Fixing Botched Penile Thickening Procedures: Repair & Revision Options

Countless problems can occur following a penile thickening procedure.

Ignoring the problems associated with silicone filler injections, which is thoroughly discussed on another page, here we’ll discuss the most common problems that occur with penile girth enhancement procedures and how we usually resolve the issue at Rejuvall.

Lost Fat Graft Repair: Restoring Penile Girth After Fat Transfer Failure

A common repair request we receive is to resolve issues from the loss of all or a considerable percentage of transplanted fat cells from another clinic.

We discovered that the majority of failed fat tissue transplants were not ideal candidates in the first place, due to any of the following:

• insufficient adipose cells for transplant
• patient age
• smoking history
• elevated A1C

For those individuals, we typically advocate sculpting PMMA around the remainder of the transplant to obtain a symmetrically bigger penis.

Sometimes the transplant fails due to insufficient filtration of the grafted cells, and for those patients, we normally propose performing a FTT with our FDA-approved filtration equipment, as our results are reliably good.

Finally, some patients who complain of fat loss have a positive outcome but wish to maintain the bigger thickness they had during the post-surgical swelling phase.

For certain patients, we typically recommend a second FTT or PMMA filler to attain the necessary thickness.

Uneven Penile Shaft Repair: Fixing Lumps, Asymmetry & Irregularities

Unevenness along the penile shaft is one of the most typical complaints after a penile girth enhancement.

Uneven Penile Filler Correction: Fixing Lumps & Irregular Results

Unevenness issues following a non-surgical girth injection enhancement are typically caused by the naturally uneven consequences of using a cannula to add filler.

This happens for 2 reasons:

1. A disadvantage of utilizing a cannula is that precise placement is significantly more difficult to achieve.
2. Utilizing a cannula rather than a needle increases the likelihood of forming a long-lasting granuloma.

Granuloma is an inflammatory reaction to a biologic injection into the human body. It is a natural inflammatory response.

If this response happens in a location where a larger volume of filler was injected, the granuloma will nearly invariably be long-lasting.

Unfortunately, only a board-certified urologist possesses the expertise required to safely inject a penis shaft without a cannula, hence few facilities offer such precise treatments.

Repairs of Penile Shaft Unevenness following Surgical Girth Enhancement

An uneven penile shaft after surgical girth enlargement can be caused by a multitude of factors.

Unevenness after a Fat Tissue Transplant is commonly caused by transplanted adipose cells dying in a specific area of the penis, resulting in an uneven finish. This type of asymmetry is usually corrected with shaped injections of PMMA.

Silicone implant unevenness issues are mostly about where the implant sits against the glans during an erection. Some men report that this stage is noticeable and emotionally distressing.

We’ve smoothed out the area several times by sculpting PMMA into it, but this is problematic because this is an area of the penis that is prone to infection after using a silicone sleeve. In these situations, we normally advise against taking any action.

Shaft unevenness after a dermal transplant can only be “repaired” using injectable fillers. It is usually successful, although it can take a few applications to totally smooth out. Complete repair necessitates surgical excision of the skin graft.

Vanishing Hyaluronic Acid Fillers: Why Some Penile Injections Don’t Work

This is perhaps the newest penile enlargement repair we’ve encountered recently, but we’ve already had 4 of them in as many months.

Each patient reported basically the same circumstances. They visited a clinic performing penile thickening with injections of hyaluronic acid filler.

They received the injections but there was no improvement in size. In one case, the patient had received approximately 18 mL of hyaluronic acid, and saw no size increase.

Honestly, we weren’t sure what to believe after the first 2 patients. None of them had any palpable H/A in their penile shafts, yet claimed they had varying amounts of H/A injected.

As best we can conclude, this is a function of 2 problems:

1. We suspect the provider is inserting the cannula in a manner where the injected filler is entering the shaft in a way where it almost immediately drains into the lower body. There’s no medical harm from loose H/A in the human body. The body will safely reabsorb it soon afterwards. It’s just a very expensive path for the patient. We don’t employ a cannula when performing penile girth injections. We find this technique tends to cause unsightly lumpiness along the penile shaft. We understand why most use it: safety. However, we’re board-certified urologists at Rejuvall. We know how to navigate a penis with a needle without the need for training wheels. The result is a smoother, more natural looking, longer lasting, larger penis.
2. Most enhancement doctors take a weekend class in male enlargement and subsequently use the branded marketing materials provided by the licensor of their brand to tout themselves as a “penis enlargement doctor” and an expert with male enhancements. Sadly, many patients suffer because of this paradigm.

Penile Dermal Graft Repair: Fixing Degradation & Uneven Results

Dermal grafts are a more popular pathway for increased penile thickness in certain other parts of the world than they are in the US.

A variety of sources for donor tissue are available ranging from the patient’s own skin harvested from another part of the body, to cadaver skin, to man-made grafting material.

Rejuvall explored dermal grafts as a source for penile thickness earlier in our clinic history and opted against continuing them for a couple of reasons:

1. The only version that doesn’t usually degrade and require repair or intervention is a graft harvested from the patient’s own skin. These procedures are very expensive to perform as they require almost a week in the hospital to ensure the donor site doesn’t become infected.

