The Different Types Of Filler

The different types of filler - CALIBRE Clinic

The Different Types Of Filler

The Penis Podcast Episode 3  |  Follow on Spotify | Follow on Apple iTunes

DR JAYSON: Hi, guys. It’s Dr Jayson and I’m here with Dr Gav. We are the dick doctors who perform CALIBRE. Remember confidence changes everything. How are you, Dr Gav?

DR GAV: I’m really well, thanks, Dr Jayson. Thanks for having me here today, great to be speaking again as always.

DR JAYSON: So I understand you wanted to be explaining to people the difference between a HA filler, a gel filler and a collagen stimulating filler. 

DR GAV: Yeah, that’s right. It’s a really common question we get, almost in every consult really, because there are different options out there, not only in Australia, but all around the world. So I think it’s a really good one and the common questions are, what’s the difference in the results, the outcomes? What’s the difference in the risk profile? Are there any benefits of one versus the other? So those kind of questions, I think a really great place to start today.

DR JAYSON: I guess like I was explaining to you nearly five years ago, what I started off with, in developing the CALIBRE procedure, was using the HA gel fillers – the same fillers that you and I had been injecting into faces, lips, cheeks, that mostly women I guess for really the last 20 years. People have heard of injecting collagen fillers and we had those 20 years ago, but they didn’t last very long and so that sort of fell out. Then the HA gel filler came in and because we had, well at that stage sort of 15 years’ experience with it, and a good safety profile, that’s why I wanted to use that to start with. The other big thing is that it’s dissolvable, there’s a medication where you can dissolve it away. So that was really where we started and that’s what I trained you with all those years ago.

DR GAV: Yep, definitely, and it’s still the most commonly used product, both for the face and for our procedure CALIBRE. There’s a reason behind that, as you just mentioned, it’s the safety profile, it’s fantastic and it’s fully reversible that guys feel much more comfortable knowing. Even though we’re not reversing procedures, really, it’s the peace of mind, that if you’re doing something like this procedure (in that area) that you could potentially, if you want to, reverse it. I think that’s a nice thing to know when you’re doing this kind of procedure.

DR JAYSON: I think when we did one of our earliest videos, we also talked about that ‘tune-ability’ of it. If you get a slight fullness in a certain spot, you can use the tiniest amount of this medication to smooth that down, without making any difference to the overall size, and to get that evenness and symmetry. Everybody wants it to be nice and symmetrical, but full and fat.

DR GAV: And that’s something not everyone understands, they think it’s in there, or when you reverse it, it’s fully gone. I think it’s important to distinguish that we can actually make fine adjustments, using that medication, to just really fine tune the symmetry. I have had a couple of patients in the past actually get to know how the medication works really well. There are some guys who don’t mind a little bit of asymmetry here and there, they don’t see it makes much of a difference and when it’s erect, it looks the same anyway. But there are some guys who really care a lot about the perfect symmetry, and I’ve got a couple of guys like that, who have taken advantage of the fact that HA can be (in small amounts) dissolved, and really fine tune that symmetry and gotten the perfect symmetry.

DR JAYSON: Yeah, it’s absolutely right that if the appearance of it, if they’re so pedantic about the tiniest little thing, the HA fillers are the way to go because you’ve got that ease of adjustability, over using collagen stimulatory filler. So not injecting collagen, which is what we did in the lips and was harvested out of cows 20 years ago. It’s this microscopic particle called PCL, and it goes in a in a gel carrier to get it into the tissue. The PCL breaks down over time, and there are other different versions of it, but they last for years and years. It’s not the PCL that is really giving the augmentation, it’s the body’s response to that and the production of collagen and then that lasts a long time.

DR GAV: And maybe a little bit longer than what we expect in different areas of the body. In Australia the products we are using, the collagen simulating dermal filler, is meant to only last two, to three, to four years (depending on the type that we use) but actually in reality, in the penis, it may be lasting a lot longer.

