Managing Complications: What Happens If Something Goes Wrong (And How We Fix It)
A transparent clinical review of the complications that can occur in nonsurgical phalloplasty, how they are recognized, and the management pathway for each.
Dr. Luis Casavantes | Dr. Palmira Morales
Avanti Derma, Tijuana, Mexico
Every injectable procedure has a complication profile. Providers who say otherwise are being dishonest. What separates a competent practice from a marketing operation is not whether complications occur — it is what happens after. This article documents, transparently, the complications we see and the management pathway for each.
The Predictable Risk Factors
Complications in this field cluster around a small number of preventable variables:
Poor patient selection (subclinical autoimmune conditions, unresolved infections, prior filler of unknown origin).
Inappropriate material for the specific patient.
Volume delivered too aggressively in a single session.
Injection technique that ignores individual anatomy.
Most complications are consultation failures before they are clinical failures. This is why we spend more time on selection than any competing clinic we know of — see our 12 consultation questions for the framework.
Edema and Bruising (Expected)
Not complications — expected. Edema is present from day zero and resolves substantially within two weeks. Bruising, when it occurs, resolves within 7–10 days. Both are managed with observation and standard measures. Patients who evaluate their result at day three are evaluating an edematous shaft.
Nodularity
Palpable irregularity, usually detected at the 4–8 week follow-up. Causes: inappropriate injection depth, uneven distribution, patient tissue response.
Management: For HA — hyaluronidase, sometimes with massage protocol. Resolution days to weeks. For biostimulatory or PMMA — targeted intralesional steroid where indicated, staged massage protocol, revision injection to correct contour asymmetry. Most nodularity resolves within 3–6 months of active management.
Migration
Filler shifting outside the intended plane. Rare with proper cannula technique; more common with needle injection or aggressive single-session volume.
Management: Assessment of pattern and extent. HA dissolves. Biostimulatory/PMMA migration is managed with targeted revision — surgical excision only in the rare severe case.
Infection
Uncommon but must be recognized quickly. Signs: expanding erythema, warmth, tenderness beyond expected recovery window, systemic symptoms.
Management: Culture-guided antibiotics; drainage if abscess forms. Filler removal only where clinically indicated. Standard antibiotic prophylaxis at time of injection is our default in patients with any risk factor.
Granulomatous Reactions
Delayed inflammatory response, sometimes months or years after treatment. Documented predisposing factor: subclinical autoimmune conditions. This is exactly why we screen carefully.
Management: Intralesional steroid protocols; oral treatment when indicated. Recognition and management pathways exist and are well documented. In rare severe cases, surgical excision may be required.
Contour Irregularities
Uneven appearance, asymmetry, visible edges. Almost always a technique outcome, not a material outcome.
Management: Assessment at the 6-week mark. Revision injection to correct — usually a small volume adjustment in the deficient area. Most are resolvable without major intervention.
The Follow-up Protocol Is the Insurance
The reason we insist on structured follow-up (week 2, month 3, month 6, annually) is that early detection of any complication dramatically improves management. A nodule detected at week 6 is straightforward; the same nodule detected at year 3 is a harder problem.
When You Should Contact Us Immediately
Expanding redness, warmth, or severe pain beyond day 5.
Fever or systemic symptoms.
New nodularity appearing after the first 6 weeks of clean recovery.
Any concern that does not match what was described as expected.
We prefer a call about nothing to a delayed call about something.
Frequently Asked Questions
How common are complications in your practice?
Rare in appropriately selected patients — well below the rates commonly reported for penile filler procedures in general. Our published work (Casavantes et al., J Sex Med 2016) documented safety in a large series. But no rate is zero; anyone quoting zero is being dishonest.
If I have a complication years later, will you still treat me?
Yes. Long-term follow-up is a commitment we honor. Patients from 5, 10, and 15 years ago can and do contact us for follow-up care.
Can complications from another clinic's work be corrected?
Often yes. See our revision and correction guide for the evaluation process.
Does using PMMA increase complication risk vs. HA?
Not intrinsically. Per unit of injection, complication rates are similar with proper patient selection and technique. The difference is that PMMA complications require more complex management because the material is not enzymatically reversible.
Will I have to travel back for complication management?
Depends on severity. Many issues can be managed via video consultation with local support. Complex cases benefit from in-person assessment. We coordinate.
Clinical Takeaways
Complications occur in every injectable practice; the difference is management.
Recognition and early intervention dramatically improve outcomes.
Structured follow-up is the mechanism by which complications become manageable.
Providers who claim zero complications are not being honest.
Bibliography
Pang, K.H., et al. "Complications and Outcomes Following Injection of Foreign Material into the Male External Genitalia." Int J Impot Res (2023).
Garcerant Tafur, M., Rodríguez-Cerdeira, C. "Granulomatous Reactions Following the Injection of Multiple Aesthetic Microimplants." Reports 8, no. 4 (2025): 194.
Casavantes, L., Lemperle, G., Morales, P. "Penile Girth Enhancement with PMMA-Based Soft Tissue Fillers." J Sex Med 13, no. 9 (2016): 1414–1422.