2. The size increase is limited and can only be performed once. You can’t add derma grafts on top of one another. Most of our patients wanted thicker final outcomes than can be achieved from a dermal graft. Thus, we no longer offer dermal grafts for penile thickening.

Fixing Degraded or Uneven Dermal Grafts for Penile Enhancement

Repair is most usually associated with resolving some degree of degradation in the previous dermal transplant.

Solutions are tailored to the patient’s health status as well as their future size goals. If the degeneration is modest, we may propose using injectable filler to correct the unevenness.

If the degeneration is more severe or the graft is creating necrotic dangers to adjoining penile shaft skin, we typically perform surgery to resolve the problem.

Sometimes we can replenish lost thickness while repairing or removing the previous dermal transplant.

In other circumstances, we must remove the dermal graft and must let the entire tissue area recover before adding thickness.

Fat Necrosis After Penile Fat Transfer: Hard Lumps & Nodule Removal

Did you end up with palpable nodules or “bumps” along the shaft of your penis from a previous fat tissue transplant?

Those nodules occur when fat cells become inflamed and die from a lack of oxygen. When this occurs, the fatty tissue is replaced by the oily contents of the fat cells that have ceased to function.

Necrosis or oil cysts usually feel like a round, firm lump, and nearby skin may show color changes. Fat necrosis and oil cysts are not cancerous.

Fat necrosis can occur following any procedure involving a fat tissue transplant with penile girth enlargements.

Fat necrosis symptoms frequently vanish without treatment with massaging and reabsorption within the body’s lymphatic system.

However, if they persist or become a source of embarrassment, a surgeon can remove them using fine needle aspiration. In more severe cases, we may recommend surgically cutting the fatty cysts from the penile shaft.

Fat necrosis occurs in stages:

1. Fat cells die, releasing their contents.
2. The discharged oil condenses into an oil cyst, which is a sac of greasy liquid.
3. Calcium builds on the exterior of the breast, resulting in a hard lump seen on mammograms.
4. The body heals the damaged tissue, resulting in denser scar tissue.

Fat necrosis symptoms don’t usually appear right after surgery. They can manifest themselves over a few weeks or months following an FTT.

Penile Filler Granuloma Removal: Treating Hard Nodules & Lumps

Granuloma repair and removal is becoming an increasingly busy area of our penile enhancement repair clinic as a growing number of men become aware of enlargements and many seek non-surgical penile improvements.

Unfortunately, some don’t come out exactly as anticipated.

What is a granuloma?

Patients frequently refer to any granuloma formation that protrudes noticeably from beneath the skin as a “nodule”. Unfortunately, the phrase encompasses everything from a skin blemish to a malignant tumor.

A granuloma is a cluster of immune cells or inflammatory tissue in the body. They form around any foreign object placed within the human body. Most of the time, they vanish with time or after regular massage.

Granuloma Following Injection of Hyaluronic Acid for Penile Enlargement

The most common granuloma that develops after penile girth enlargement with H/A injections is termed as “foreign body giant cells” or FBGC.

A foreign-body giant cell is a collection of fused macrophages that form in reaction to a large amount of foreign body (injected dermal filler).

Penile augmentation with off-label hyaluronic acid injections requires substantially more H/A (5mL to 15mL) than what the FDA permitted for use with face injections (1mL to 2mL).

As a result, the risk of granuloma formation following H/A injections for penile enlargement is at least ten times greater than that for facial fillers.

The degree of FBGC response following H/A injections into the penile shaft is directly connected to the number of mLs used, the precise position of the filler (which is why we do not inject through a cannula), and the patient’s immune response system.

Patients with a weakened immune response owing to disease are more prone to develop a chronic granuloma because their body’s ability to heal is hampered.

How to Treat & Remove Granulomas from HA Fillers

Granuloma produced by H/A injections is treated with hyaluronidase, an enzyme that degrades hyaluronic acid.

Persistent granulomas generated by hyaluronic acid injections are the result of an inflammatory immunological response. Eliminating the underlying cause of this inflammatory process leads to a speedy resolution of the issue.

Treatment & Removal of Granuloma from PMMA Girth Injections

As previously stated, a granuloma is a localized cluster of immune cells or inflammatory tissue in the body. They form around any foreign object placed within the human body.

When these inflammatory factors surround the PMMA (polymethyl-methacrylate) microspheres, the resulting granuloma is usually persistent and does not require intervention.

Polymethyl-methacrylate is prone to eliciting such inflamed responses because the compound causes inflammation as it grows within human tissue by design, especially when injected into an area that has never been injected with a foreign biologic before (i.e. H/A) and in large quantities.

In such circumstances, the body’s normal immune response mechanism becomes overloaded, resulting in a large number of granuloma nodules.

Adding additional PMMA will simply exacerbate the immunological reaction.

The LAST thing you want to have done is return to a provider and request they attempt to cover them up with more PMMA. Sadly, this has happened a few times.

Granuloma is an immune inflammatory response. Adding more can make it much worse very quickly.