January 12, 2012

 I am inquiring about penis lengthening. I’ve done some research I’ve read some good things and some bad things. What concerns me most is

1. Erectile dysfunction – I certainly don’t wanna have a problem with that after the surgery. I don’t wanna solve a size problem but get another problem.

2. The before and after pics look great, but I read that the lengthening really only makes a difference in the flaccid state, and that an erection won’t be directed upwards anymore but towards the floor.

So my questions are : what are the chances of me having to take Viagra after the surgery to have an erection, will my erection point to the floor, and how much does this cost?

Ramsey

January 12, 2012

Good afternoon Ramsey,

Thank you for your interest in what we do.  Dr. Whitehead is retiring and referred your inquiry to our office.  My phalloplasty experience dates back to1986 and includes several thousand procedures.

Lengthening results are in the erect as well as flaccid stage, and penises go up pretty as a before, but are more deflectable.

So the standing joke is if you can hang 2 wet towels on our penis now without any deviation, after surgery plan on only one wet towel. The root of the penis is attached to the underside of the pubic bone which causes its typical elevation.  In surgery, only a portion of the suspensory ligament is released, the proximal portion is not disturbed.

In our experience with perhaps 2500 cases, only one reported some erectile impairment, and when referred to a specialist for evaluaion, he felt my operation did not cause this.  This singular incident occured about 10 or more years ago.

Please review our website http://www.penisdoctor.com/  for te answers to many commonly asked questions.  Our fees
are also published there.

After reading the attached, if you believe I am the doctor for you, please initiate a consultation over the phone with our office by sending us your name, address, and telephone number in an envelope along with a check for 250.  We’ll
get started ASAP.  We’ll have a lot to talk about.

Cordially,

Harold M. Reed, M.D.
Phalloplasty Services
1111 Kane Concourse, Suite # 311
Bay Harbor Islands, Florida 33154
305-865-2000

December 1, 2011

I am not abe to get an erection for any length of time. I find when I’m with a hot woman taht i can not even get hard.  Roland

December 1, 2011

Good morning Roland,

Thank you for your interest in what we do.  Please consider
non-operative measures first.  We can advise during your
consultation .

After reading the attached, if you believe I am the doctor
for you, please initiate a consultation over the phone with our office
by sending us your name, address, and telephone number
in an envelope along with a check for 250.  We’ll
get started ASAP.  We’ll have a lot to talk about.

Cordially,

Harold M. Reed
1111 Kane Concourse, Suite # 311
Bay Harbor Islands, Florida 33154
305-865-2000

Then the cost of each dose or injection depends on the unique volume for you.  For example one vial might be good for 10 or 15 injections and the cost could be 150 to 250 dollars. After all is said and done, the cost per injection might compare very similarly to the cost of one Viagra tablet which had been selling for about $12 +/-.

Please do not be your own doctor, as this is serious stuff.

Sincerely,

Harold M. Reed, M.D.

Personally I do not think tri-mix is necessary as bi-mix usually does it, if you are a responder. The concentrations may also vary. More important is to be dose-regulated by a knowledgeable physician who will show you proper injection technique. Can’t tell you how important that is. The sky is not the limit as over-dosage can have very serious consequences including priapism (sustained erection without sexual desire) with possible loss of any residual erectile function and a cardio-vascular event. Not a toy.

Best to you,

Harold M. Reed, M.D.

— In PROCIRCORG@yahoogroups.com:
>
>
> What is the cost of tri-mix ?
>

Taken from a web-site of a purveyor…

Intracavernosal Injection
An intracavernous injection, according to the American Urologic
Association, is the most effective non-surgical treatment for ED.
Injections into the penis, unlike oral medications, trigger an automatic
erection. Injection can be done by the individual 5 minutes prior to
sexual activity and should last for no more than 1 hour. Injection is
considered second line to be used if oral therapy fails. Compounds that
can be injected include alprostadil, papaverine, and phentolamine.
Alprostadil and phentolamine are the most common agents used as
monotherapy. However, combination therapies are used to increase
efficacy and decrease side effects. Combination therapy includes Tri-Mix
and Bi-Mix. Both products are not commercially available and must be
compounded by specialty pharmacies. Below is a description of the
medications that are in Tri-Mix and Bi-Mix including mechanism, dose and
side effects of each agent.

