Avanti Derma’s Phalloplasty is an outpatient, minimally invasive procedure developed by Dr. Casavantes and designed to give patients a more prominent, and substantial penis.*
What is Nonsurgical Phalloplasty?
Our Phalloplasty procedure is performed in our medical office; the process takes less than two hours from the arrival to the release of the patient.
It does not involve surgical cuts or drains, and downtime is minimal; patients can leave our facility immediately after the procedure but are recommended to remain in the area for at least 24 hours to supervise the understanding of their post-care, and minimize the possibility of imperfections.
Our soft tissue fillers are always visible and available to the patients for inspection; They are opened in their presence, as the doctors need them.
Patients receive detailed, hands-on post-care instructions before they leave, and they are provided with the official manufacturer’s label of the product, containing brand, lot number and expiration date.
Temporary or permanent? It’s your choice.
Depending on the filler used, the girth increase can be temporary or permanent. Avanti Derma offers the four most popular products used for phalloplasty:
- Made of a gel that holds water and remains as a soft substance in the tissues.
- The deposits of gel are loosely surrounded by a thin collagen membrane, and can give a “spongy feel” to the penis.
- Temporary results.
- It’s effect can be reversed with injections of hyaluronidase.
- Popular brand names: Voluma®, Belotero®, and many more.
- Very similar to PMMA but temporary.
- Shorter lasting than polycaprolactone.
- Made of microscopic spheres of calcium that are slowly absorbed.
- While they are in the tissues, the micro-spheres get surrounded by the patient’s collagen, which produces volume.
- Long-lasting results.
- Brand name: Radiesse®.
- Very similar to CaHA and PCL but permanent.
- Made of microscopic spheres of plastic that are never absorbed.
- The micro-spheres get surrounded with the patient’s collagen creating volume.
- Permanent results.
- Brand names: Linnea Safe® and Metacrill®
- Very similar to PMMA but temporary.
- Longer lasting than calcium hydroxylapatite.
- Made of microscopic spheres of a biodegradable polyester that eventually disappears.
- While in the tissues, the micro-spheres get surrounded by the patient’s collagen, which produces volume.
- Long-lasting results.
- Used for substantial, non-absorbable gains.
- Brand name: Ellansé®
Avanti Derma offers Voluma® for termporary results, Radiesse® and Ellansé® for long lasting, and Linnea Safe® for permanent results.
Am I a good candidate for nonsurgical phalloplasty?
The following guide helps prospective patients decide if they are good candidates for phalloplasty. It is not intended as a substitute for clinical evaluation by a physician:
The ideal candidate for phalloplasty meets most of the following statements:
- Small to above average size penis (bigger than 7 cm or 2.75 in during full erection)
- Non-retractive or moderately retractive penis during relaxation
- Lean individuals with regular pubic fat pad
- Psychologically stable
- No previous implants or surgeries other than the circumcision
The ideal candidate for phalloplasty is a circumcised individual; however, uncircumcised prospects can always be considered. The injection of soft tissue fillers is more stable in circumcised patients because their skin is tight, and its movement is restricted.
Implanting any filler under the loose skin of an uncircumcised patient is challenging, and the possibilities of migration and product clumping are high.
The implanted fillers should never involve the foreskin to preserve its aesthetics and dynamics.
Non-circumcised patients are generally accepted but treated conservatively, with limited volume and low concentration of product (if available).
The use of large amounts of tissue fillers in the uncircumcised patient elevates the risk of developing the “accordion effect” or clumping of the skin at the base of the penis when it is retracted.
Uncircumcised patients seeking more significant volume are encouraged to have a “high, tight” circumcision three months before their phalloplasty procedure.
Some individuals believe that they have a small penis when in reality their size is average or above average; more than psychological therapy, these patients benefit from a real, palpable size increase through our phalloplasty procedures.
The mean length of the erect penis is around 13 cm (5.25 in). A small penis measures less than the average size, but it is larger than 7 cm (2.75 in) during erection; individuals with a small penis are considered good candidates for phalloplasty.
Micro-penis is an abnormally small penis that measures less than 7 cm (2.75 in) during erection; These patients require a multi-disciplinary approach that goes beyond the essential girth enhancement.
Buried penis (or hidden penis) commonly associates with obesity or other conditions that increase the volume of the pubic fat pad. Buried penis can be of average size, making these patients good candidates for phalloplasty after liposuction of their pubic fat pad.
An uncircumcised patient with micro-penis and buried penis is the least desirable candidate for phalloplasty.
Prospective patients s with previous procedures are taken based on the results and nature of their past treatments:
Autologous fat transfer typically results in irregularities, but develops fibrosis which facilitates the implant of soft tissue fillers. These patients are good candidates for phalloplasty.
Biological membranes Alloderm™ and Veloderm™ are implanted through invasive surgical procedures that include incisions, degloving of the penis and drains. While being slowly reabsorbed by the body, they leave the skin firmer due to residual scar tissue. These patients are good candidates for phalloplasty, although some areas may be problematic due to the presence of surgical scars and skin adherences.