DR JAYSON: It’s an interesting thing because the kind of collagen that is stimulated has this half-life – meaning that half of it will break down over a period of what is apparently 15 years. So the collagen we make, half of it will still be there in 15 years. And you’ve got another 15 years and then half of it will be gone (so down to a quarter) which is a long time. Until last week, I’ve always said I’ve never seen a patient who has lost their penis augmentation from this collagen stimulatory filler. Had a guy call up last week (he had the two year product) it’s been two years and he thinks that he’s seeing a decrease in size. So we haven’t actually seen him yet, but that’s the first time I’ve ever had a patient sort of come back and say I need more volume. So I don’t know if you’ve ever seen anybody…

DR GAV: I’ve seen patients come along for a small top up because they want extra size…

DR JAYSON: They are always wanting extra size…

DR GAV: but not because of decreased volume, not with the college stimulating dermal filler. So I haven’t actually seen that yet, but it’s probably been about three years we’re talking about since we first started using that collegen stimulating dermal filler. So I guess most guys will be listening to this, and what they say to me is, if it’s lasting that long, why aren’t we going for that option every time? Why aren’t we using that.

DR JAYSON: As I was sort of saying, if you’ve got somebody who is extra intense about how their penis looks, and wants to ensure there’s not the slightest irregularity, or little bump or anything anywhere, then those guys are better off with the gel fillers. If that is going to drive them crazy (having a tiny little nodule etc) then it’s best to keep away from the stimulatory fillers because it is relying on your body to make the collagen and create that that volume. Although there are things that we can inject, and we can modify the collagen that’s being produced, it’s not to that same sort of extent. So if longevity is the guy’s main aim, then the stimulatory filler is good. It’s more expensive, as you know it’s a lot more expensive to buy from the suppliers than the gel fillers (and they’re expensive enough), but maybe on a on a cost per longevity sort of scale, the stimulatory fillers have that slight edge.

There’s a guy actually on the Phalloboards forum, and we’ll talk about Phalloboards as a resource for guys to go to (maybe some of the guys are coming here because they heard about our show on Phalloboards) but yeah, there’s a ‘member’ (excuse the pun) who did it almost four years ago. Every so often people are sending him messages and asking – How’s it going? Has it changed? and it’s getting close to four years now and he says that it hasn’t changed, it’s exactly the same as what it was four years ago. So, that’s one of the best feedbacks that I’ve had, because, as you know, you do a treatment and the guy is happy, he disappears and as long as he’s happy, you never see him again.

DR GAV: Exactly. So then the downsides, I guess for the collagen stimulating product would be in my eyes, is that it’s not fully reversible with a simple injection and the tune-ability. We can’t tune it and shape the penis in the case that there are any irregularities; the only option is really either adding more or waiting a long period of time until it dissolves. Then there is, as you briefly mentioned, where the stimulation of collagen can be so great in some areas that it can cause hardening of the tissue and what we call a nodule. For guys who are looking into this procedure, a nodule just feels like a lump of a harder area, and sometimes that can feel unnatural and guys worry about how that might feel to someone, their partner or someone who they have newly met and they don’t want someone to know that they’ve had a procedure done and that needs to be something that that they consider. There are other guys who have had areas of hardening with overstimulation of collagen who say when it’s erect, it doesn’t matter at all, and it actually makes it even better.

DR JAYSON: Yeah when it’s erect, it’s hard and I guess that’s another slight difference between the gel fillers and the stimulatory filler when you start getting into bigger volumes. So I did a guy today, and we’d done a Skype consult previously, he just sort of said I’ve got an average to small penis. Anyway, he dropped his pants and showed me and he had this great big, long, thick penis and I’m thinking, why do you want anything augmented with that? But he was obviously keen to go ahead.

But when guys are really starting to inject a lot of volume, say twenty to twenty five mls, and they’re using the gel filler, when it’s flaccid, sometimes they’ll feel that it’s a little bit soft and ‘gel-like’ but when it’s erect the penis is still as hard as ever, the skin is really tight because it’s now having to stretch around this much increased circumference. It could be four or five centimetres sort of bigger (maybe five centimetres when it’s flaccid and four centimetres when it’s erect). The skin is tight, but sometimes they can feel that that little bit of squish to the shaft of the penis with the HA filler. I personally have never had a patient who’s concerned about it, but certainly I’ve seen on the forums that guys get it into their head that HA gel fillers are going to be soft and squishy. Have you ever had a patient who’s been concerned about real squishiness?

DR GAV: Honestly probably one patient has come back and mentioned that it was not the kind of feeling he liked, but that’s one out of, who knows how many now, over a thousand.

DR JAYSON: Did he want to go back to the way he was?