Alprostodil
- Commercially available for monotherapy as Caverject® and
Edex®
- Mechanism: a prostaglandin E1 that stimulates the relaxation of
the smooth muscle and dilates arteries in the penis increasing blood
flow
- Studies have shown efficacy in 75% of men when injected into the
penis
- Usual dose: start at 10-15 mcg in patients who have failed oral
therapy or 2.5-5 mcg in patients who have neurogenic or psychogenic ED
and have failed or declined oral therapy
- Median dose is 12-15 mcg. Benefit is not seen at doses greater
than 40mcg. It is recommended to try a drug combination that includes
papaverine, phentolamine or both.
- Side Effects
o Priapism: prolonged erection lasting more than 4 hours- must seek
medical attention
o Penile pain- during or immediately after injection, occurs in up to
31%, may be reduced if mixed with other agents
o Bruising at injection site- can be minimized with a 30G needle,
should be minimal with proper injection technique
o Hypotension- occurs when drug leaks out of injected area into
general circulation. Rare with alprostadil.
o Fibrosis- scaring of penile tissue is lower with alprostadil, may
result after long term use of injection therapy
o Occasional increase in liver function tests

Phentolamine
- Commercially available as Regitine®
- Mechanism: alpha-adrenergic antagonist that produces a direct
vasodilation in the arteries increasing blood flow to the penis.
- Usual Dose: 1 to 2 mg
- Side Effects
o Painful prolonged erection lasting more than 4 hours
o Fibrosis- penile scaring
o Systemic hypotension (low blood pressure)
o Reflex tachycardia (increase in heart rate)
o Nasal congestion
o Gastrointestinal upset

Papaverine
- Not commercially available and must be used with phentolamine to
produce hard erections.
- Mechanism: Phosphodiesterase inhibitor that results in smooth
muscle relaxation allowing for an increase in blood flow to the penis.
It’s used mainly in combination with alprostadil and/or
phentolamine. Although it has been used since the early 1980′s, it
is not approved for ED.
- Usual dose ranges from 5 to 30mg
- Side effects
o Priapism- high rate of 1-6%
o Fibrosis- highest rate and can present as a lump within the penis
o Hypotension

Combination Therapy

Bi-Mix: Papaverine + Phentolamine
Bi-Mix was first introduced by a study in 1985 that showed a success
rate of 71% amongst 250 patients that were given 1mg of phentolamine
mixed with 30mg of papaverine. In 1987, 2 more studies were published.
One study showed that phentolamine mixed with papaverine had a 72.9%
success rate verse 20% with papaverine alone. In another study,
papaverine mixed with phentolamine was examined for a follow up of 26
months. Only 13% of the patients failed to respond to therapy.

Click Here For Study Information
<http://trimixinjection.com/erectile_dysfunction_studies.html?ordinalpos\
=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_Default\
ReportPanel.Pubmed_RVDocSum>
<http://0-www.ncbi.nlm.nih.gov.catalog.llu.edu/sites/entrez;%20http://ww\
w.ncbi.nlm.nih.gov.catalog.llu.edu/pubmed/8399501?ordinalpos=3&itool=Ent\
rezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.\
Pubmed_RVDocSu>

- Usual prescribed strength: Papaverine 6-25mg + Phentolamine
0.05-2.0mg/ml

Tri-Mix: Papaverine, Phentolamine, Alprostadil
Tri-Mix is a compounded medication the combine’s papaverine,
phentolamine and alprostadil in one vial to achieve maximum efficacy,
lower incidence of pain, and lower cost per dose. Studies have been done
that have shown the efficacy of all three agents combined into one
formulation. Combination therapy was first introduced in 1991 by Bennett
and his colleagues who demonstrated a success rate of TriMix of 92% in
116 patients. Tri-Mix is often reserved for patients who fail
alprostadil (PGE-1), fail Bi-Mix or for patients with severe penile pain
from prostaglandin E1. Since Tri-Mix uses lower doses of alprostadil,
penile pain often subsides.

Click Here For Study Information
<http://trimixinjection.com/erectile_dysfunction_studies.html>

- Usual prescribed strength: Papaverine 18-25mg + Phentolamine
1.0-2.0mg + Prostaglandin E1 10-25mcg/ml

Quad-Mix: Papaverine, Phentolamine, Alprostadil, Atropine
Quad-Mix includes the addition of atropine which may work
synergistically to cause smooth muscle relaxation in the penis. In a
study conducted by Israilov and colleagues, 13 patients that failed
tri-mix had a positive response to quad-mix. Seven (53.8%) of the
patients responded successfully with the addition of atropine.

So the article says it may help. MAY.

