PMMA/PCL integration phase 

Polymethylmethacrylate (PMMA) and Polycaprolactone (PCL) microspheres are biologically inert; they don’t react chemically with tissue. Their effect depends entirely on the host’s collagen response, which stabilizes the filler over several weeks. 

1. Inflammatory phase (0–2 weeks): Local immune activation and macrophage recruitment around microspheres. 

2. Proliferative phase (2–6 weeks): Fibroblasts deposit new collagen (types I and III). 

3. Maturation phase (6–12+ weeks): Collagen crosslinks and the tissue becomes stable and less metabolically active. 

Testosterone and anabolic steroids during healing 

Testosterone and its synthetic derivatives influence several tissue processes: 

1. Mild anabolic and anti-inflammatory effects at physiological or replacement levels, which generally do not interfere with microsphere integration. 

2. Supra-physiologic doses can alter local inflammation, increase erythropoiesis, and modify collagen metabolism (potentially favoring denser, sometimes stiffer collagen). 

3. Some anabolic compounds (especially those with androgenic or aromatizable activity) may cause fluid retention or temporary edema, which can distort contours during early integration. 

Timing recommendations 

1. Weeks 0–6: Avoid hormonal cycles, anabolic stacks, or significant dose escalations. Allow the filler to stabilize and early collagen to organize. 

2. After week 6: Physiologic or moderately elevated testosterone use is acceptable once swelling has resolved and no nodules or irregularities persist. 

3. After 3 months: Most patients can safely return to their usual cycles if tissue texture is normal and integration is complete. 

Risks of premature use 

Resuming supraphysiologic doses too early can: 

1. Prolong local inflammation 

2. Exaggerate edema or firmness 

3. Mask early complications (granulomas, asymmetries) 

4. Lead to misleading perception of increased girth due to transient water retention rather than stable collagen 

Avanti Derma’s insight: 

Normal testosterone replacement is safe after the first few weeks. Anabolic “cycles” should be deferred until at least six weeks post-procedure, preferably closer to three months, depending on clinical evolution. Once healed, the microspheres are encapsulated and unaffected by hormonal variations.