DR GAV: No, not really.

DR JAYSON: Nobody wants to go smaller again, do they?

DR GAV: No, so he was willing to compromise. And look, guys have mentioned offhand, that yes, that maybe when it’s erect maybe they can feel the filler a little bit, but it doesn’t affect the sex, doesn’t affect the performance of their penis.

DR JAYSON: They’re much bigger and their partners sort of notice and appreciate it. We mentioned it before, I never expected that to be a benefit, I thought it was a locker room procedure and they come back and say, well, the wife likes that!

DR GAV: It was great feedback. So yeah, going back to the HA gel type filler versus the collagen stimulating type of fillers, there are pros and cons. I still basically use the gel filler as my main product I would say 90 percent of the time because of the safety profile, the reversibility, because it works and it does last a long time and guys are not getting top ups for a year, 18 months, two years. They’re coming for smaller top ups and it lasts a good amount of time. So they’re not needing something that lasts longer, then you do have some guys who really all they care about is longevity and really not wanting to come back and see us, really ever again.

DR JAYSON: Dr Danh, who is the other Dick doctor here loves the collagen stimulators. So where I would probably do seventy five percent HA and twenty five per cent collagen stimulator, I think he does seventy five percent collagen stimulating filler and probably only twenty five percent with the HA gel fillers. He just really likes it, and when he explains the longevity benefits, he finds that the majority of his patients are happy and they go with that. So it’s sort of interesting and it may be one day that we’re all doing seventy five per cent of the stimulatory filler. Because it does last so long, we’ve been that little bit more conservative in how we adopt it and don’t want to rush in, because really this is still an experimental procedure, and we need to be very cautious with how we’re spreading it to the patients and making sure that we’re giving them the safest sort of option all the time.

DR GAV: Exactly, and just with them understanding those options, often they will choose the safer option anyway.

DR JAYSON: Now of course there are other stimulatory fillers around the world that we don’t have here in Australia like PMMA.

DR GAV: Yep. Yeah, a very popular one I believe in Mexico.

DR JAYSON: Dr C at a clinic in Tijuana, Mexico, and the world authority in using PMMA as a penile augmentation injection therapy has probably done more penile augmentations than anybody in the world I would say, he loves PMMA. So PMMA, Polymethyl methacrylate, is acrylic Plexiglas basically. There’s a compound and it’s exactly the same as acrylic Plexiglas, but it’s made in a in a pharmaceutical laboratory, it’s sterile, it’s made to very, very precise and accurate dimensions and sterility, but it’s just not available here in Australia. We have had permanent stimulatory fillers here before, but the TGA, our drug regulatory body, has sort of clamped down on them and banned them because the complications that they were getting were too high, too frequent and too significant. But it would appear that now they’ve solved a lot of those sort of problems. The Tijuana clinic has done a lot of it, for many years and clearly just not getting the big problems. Certainly Phalloboards, where they talk about it a lot, there’s a lot of patients who have been there, had had it done and if they were getting significant problems from it I think we would have heard about it. There are other places in the world that you can get PMMA injected, and that could be Korea and Poland and various other places and with other doctors who clearly just don’t have the experience and the skill that Dr C has and I’ve seen some very worrying results from that, and the problem is that they’re permanent. Have you have you seen any PMMA patients yourself?

DR GAV: I have, yeah. I’ve seen a few and some really good results actually. Symmetry is great, the feeling of it great (a little bit harder in certain areas) similar to our collagen stimulating option here in Australia, but the guys have been really happy.

DR JAYSON: Were they done in Mexico.

DR GAV: Yes. Yes, they were. I think I may have been seeing them here, they were coming for the glans, just some glands augmentation with some of the HA gel filler. But I was quite impressed with the results and yeah, it certainly works. What I believe is that there’s different concentrations available of PMMA, and depending on the concentration you have, it depends how much augmentation you get and how long it lasts and all that kind of stuff.

DR JAYSON: It comes in a 10, 20 and 30 percent. So that means 10 percent of the volume that they’re injecting in, is these microspheres of the PMMA, and that has less stimulatory effect than the 20 percent and that’s got less than the 30 per cent. There’s perhaps a slight trade off in safety where you’re getting such a strong stimulation with the 30 percent that you’ve got a slightly increased risk of getting some nodules or harder sort of areas, so it’s easier to use the lower percentages. So 20 percent seems to be a really common sort of percentage to use, although every guy wants the 30 per cent and get the maximum augmentation of the penis that they can get in the shortest amount of time with the least amount of volume.

