26 Mar Complications That May Arise With CALIBRE
The Penis Podcast Episode 9 | Follow on Spotify | Follow on Apple iTunes
DR GAV: Hi everybody, I’m Dr Gavin Scriven, people call me Dr Gav, and with me is the founder of the non-surgical penis augmentation procedure we call CALIBRE, Dr Jayson Oates.
DR JAYSON: Thanks Dr Gav, and together we are the dick doctors and we are going to be talking about all things penis. Our area of expertise is injectable penis augmentation. There’s a lot to talk about penises and together myself and Dr Gavin will be doing that.
DR GAV: Dr Jayson, how are you going?
DR JAYSON: Yes, good to speak Dr Gav and together obviously, we are the dick doctors. Today we’re looking at a different topic, it’s the complications that we’ve seen with injectable penis augmentation, problems that we’ve created ourselves, problems that we’ve seen patients come in with from other clinics. It’s also an important thing for guys to understand that medicine isn’t the answer to creating a perfect gigantic penis every time we do a treatment. There are things one has to understand when they’re coming into this treatment. And the more they understand about what they’re getting into, the better. And for us, it’s very important to be open about it and we’ve spent six years now learning this procedure, getting better at it so that we can minimise any of these problems. So, Dr Gav, have you ever had a problem with a penis augmentation?
DR GAV: I would love to right now say absolutely not but, you’re right. Medicine isn’t an exact perfect science all the time, there and with the procedure, we have been learning it over the last six years, as you said, and refining and perfecting it. So yeah, I have seen a couple of issues patients in and we obviously try and help them get a good result with, but very quickly, asymmetry is an issue guys have after an injectable penis augmentation procedure. But having said that, I really do talk to my patients about this beforehand, so it’s not something that takes them by surprise. As part of the procedure we are putting in a decent amount of dermal filler, which can result in a bit of swelling in the beginning, during which it can migrate and you end up with some asymmetry. As a part of our protocol, and I’m sure you do the same thing (informing them before hand), we do the procedure over usually two treatment sessions for this reason so that we can actually have a look to see if there’s any asymmetry and then address it by topping it up with a little bit more filler and correcting it. We also always have the option of dissolving small bits of dermal filler as well. So that’s probably the number one thing or minor complication or risk that guys see, is some asymmetry afterwards.
DR JAYSON: So guys who have a nice tight circumcision, especially one closer to the glands, have a better result with the product positioning. Some have a very loose circumcision and that allows a little bit more mobility. Obviously when you haven’t been circumcised at all allows more mobility of the product and from the circumcision itself, some guys have more scarring beneath it down to that deeper layer of fascia (the fibrous tissue). And depending on when we made the circumcision which at time is right up close to the head of the penis (and I’ve seen it like five centimetres down mid shaft) that can cause some difficulties in getting the filler to go past it because you want to have this nice even taper in the product. So some of these things are patient sort of characteristics The other issue is shrinkage, so guys who have got a lot of shrinkage are usually growers rather than showers, so when their penis shrinks up, it can fold and create an irregularity. And that, as you say, is why we do it as a two-step procedure, to bring them back and even things out a little bit. And that’s also the advantage of having a hyaluronic acid filler where you can tune it with the medications to address that. So yeah, these are the sort of things that because we’ve been doing it for years, and done hundreds of cases, we’re good at avoiding those sorts of issues-
DR GAV: And often guys are asking me how they can avoid that happening in the first place, and I guess I’ll quickly mention everything I just said. But yes, I tell them to avoid any severe retraction, which I am aware is difficult as it’s something that’s out of your control. We do have medication that we prescribe which is something we’ve talked about in one of our other episodes, that helps prevent some of the more severe retraction, but also just making sure they’re checking the penis regularly, that it’s straight, it’s not folded up in one side of the pants in one direction and squashed up, and they’re driving six hours somewhere, they need to stand up at home, stretch it out, make sure that it’s straight sure in those first couple of days when the filler hasn’t fully integrated into that space and when there is a bit of swelling and there’s more risk of the filler moving. We offer a Crepe style bandage that’s fairly elastic, that helps keep it in a straight line and also some gentle massage at home is something they can be doing. If there’s no tenderness in the swelling and it isn’t too significant, then some gentle massage to help keep the product in place in those first couple of days really helps. And certainly I’ve seen some guys come back with some amazing, perfect symmetry after one treatment.
