As enhancement procedures with dermal fillers have become more common, more and more men who have had HA and are happy with the results are now wanting to transition to PMMA. So the questions arise. Is it okay to combine HA and PMMA? Is it okay to use PMMA without first dissolving the HA? Hyaluronic acids (HA), like Voluma or Volux are very popular for male enhancement because they are reversible and not permanent. With HApatients can “test-drive” enhancements and see if they will like it before committing to something more permanent like PMMA. So can patients who have had a good experience with HA fillers transition to polymethyl methacrylate (PMMA) for permanent results? Before directly answering this question talk about the pros and cons of both filler types.
Hyaluronic Acid (HA)
Hyaluronic acid is naturally in the body, it surrounds collagen and provides elasticity to tissues such as the dermis. In male enhancement, HA fillers are probably the most commonly used filler because of their natural feel and the ability to be absorbed by the body over time. Importantly they are reversible which greatly increases their safety. This impermanence is a double-edged sword; while it allows for safe, reversible girth enhancement, it also means that if you love the result, which at GetMoreGirth we know you will. It means that over the years you will need touch up treatments to maintain results.
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Polymethyl Methacrylate (PMMA)
PMMA is a synthetic, biocompatible substance that, once injected, provides a semi-permanent to permanent enhancement. It’s the most common choice for men seeking permanence in the U.S. In the U.S. the only PMMA available is Bellafill and it is used because it offers long-lasting results without the need for repeated procedures. PMMA’s permanence stems from its ability to stimulate your own collagen production on an ongoing basis.
Can HA and PMMA Be Used Together?
Here is the most common: A patient gets HA and is thrilled with the results. Now knowing that they like their new bigger selves they either want more or want to maintain their results with something permanent going forward. The obvious choice is PMMA. The question now becomes: Can you use PMMA if you already have HA? The short answer is yes.
Some doctors suggest this is a problem and want you to dissolve all your HA before proceeding with PMMA and other doctors tell you that you must have HA before you get PMMA. So who is right? First lets go one by one through the concerns of the doctors that want you to dissolve the HA before they will do PMMA:
1. Risk of Complications:
These doctors argue that the presence of HA will interfere with the PMMA integration into the penile tissue, resulting in unevenness, granulomas formation (inflammatory reactions), or possibly even more severe complications.
The GMG Response:
There is no biological reason to think a reaction between HA and PMMA will occur or is even likely. Believing this demonstrates a misunderstanding of skin biology and a lack of experience with fillers. Remember hyaluronic acid naturally occurs in the skin’s dermal matrix. HA maintains skin hydration, elasticity, and volume. It surrounds collagen in the dermis. When we inject PMMA fillers, like Bellafill, into the skin where there is natural HA, that HA does not provoke adverse reactions from the PMMA. This is because PMMA microspheres are designed to be biocompatible and do not interact negatively with natural HA. Why would we think it is different just because you have some extra HA that was placed there during a prior procedure? Injecting PMMA in areas previously treated with HA-based fillers should theoretically be as safe as injecting it into the untreated dermis, which already contains HA. In fact some physicians even think having HA injected prior to the first round of PMMA makes the chance of side effects from PMMA even less. They believe it slows the introduction of the PMMA to the immune system and thus reduces possible granuloma formation.
2. Unpredictable Outcomes:
These practitioners argue results are unpredictable when layering PMMA over HA. They think that because HA fillers are temporary and are slowly absorbed by the body, and that PMMA are permanent there is some inherent contradiction between the two. The concern is that as the HA filler is absorbed by the body it could somehow alter how the PMMA settles, potentially leading to asymmetry or an unsatisfactory aesthetic outcome.
The GMG Response:
No matter what the order the doctor must be precise when injecting PMMA to ensure the microspheres are evenly distributed and to avoid clumping and possible nodules just as they would when injecting into a penis with no HA. The process is the same either with HA present or without its presence. A thorough understanding of the various tissue layers and the existing HA filler placement is key. PMMA should be carefully injected to avoid disrupting the uniformity created by the HA fillers and having a previous good result with HA filler injections usually indicates a favorable environment for PMMA.
3. Difficulty in Reversal:
HA fillers can easily be dissolved with hyaluronidase, allowing for adjustments or complete reversal if need be. Some argue that introduction of PMMA into an area already treated with HA without dissolving the HA first could complicate or even prevent the reversal process if needed.
The GMG Response:
PMMA is not reversible no matter what. We advise patients to think of it like a tattoo. The irreversibility of PMMA exists whether HA is present or not. The presence of PMMA does not limit the reversibility of any existing HA.
4. Gradual Transition:
Some doctors think a slowly moving HA to PMMA is the best approach. They want to let the body absorb all the HA and slowly replace it with PMMA as that happens. They suggest this approach provides a smoother transition and reduces the risk of complications associated with immediate layering.
The GMG Response:
We fully agree with this. If you are at a size you are happy with why not just slowly replace your HA with PMMA over time. No rush. Just slowly add PMMA as your HA is absorbed.This also allows for more precise placement of the PMMA.
5.Time Interval:
Sometimes it is advised to allow time between the HA filler dissipation and the PMMA injections. Essentially they want you to be without any filler for a period of time. They suggest that this gap can help the practitioner assess the natural anatomy of the penis without the influence of the HA filler.
The GMG Response:
Not necessary. If the original HA filler was well placed and has been well integrated into the tissue it’s a great foundation for the PMMA. We only suggest this if the original HA was poorly placed.
Why Not Dissolve the Existing HA?
Dissolving HA is not cheap, hyaluronidase is expensive, and a significant amount is needed for full reversal. So you will be paying for the reversal and even more importantly you will be wasting a perfectly good enhancement with HA. Why incur this expense if it is not needed. Also why reverse the gains that you have already paid for? Dissolving the existing HA just seems like an unnecessary expense. At GMG sadly we think some unscrupulous providers suggest this so that you end up buying more PMMA from them.
Conclusion
From a biochemical standpoint, there’s no reason to expect that PMMA cannot be safely injected into areas where HA fillers have been previously placed. However, the safety and success of such procedures depend largely on the skill and experience of the doctor performing the procedure.
At GMG we have have found that both hyaluronic acid (HA) and polymethylmethacrylate (PMMA) fillers can be safely employed for penile augmentation, whether they are used together or in a sequential approach. We work hard to give you a good result while at the same time respecting your preferences and objectives. Each type of filler has distinct characteristics that might make one more suitable than the other depending on you and your objectives. HA and PMMA be used safely at the same time or one after the other. It really up to you and your goals of course in consultation with Dr. Sullivan to help you get exactly where you want to be.
A more confident you starts with one decision and that is to contact GetMoreGirth today. If you think male enhancement using dermal fillers might be right for you. Don’t wait? At GetMoreGirth are always here to help. If you have any concerns, don’t hesitate to reach out to us at GetMoreGirth – we’re here to make you your best and biggest!
FAQ
Yes. Patients Often Start With HA Fillers For A “Test-Drive” So To Speak And Then Move To PMMA For Permanent Results. They Are Completely Compatible.
PMMA Is Long-Lasting, At Least 5+ Years, And In Most Patients It Is Permanent.
No. PMMA Cannot Be Dissolved, Only HA Can.
No, PMMA Can Be Added To HA Safely. If Fact This Is Common.
HA Is Temporary (2+ Years), Reversible, And Adjustable. PMMA Is Permanent And Non-Reversible.
HA First, Then PMMA. This Lets Patients Preview Results Before Committing To Permanence. Any Order Is Safe.
No. Many Patients Start Directly With PMMA.