rejuvenation. Since its beginning, PMMA products have undergone many improvements and refinement to become one of the most widely used dermal fillers.
What Is PMMA And How Does It Work?
PMMA (polymethyl-methacrylate) fillers usually consist of about 20% tiny PMMA microspheres (microscopic synthetic polymer beads) suspended in 80% of purified bovine (cow) collagen gel. Injections are usually offered is 1cc syringes in order to maintain a well-controlled dosing and prevent over injections with several serious side effects. Due to the limited amount to be injected at once, multiple injections are usually required to achieve a volume effect.
The principle of PMMA injections- When injected inside the wrinkles and underneath the skin, the PMMA microspheres (micron sized plastic beads) are delivered into the tissue alongside with the collagen gel. After a few months, the collagen gel is broken down and absorbed and body’s newly formed collagen replaces its place by surrounding and encapsulating the PMMA microspheres.
While mostly claimed to be permanent, the world of plastic surgery only refers to PMMA fillers as being semi-permanent and only effective to use for the treatment of medium-to-deep wrinkles, folds and furrows, particularly nasolabial folds. It can also be used to fill out pitted scars and to augment thin lips.
Besides the traditional PMMA injections using collagen gel as carrier, a new generation of PMMA is told to be developed south of US borders which is reported to use a water-based carrier- this product has been developed in Brazil and mostly available in South American countries.
PMMA injections were developed based on the same principle as free fat transfer (FFT) in order to fill tissue gaps and defects with longer lasting results. As with fat injections which needs a solid surrounding supportive tissue in order to revascularize and fill out a gap, PMMA injections require a solid collagen and soft tissue surrounding structure in order to a) stay put where injected in [gel injection in a mold vs in a lose plastic bag, here: your penile shaft and the overlying skin] and b) in order for the injected collagen/ water-based solution to be absorbed and replaced by the body’s natural collagen.
What Surgeons Say About PMMA Injections?
A large number of plastic surgeons utilize PMMA injections for facial rejuvenation and wrinkle reduction.
The results reported are usually very well documented and associated with mild top moderate side effects- again, if injected in the right area of the body.
While reviewing past and current literature, many plastic and reconstructive surgeons do warn of the use of PMMA and other dermal fillers in areas larger than small wrinkles; in fact, many report revisional surgeries performed on patients with horrific side effects after PMMA injections in appropriate parts of the body.
“Artefill is a PMMA containing filler that is FDA approved for correction of the Nasolabial folds. Although originally manufactured by Artes Medical (reportedly bankrupt), it has been picked up by Suneva for distribution. It is 80% Bovine (cow) Collagen and 20% PMMA. Each 1cc syringe when administered by a physician may range from $1000-2000. Clearly this is available for use as an off-label indication. However the economic costs are not the reason why physicians do perform the procedure. There are concerns with granuloma formation and other possible side effects.”
“PMMA injections are NOT approved by the FDA for soft tissue augmentation. No REPUTABLE Plastic surgeon will do them because it involves placing small, hard particles in soft tissue which leads to irreversible scarring and lifelong complications. DO NOT DO IT.”
“As you can see every single person on the panel is against both of the products. What other info could you possibly need? PMMA is not reversible and I saw a patient today using a walker for the last 2 years after having PMMA.”
“Once a week I see a patient who went abroad for discount surgery and had problems. If you want to be educated and get information seek it from a board certified Plastic Surgeon in the good old USA. We may be more expensive, but you know who we are, we have malpractice insurance if you have a problem and we have peer review and usually follow good ethical morals. Nothing is approved for injection into the butt for augmentation.”
“The complications I have seen are horrific, even though not deadly.”
What Does The Scientific Literature Say About PMMA Injections?
Adverse results with PMMA fillers.
Aesthetic Plast Surg. 2012 Aug;36(4):955-63. doi: 10.1007/s00266-012-9871-8. Epub 2012 Mar 22.
Various alloplastic materials have been used for filling depressions and for body contouring. Among them, polymethylmethacrylate (PMMA) has provoked many clinical compilations in both the acute and chronic phases. This study shows the correlation between the clinical application of PMMA and the physiopathology of the acute and late complications.
The injection of PMMA within the tissues can cause severe complications and side effects in both acute and chronic phases. Initially, the complications are related to vascular compromise, but at the late phase they are a consequence of capsular contracture that involves particles of PMMA. The contracture causes local tissue hardening and clinical nodulation of the implanted areas, ending with extrusion of the filler material.
Complications After PMMA Injections: Report of 32 cases.
Plast Reconstr Surg. 2008 May;121(5):1811-20. doi: 10.1097/PRS.0b013e31816b1385.
During the past 15 years, polymethylmethacrylate has been used as a synthetic permanent filler for soft-tissue augmentation.
The average age of the patients was 43.6 years (range, 22 to 70 years). Twenty-five patients were women. Sixteen injection procedures were performed by certified plastic surgeons, nine by dermatologists, two by urologists, and one by a nonphysician. Complications were classified into five groups according to main presentation as follows: tissue necrosis (five cases), an acute complication that can be related to technical mistakes but that can also be dependent on patient factors or caused by local infection; granuloma (10 cases), which usually presents as a subacute complication 6 to 12 months after the procedure; chronic inflammatory reactions (10 cases), which usually occur years later and can be related to a triggering event, such as another operation or infection in the area that was injected (these reactions are immunogenic in origin and may have cyclic periods of activation and remission); chronic inflammatory reaction in the lips (six cases), which may be present with severe symptoms, especially with lymphedema, because of mobility of the lip; and infections (one case), which are rare but possible complications after filling procedures.
Polymethylmethacrylate filler complications, despite being rare, are often permanent and difficult or even impossible to treat. Safety guidelines should be observed when considering use of polymethylmethacrylate for augmentation.
PMMA Penile Augmentation Procedures Side Effects
As with all types of surgical procedures, PMMA Penile Augmentation procedures can also be associated with general complications such as swelling, bleeding, pain, hematoma, and infection.
Risks and complications specifically reported with PMMA Penile Augmentation procedures are based on two general pathophysiological mechanisms:
A) Injection of a free gel inside a pocket between the penile shaft and shaft skin
Specific risks and complications:
- Uneven and non-homogenous penile shape after injection
- Dislocation of the injected with disproportional spreading of the content
- Uneven absorption rate of the freely injected gel with asymmetries
- Unpredictable amount and areas of absorption resulting in disproportionate penile shape and deformity
B) Injection of an army of micro-beads inside the same pocket
Specific risks and complications
- Detachment of the injected material and permanent floating gel
- Multiple micro and macro granulomas surrounding the injected foreign material
- Buildup of multiple lumps and bumps
- Severe fibrosis and internal scarring
- Acute, severe infection as a reaction to foreign material
- Chronic inflammatory reaction to micro-beads
- Damage to arteries and veins due to granulomas and capsule formation resulting in severe damages to the penile shaft and penile skin
- Severe granuloma formation with necrotic damage to the penile skin with acute and chronic skin scarring, necrosis, and skin loss
- Multiple capsule formation with soft tissue retraction and penile deformity
- Internal invasive granuloma formation with severe damages to the penile erectile tissue resulting in curvature and erectile dysfunction
- Severe internal dermal damages resulting in a thickening and leathering of the penile skin
What We See in Patients with PMMA Penile Enlargement Procedures?
The extent of damages caused by PMMA Penile enhancement procedures can be best described by the following case which were presented to our facility for revisional surgery:
Patient from Brazil with severe penile deformity
Patient with Scrotum PMMA injections
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