DR JAYSON: Yeah. Although the funny thing is you get some guys who just don’t want to touch or even look at it, from the fear of disfiguring it. People expect us to get it all smooth and even which isn’t a great way of approaching it really. So it would be preferable to be on the same page, working together so that we can achieve the best outcome. Then again, there are some potential issues with the product itself when a lump is sometimes formed, which we tend to think is granuloma. That’s when the body reacts to a foreign substance. We’ve been injecting these fillers in the face for up to 20 years now and we have found that the occasional patient reacts to a filler. And when it reacts in the penis, you can get a lump and I know that you’ve seen these sort of problems yourself as well.
DR GAV: I have! Whether it’s a granuloma or a post inflammatory type nodule, I guess unless you biopsy the lump itself one can’t be entirely sure, but it is definitely some kind of inflammatory immune response that causes the hard nodule and reaction as you said with the foreign object. So how that happens and how the body reacts is often unfortunately out of our control, and it is a risk that we have to tell everybody about before we do the procedure. And again, the good news is if you’re using hyaluronic acid, you know that it is reversible as the filler can be dissolved, but there are other things we can do to help stop the reaction/inflammation and that is by giving certain medications early on. I’ve personally seen some really good response and actually almost been able to get it back to a normal outcome using them! So with us being on top and people being aware of and actually contacting us, we’ll work together to fix it.
DR JAYSON: Yeah and that’s great that we have the ability to keep close contact with our patients because if they have any worries, they can come back and discuss them with us. And we’ve seen these reactions in the face, lips, etc., which is also where we learnt how to manage these sort of lumps/bumps. I’ve never quite had a guy come back and say “Oh, I’ve got a great big lump on my penis and it’s fantastic, you know, my partner loves it” But I was always waiting for somebody to kind of say that. But personally, it’s been a long time since I’ve seen one of these granulomas as that’s something that we’ve changed over time, just with the experience. Initially you think you have the best product for doing the augmentation, and then you find you’re getting some reactions to it. And it may be because we put 15 or 20 mils in, as opposed to only putting one mil in a cheek, maybe there’s something about that that tends to make it more likely to happen. For me, it’s been a long time since I’ve seen any sort of a granuloma reaction, which is great. Also, there’s the stimulatory fillers as well, which last a lot longer. I’ve never seen a granuloma in the penis from it but I had seen it in face which was interesting, because she liked it! She liked how it just increased the amount of augmentation she got in her cheeks. But we managed it with steroid injections and that sort of kept it at bay. Another thing that we need to keep in mind is infection and we certainly don’t want to get infected in this area, it’s why we do it as a sterile procedure. We wash the area with antiseptic and lay blue towels all around, there’s no touching once everything is blue, we use sterile gloves all throughout and keep the process sterile as the last thing we want again, is infection. I have actually seen a significant infection before, it wasn’t one that that I did myself, but it was a full on. It was initially treated with antibiotics, but it was swelling up to the point that it actually had an abscess that was collecting pus. And I had to take this guy actually to theatre to knock him out. He had this weird bridging band of tissue on his circumcision scar, and there was a drainage point for the abscess sort of bare. So it was opened up, drain of its pass, and flushed out and then with antibiotics very quickly it got better. It certainly reinforced to us the importance of keeping things clean and also telling clients to keep it really clean afterwards. We’ve not had any further issues like that. But cleanliness and this is what sort of worries me when I hear about all the doctors starting to do it, sometimes I hear about or see it being done on YouTube and I’m seeing no sterile drapes/gloves, touching all sorts of things and everything’s fine until it’s not fine. So doing it sterile, I think is very important.
DR GAV: Yeah, we do it as a sterile procedure. But dermal filler in itself normally is not a fully sterile procedure in the face. For example, you’d see nurses and doctors injecting in the face but not as a sterile procedure. And yes, normally there’s no infection, you barely ever see an infection in the face although it can happen. But with penis area, the consequences of an infection is a little bit worse if it happens. There’s some risky infections that can happen that can have quite bad consequences. So we, as you said, treat this as a as a sterile procedure to try to avoid that ever happening in the first place. We also have a particular aftercare regime and we ask that guys follow that after care very closely to minimise any risk of infection. So they do have to take it seriously.