However, 90% or more of patients with ED have 2 problems that a stent cannot overcome. One is corporal fibrosis. The spongy tissue is scarified. Secondly the problem is not reduced arterial inflow, the problem is venous leakage which is a colloquialism meaning the blood is returning to the central venous circulation as fast as it is coming in. So the patient cannot retain sufficient blood volume to produce and sustain an erection. That is why in my opinion, stents will have limited usage.

Next if any of you have access to any scientific articles, we have to see the selection process. That is out of all comers with ED (yes a medical phrase) how many receive the stent, and also the followup period because ED is usually a process in evolution. So you may be King for a few months, but ultimately the same physiologic aging process continues and ultimately you’ll back to square one. My bias anyway.

Harold M. Reed, MD.

 I know this is a bit off subject, but many men have ED and might be
interested in your opinion.
>
> Somebody on another Yahoo group mentioned that there is a stent for
the penile artery that can cure some cases of ED. I looked further, and
found that there is a doctor right in Miami who is advertizing this
treatment.
>
> Is this a reasonable treatment, with a good chance of success and no
serious side effects?

A study released Wednesday found the Medtronic stent is safe and
improves erectile function in men who don’t respond to drugs like
Viagra, Levitra and Cialis.

The clinical trial is the first to test stents for treating impotence in
men who don’t respond to drug therapy, researchers said.

The stent — a tiny wire mesh tube similar to those used to prop open
heart arteries — was based on technology developed in Santa Rosa,
where Medtronic has 840 employees.

Investigators implanted stents in 30 men, with an average age of 60, who
suffered from erectile dysfunction caused by narrowed arteries in the
pelvis. There were no safety problems such as clots or the need for
repeat surgery one month after treatment in the study, which was funded
by Minneapolis-based Medtronic. The men reported a 68 percent
improvement in erectile function three months later.

“Achieving a good erection requires a variety of vascular components
to work well, including a good flow of blood to the penis through the
arteries,” said Jason Rogers, director of interventional cardiology
at the University of California Davis Medical Center in Sacramento.

While drugs like Viagra relax the spongy tissue to allow the blood to
enter, “if you don’t have good inflow into the penis, it doesn’t
matter how much that tissue relaxes, you don’t have a good
erection,” he said.

Thirty million men in the United States and more than 300 million
worldwide suffer from erectile dysfunction. The majority of the cases
stem from vascular problems, including insufficient blood from the
arteries, studies show.

The study was released at the annual meeting for Vascular Interventional
Advances in Las Vegas.

Bloomberg News contributed to this report
Medtronic stent may help erectile dysfunction when drugs fail
<http://www.pressdemocrat.com/article/20111020/articles/www.pressdemocra\
t.com/article/20111020/articles/111029965> STAFF AND WIRE REPORT
[http://www.pressdemocrat.com/] PressDemocrat.com
<http://www.pressdemocrat.com/article/20111020/articles/www.pressdemocra\
t.com> October 20, 2011 2:53 PM <p>A drug-coated stent developed in
Sonoma County by Medtronic Inc. to unclog arteries may provide doctors
with a new way to treat erectile dysfunction.</p><p>A study released
Wednesday found the Medtronic stent is safe and improves erectile
function in men who don’t respond to drugs like Viagra, Levitra and
Cialis.</p><p>The clinical trial is the first to test stents for
treating impotence in men who don’t respond to drug therapy, researchers
said.</p><p>The stent — a tiny wire mesh tube similar to those used
to prop open heart arteries — was based on technology developed in
Santa Rosa, where Medtronic has 840 employees.</p><p>Investigators
implanted stents in 30 men, with an average age of 60, who suffered from
erectile dysfunction caused by narrowed arteries in the pelvis. There
were no safety problems such as clots or the need for repeat surgery one
month after treatment in the study, which was funded by
Minneapolis-based Medtronic. The men reported a 68 percent improvement
in erectile function three months later.</p><p>”Achieving a good
erection requires a variety of vascular components to work well,
including a good flow of blood to the penis through the arteries,”
said Jason Rogers, director of interventional cardiology at the
University of California Davis Medical Center in Sacramento.</p><p>While
drugs like Viagra relax the spongy tissue to allow the blood to enter,
“if you don’t have good inflow into the penis, it doesn’t matter how
much that tissue relaxes, you don’t have a good erection,” he
said.</p><p>Thirty million men in the United States and more than 300
million worldwide suffer from erectile dysfunction. The majority of the
cases stem from vascular problems, including insufficient blood from the
arteries, studies show.</p><p>The study was released at the annual
meeting for Vascular Interventional Advances in Las
Vegas.</p><p>Bloomberg News contributed to this report</p>Copyright 2011
PressDemocrat.com – All rights reserved. Restricted use only.
<http://www.pressdemocrat.com/article/20111020/articles/111029965#licens\
e-43929ECB-422F-40B2-A883-9E6BEBF8A9E7>
[http://analytics.apnewsregistry.com/analytics/v2/image.svc/SR/RWS/www.p\
ressdemocrat.com/CAI/111029965/CVI/11102996520111020/MAI/43929ECB-422F-4\
0B2-A883-9E6BEBF8A9E7/E/prod/PC/Premium/AT/A]
— In PROCIRCORG@yahoogroups.com, “headout2000″ <halfshekel@…> wrote:
>
>