I’ve seen one guy who had it done in Korea. Unfortunately, his penis looked a bit like a condom filled with peanuts or something – lumps and bumps and stuff all over. That wasn’t so great and we tried various things; I tried injecting steroid into the to the nodules, but then you have to remember that inside that nodule, as well as being the scar tissue, is all these little balls of plastic. So we got some improvement, and then in the end, I did inject some filler around it and between the nodules to cover it. But it’s a worry when there’s a permanent filler in there, if you don’t have that perfect result, then you’ve got a permanent, imperfect result. And if it’s a little bit imperfect, maybe that’s not a problem, but if it’s a lot imperfect, if it looks terrible, then you’re talking serious surgery to get that out.

DR GAV: That’s right and I think that’s the important thing to understand, is that at the end of the day, if there’s something permanent in there that’s not dissolving any time soon, it is a surgical procedure to remove that, and you’re talking about cutting the penis open.

DR JAYSON: There there are some other permanent things that have been injected into the penis. Silicone is one, and just for DON’T LET ANYBODY INJECT SILICONE INTO YOUR PENIS, that’s not a good idea. People have gotten away with it over short periods of time. It was used in the face back in the fifties and sixties, and sure, there are some people who are really good at it, in what they call micro droplet technique, putting tiny, tiny sort of drops spread out. But the problem is, when it goes wrong, and it could be a decade later, 20 years later, it’s just a nightmare. I’ve never had to cut silicone out of a penis, but I’ve cut it out of the face a number of times, and it’s woven into the tissues, you’ve got scar tissue around it, the skin over the top is abnormal and you have to excise the skin as well. Silicon and the penis, just a no go!

DR GAV: Yeah, it’s really good advice. There’s also been in Australia as well, the fat grafting around the penis.

DR JAYSON: Yeah. So I haven’t seen as much of that. It certainly sounds a little bit more plausible and it can actually be done as what we call a pedicle graft now. They used to take the strip of skin and fat from the crease underneath your butt, what is called the infragluteal crease, and you can take a slice of skin out but you end up with a scar underneath your buttocks. You don’t really see it and that’s why they chose that sort of spot. But then it’s a free graft, so you’re taking it totally detached from the body, they shave it down relatively thin and stitch it and have got to peel the whole skin of the penis off. They make an incision around the glans, peel the skin right down to the base, put these strips of dermal fat on, stitched onto the penis, and then pull the skin up and close it around. Sometimes worked quite well, but they can get fibrosis and scarring and tightening and they could get loss of length doing that, some guys would get a bit firm and fibrotic in there. So I think that the current technique is more using the skin and the fat from the abdomen, swinging it down and having as a pedicle, so it’s still got its blood supply, less chance of the fat sort of dying and having hopefully less of the scarring sort of issues.

DR GAV: But it sounds like obviously a lot more invasive procedure with a lot more downtime.

DR JAYSON: Oh, yeah. I see that was one of the main things when we were developing CALIBRE, I wanted something that’s walk-in, walk-out, nobody needs to know about, you’re back up in action in a short time, as in like back to having sex. Those were the sort of things that when we were developing the procedure were really important because sure, there was options of surgery with big down time, big risk, big scars, and maybe we’ll talk about that in our next videos about what the options are for length and surgery and those sorts of things. But, yeah, the whole idea was cosmetic medicine had moved into that minimally invasive sort of realm and we were doing so much with injectable fillers, mainly for women, and we wanted to see if we could develop that for men. And that’s where the CALIBRE procedure came from.

DR GAV: Beautiful, it’s a big round circle, we’ve come back to CALIBRE and our procedure, so think it’s a great place to maybe end this episode.

DR JAYSON: Great talking to you, Dr Gav.

DR GAV: As always, we could talk for hours about these topics, but we probably have to stop. But thanks for joining us and thanks for having me, Doctor Jayson. Don’t forget, guys, confidence changes everything. And it’s been the dick doctors here. I’m Dr. Gav and Dr. Jayson Oates with me today and it was great chatting to everyone and we hope to speak to you soon.

DR JAYSON: Bye everybody.

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