DR JAYSON: Let’s quickly touch on a few other things. Something else that can come from the treatment is, occasionally we’ll use an injectable medicine for a guy to have an erection while we’re doing the procedure. Years ago, I used to do it every time we did a treatment and there was some advantage of having that penis sort of stretched out to its full length for injecting. With the experience, I realised you don’t need to do that very often now unless someone particularly during the second session saying he’s happy with it when it’s flaccid, but when it’s erect, there’s this one area that has a little bit of a dip and you actually see it when the penis is kind of grabbed and stretched out. Sometimes it also happens that they’re are really keen having an erection created, sounds a bit funny sometimes when I said out loud. So you use this medication and the erection is great for 15 minutes or an hour, maybe a couple of hours, but then when it goes on for four, six or twenty four, it isn’t so great. I’ve had one experience with a bodybuilder and who was potentially using various medications to help with bodybuilding, he was really fit, but he had this prolonged erection. And again, we’ve got medications and protocols for it, but I had a call in the middle of the night, telling me that he still had this erection and I asked him if he had taken the tablets, etc., and surely enough, he hadn’t. There’s an instruction sheet that we gave along with these medications and if it was followed, all these issues could’ve been avoided. But yeah, a prolonged erection is painful and a really prolonged erection beyond twenty four hours is damaging, so we don’t want to have that.
DR GAV: Yes. I haven’t had that experience myself or from other patients after receiving one of those injections to correct an erection to do this procedure who’ve actually ended up having to come back into and deal with it in the clinic by injecting another medication to help reduce that erection. And so as you said, it is a medical induced complication that can happen as a result of injecting this substance to cause an erection that we sometimes use for the procedure.
DR JAYSON: Again, from years of experience, we now have protocols that help manage and avoid it. And yet it’s not something that I’ve seen through the years. Then I think about some of the problems I’ve seen from injectable penis augmentation coming in from elsewhere. I had a patient who had PMMA injected in Korea which is poly methyl metabolite. It’s essentially ground up medical version of acrylic plexiglass, and it can be used for permanent penile augmentation. There’s only one doctor in Mexico who I would probably suggest is worth seeing for that procedure as he’s got experience, but this guy had a penis that’s just full of lumps and bumps, and its worrisome because this PMMA is essentially plastic injected in under the skin, and the only thing that we had was to inject more filler around it to try and hide the lumps and bumps, but you’re never keen at all to inject when there’s permanent filler in there, so I was concerned doing it, and fortunately, we didn’t have any issues, it did hide those lumps and bumps. But that can be the problem with permanent fillers, especially if you’re having it done by somebody who’s not a real expert, you get permanent complications.
DR GAV: And a similar story I have is on that same line, is after some clients have had fat transfer/injections. I’ve seen these clients a few years down the track that had long lasting results, but there was some significant asymmetry and lumps that had formed after some of the fat had been resorbed or the fat grafting hadn’t been done very symmetrical in the first place. So this guy’s just been living like this for the last few years.
DR JAYSON: And it’s really hard to hide it, isn’t it? It’s obvious that this is not a natural penis and that’s not what we’re aiming for. We’re aiming for an injectable penis augmentation, which visually is natural, but just big.
DR GAV: Exactly, but in a similar way I was able to help these guys with using hyaluronic acid to straighten out the penis which actually worked quite well. So there are things we can do sometimes to help with these issues. So I think that it covers, most of the things that we’ve seen, but certainly if there’s anything else that we think of, we might bring it up in an episode later down the track, but the most important thing is to have a chat to us. We have the experience of the past, as you said, (me six years) we’ve seen hundreds of results and understand the risks involved and how to avoid any complications. So just come and have a chat to us and we can talk about mitigating any of those risks.
DR JAYSON: Yes. You could always leave us a comment, but if you if you’re not wanting to leave it publicly, then you can just email us directly at email@example.com. We will answer any questions.
DR GAV: Always a pleasure talking to you, Dr Jayson. Together we’re the dick doctors and this has been the penis show and I look forward to speaking to you soon.
DR JAYSON: Talk to you soon. Bye.