Patients with Soft silicone scaffoldings on site are not taken because of the excessive risk of complications. Once their silicone implant is removed through a second surgery, they must be evaluated in an individual basis because they are less-than- ideal patients for nonsurgical phalloplasty.
Hard and inflatable implants placed inside the corpora cavernosa do not alter the superficial tissues, and they can qualify for phalloplasty with soft tissue fillers.
Patients with a history of previous surgeries or implants will need to provide all medical records, along with a brief summary of the current condition of the area.
Failure to disclose any and all previous procedures may disqualify candidates, and all incurred expenses will be the patient’s responsibility.
History of unknown products or materials implanted in the penis disqualify most patients for phalloplasty.
This is typically a normal condition in which the scrotal skin extends from the front of the scrotum to midway the ventral penile shaft. Surgical removal (ventral phalloplasty) of the excess skin is sometimes recommended for a more stable implant, comfort, and a visually aesthetic and longer looking penis.
As a body alteration, phalloplasty can have good or bad psychological consequences. Although it is almost impossible to predict a particular psychological outcome after the procedure, years of experience, and thousands of patients treated, help us identify some risk factors and make recommendations or deny services. Commonly, independent symptoms and conditions are erroneously associated to the product implanted, and occasionally patients want it reversed; even though we do not have one case of a patient with a medical indication for surgical removal of soft tissue fillers after phalloplasty, a tiny number of them have request it for personal reasons.
Prospective patients must understand that removal of the implant should not be considered as a viable option when deciding to have a permanent procedure using PMMA-based fillers.
Nonsurgical Phalloplasty Options at Avanti Derma
* Note: Booster procedures have been proven to help on healing, collagen production, and bruise control in conditions other than phalloplasty. Their benefit for this indication is hypotethical at the moment.
No other medical practice in the world has performed more phalloplasty procedures with PMMA than Avanti Derma.
We offer the phalloplasty technique, developed by Dr. Luis Casavantes
After thousands of procedures and over a decade of experience performing penile girth enhancement with the use of PMMA, absorbable calcium micro-spheres, polycaprolactone and hyaluronic acid, our physicians have explored a large number of variants that have led to one of the best techniques available to date.
Our physicians do not induce erection for the penile girth enhancement procedure, because a properly placed implant requires the penis to be extended, bent, twisted and rotated while directing the micro-cannula in multiple directions to create an implant that reaches the entire shaft.
A non-erected penis offers a more relaxed alveolar space that is more accepting of both the micro-cannula and the product.
A rigid, erect penis is tough to manipulate, making it hard to reach most areas of the shaft with a non-flexible cannula. The induction of erection to facilitate the implant of a soft tissue filler is no more than a gimmick in our opinion, and makes no anatomical sense.
After being implanted in the penile shaft, soft tissue fillers need weeks to get surrounded by the host’s collagen; the claim that the filler settles better if implanted during penile erection is questionable since an erection cannot be forced for more than a couple of hours before creating priapism. Once the erect penis returns to its flaccid state, the material ends up in a similar space as it does in a non-erect penis.
Due to the cylindric shape of the penis, several entry points are necessary for the cannula to reach every single corner of the penile shaft. The use of a single entry point leaves many areas free of product, creating a fan- shaped and incomplete implant; using nonflexible cannulas aggravate this situation.
Small gauge micro-cannulas are flexible and thin, with a small orifice on the side of the tip. They facilitate the delicate approach to tissues and organs like the penis while protecting veins and arteries from being punctured. Flexible micro-cannulas are the only option offered at Avanti Derma.
Large, rigid cannulas are used mainly for liposuction have been available for decades. They facilitate the extraction or insertion of large amounts of volume and are not needed, nor desired for a delicate and precise implant of soft tissue fillers in the penis.
Unlike Radiesse® and Ellansé®, Linnea Safe® comes in different concentrations, like 10 and 30% of the micro-spheres, suspended in aqueous carriers like carboxymethyl-cellulose that create noticeable volume augmentation in the treated areas.
When using Linnea Safe® physicians use what they consider the best option for the patient and the area of the implant. Most circumcised patients receive the 30% concentration from the base to the mid-shaft, and 10% in the distal segments and neck of the penis; on the other hand, almost every uncircumcised patient receives the lower 10% concentration throughout the shaft.
Will I get perfect results from the phalloplasty procedure?*
The penis is a very distinctive and dynamic anatomic structure of the body; besides its specific functions, a significant difference is that it lacks the layer of subcutaneous fat tissue, otherwise present under the skin throughout the rest of the body.
This lack of subcutaneous fat tissue in the penis can make the implants palpable and visible since they lay directly under the skin.
Other factors that can make the implant noticeable or irregular are:
- The number of treatments performed and concentration used
- The patient’s understanding and compliance with the post-care procedures
Our phalloplasty technique and post-care instructions are designed to minimize imperfections to the degree that it’s acceptable to the patient and not identified by his sexual partner(s).
Read about Dr. Casavantes and Dr. Morales’s extensive experience with nonsurgical phalloplasty using PMMA based fillers in the Journal of Sexual Medicine:
Casavantes L, Lemperle G, Morales P. Penile Girth Enhancement with PMMA-Based Soft Tissue Fillers. J Sex Med 2016;13:1414-1422.
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