Getting the Best Result with your PMMA

What to expect following your PMMA girth enhancement:

Swelling, bruising, and/or tenderness in the groin area is to be expected following treatment but will be very minor. Most patients return to their regular activities in approximately one to two days. Rarer side effects include bumps, lumps, or skin irregularities at the injection site(s). We recommend avoiding heavy lifting, intense workouts, and sexual intercourse for seven days. While most patients see immediate results, the outcome of the procedure will continue to get even better over the course of about 18-25 months.

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Possible side effects:

• Uneven penile shape after injection

• Uneven absorption of the permanent floating gel with asymmetries

• Disproportional spreading of the injected content

• Unpredictable areas of absorption causing deformed and disproportionate penile shape

• Buildup of lumps and bumps or possible granuloma formation

• Inflammatory reaction to the bovine collagen gel matrix

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The more that you are able to "work" the product into an evenly distributed layer immediately after the procedure and throught the following couple weeks will help reduce the risks of unwanted side effects. Think Elongate, Heat, Massage.

 

Immediate Post-Procedure Care (Massage and Molding):

• The first 3 days: This is the most critical time in terms of evening out the PMMA. After the first 3 days, you may continue to massage, roll, and mold the PMMA, but you probably won't get as much benefit as you will in the first 3 days.

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• Elongation: Try to keep your penis in the most elongated position possible for your recovery. Hangers and extenders are fine to use as long as they are not compressing the product along your shaft. You can also use a light compression wrap to not compress the PMMA, but to keep the swelling down and to keep your penis from retracting. Using medications to help keep your penis from retracting is also recommended. Neurotoxin (Botox, Dysport, etc) at the time of your procedure inhibits the penis from retracting as much as it would naturally. Other medications like Cialis or PT-141 can also help keep your penis in a more elongated state post-procedure. We recommend taking Cialis (or a similar medication) daily for the first four days post procedure and getting neurotoxin with your PMMA girth enhancement to help promote elongation of the penis and limit retraction. 

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• Heat: You are going to need to use heat to continue to be able to mold the PMMA. We recommend that you heat the treated area for at least 30 minutes prior to massaging or rolling to allow it to be more moldable. Most patients have the best results using the hot towel method to keep the temperature around the penis at a warmer level for longer. To use this method, heat a wet towel in a microwave and then wrap your penis for 30 minutes prior to massage. Heating pads may also be used, but be mindful of the temperature as to not create a thermal injury (burn) to the skin. 

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• Massage or Roll: Perform massages regularly to the treated area to ensure even distribution of the filler. This can help prevent nodules or unevenness. You want to emphasize working any product away from the needle holes/injection ports. Remember, you are going to be massaging inflammatory fluid and the PMMA/bovine collagen gel. You are going to need a little more force to be able to mold the bovine collagen gel vs just pushing the inflammatory fluid around. Using the warm wet rag method to heat the product up and then massaging or rolling the penis regularly while keeping your penis as elongated as possible (immediately after the procedure and for the following 3 days at least) is going to to yield the best (most even) result with the least chance of a lump, nodule, or uneven area. You are going to want to pay special attention to working the product away from the injection sites and working any fluid away from the foreskin/frenulum area as these areas have a greater tendency to expand/swell. 

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General postcare notes:

• Rest and Recovery: Limit physical activity to allow the treated area to heal.

• Hygiene: Keep the area clean with gentle washing using mild soap and water. Allow the needle holes to heal. Make sure that until the needle holes fully heal, you are keeping the area clean and your hands clean when massaging in order to prevent any unwanted pathogens from getting introduced into the injection sites. 

• Swelling and Discomfort: Some swelling, bruising, or discomfort is normal. These symptoms typically subside within a week. Over-the-counter pain relief like acetaminophen can be used as needed.

• Compression Garments: Wearing supportive underwear can help maintain the filler’s position and reduce swelling. 

• Sexual Activity and Masturbation: As stated above, we recommend that you avoid sexual activity for at least a week post-procedure to allow the needle holes to heal and any initial inflammation to subside. Masturbation and sexual activity are allowable after the injection sites heal, but you still want to limit this kind of activity to a less-aggressive version. Remember, you just had a procedure done and you need to allow your body to heal properly. You do not want to do something that causes further inflammation, injury, bruising, or abrasions. 

• Physical Exercise: Avoid strenuous activity and heavy lifting initially and then advance activity as tolerated while listening to your body. Again, you just had a medical procedure done and want to allow your body to heal without causing any unnecessary stress. 

• Lumps and Unevenness while Healing: Most of the time, any unevenness caused by a lump or bump from the PMMA/bovine collagen gel matrix settling is a TEMPORARY complication. Your body is slowly metabolizing the bovine collagen gel matrix. This metabolism takes up to 16 weeks or longer depending on the volume injected and the product dispersion during the initial settling period. If you do have any uneven areas, you may continue to place a warm compress over the area and continue to massage it as needed. This will help your body's metabolism of the gel matrix. If there is any ongoing lumps or uneven areas, we can help either inject them directly with a medication to help disperse the product, or we can inject more Bellafill around those areas. 

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Monitoring and Follow-Up:

• Observation: Monitor the treated area for any signs of infection, such as increased redness, swelling, or abnormal skin changes. You are likely to experience some discharge from the needle sites. This can look clear, clear-yellow, pink, or a whitish-pink. Mostly this is inflammatory fluid, but may have some of the bovine gel and/or blood in it. It will be very minimal and will not affect your overall result. If any discharge, swelling, or skin changes seem abnormal, notify us immediately. 

• Follow-Up Appointments: Follow up appointments are usually recommended after 4 months of allowing the Bellafill to settle. You want to allow your body to have time to heal and then allow the PMMA to stimulate the body's collagen production while allowing time for some of the bovine collagen gel to be metabolized.  You can follow up to add more in terms of gaining more volume/girth or to even out any irregularities. 

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Long-Term Considerations:

• Results Timeline: While some immediate changes may be noticeable, the full effect of PMMA injections can take up to 24 months as collagen production increases over time. Because we are usually putting a larger volume of bovine collagen gel in a smaller space, it may take longer to metabolize than if a smaller volume was spread over a bigger surface. You have to have patience with PMMA penile injections as this metabolism and the subsequent collagen biostimulation are going to be occurring for the following months to years after your procedure. 

• Maintenance: Discuss with your provider the potential need for touch-up treatments to maintain desired results over time. The PMMA microspheres are a permanent product and will not be metabolized by your body. 

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