August 14, 2011

I am  Dr M. Gustafson , surgeon  from Denmark. I treat patient with impotence causes   injection of hyaluronic  acid ( Macrolane  ) into corpora cavernosa   for 18 months  during procedure of penis augmentation. The hyaluronic acid is still visible in ultrasound examination and there is no blood flow in corpora cavernosa.

Good morning Dr. Gustafson,

Do You know such causes, can You suggest what kind of threatment  should I use?

Injecting fillers into the corpora to produce girth enhancement is a big “no, no” and this may predictably lead to erectile dysfunction.  To the best of my knowledge there are no reports of a specific remedy, but plastic surgeons will treat hyaluronic acid overfill with hyaluronidase.  Over time the body will also break this down based upon general experience in other areas of the body.

For this man’s poor penis all this is very experimental.  Be sure you are properly consented, as patients may attribute a bad outcome to the last doctor who touched them, not necessarily the first who truly caused the problem.

Macrolane is larger particle size than Restylane and can be associated with capsulization and lumps (known to occur in the breast)  In the breast, one English plastic surgeon noted “happiness with result occurred in only 50%.   See http://www.youtube.com/watch?v=-TdX5iLdv5M

To help your patient, a trial of PD-E 5 inhibitors such as a Viagra, or Cialis taken nightly may be therapeutic.  Would be of interest to do a nocturnal penile tumescent study to see if any erectile activity and of course, some here along the way a color coded duplex Doppler ultrasound, to document what you have taken on board.  If no success with oral meds, perhaps some bi-mix intracorporally done at your office initially may help jump start the injured corpora.

Cordially,

Harold M. Reed, M.D.
305-865-2000

Hyaluronidase
38%
18 reviews
Worth It Rating Our index shows the percentage of community members saying this was “Worth it”. See cosmetic treatment rankings
Hyaluronidase Cost $600 average cost
Write a review | Ask a Question

• Reviews
• Q&A
• Find a Doctor

Hyaluronidase – for Overfilled Restylane?

Had 1cc of Restlane injected into one side of my face 2 months ago and now that side of my face looks very different from the other side. Too full/ face looks uneven. I don’t want any more Restylane – considering Hyaluronidase. What are the risks? I am concerned by the MANY negative reviews of blistering, allergic reactions, that the skin looks much worse after. If hyaluronidase eliminates the Restalyne and my own hylaronic acid- how do I know the normal contours of my face will return?
Asked 5 months ago by CS122
Tags:
face overfilled risk uneven worried
Sort 4 expert answers by: Votes Date
+1

Hyaluronidase is great for adjusting Restylane

I agree with Dr. Kabaker and Biesman. I have also used hyaluronidase in thousands of procedures over the past 20 year.  It is very effective and rarely causes problems. The body makes its own hyaluronic acid very quickly so your natural hyaluronic acid is replaced and returns to normal.  There are however some people who have an allergy to hyaluronidase.  This can cause swelling, but is very unlikely to be a serious problem. Hope this is helpful. more
 
Marc Cohen, MD
Philadelphia Oculoplastic Surgeon
+1

Hyaluronidase is safe

I use hyaluronidase on a regular basis to treat patients referred to me for correction of poorly done HA fillers (restylane, juvederm, perlane).  I have never seen a problem or serious adverse event despite having administered this drug literally thousands of times for various reasons.  
 
Brian Biesman, MD
Nashville Oculoplastic Surgeon
+1

Hyaluronidase commonly used without problems

There always is some risk with any medical procedure, but hyaluronidase has been added to local anesthetic for decades, by oculoplastic surgeons and some plastic surgeons to make the local anesthetic during elective cosmetic eyelifts (blepharoplasties) spread more readily requiring less needles and less fluid, therefore, less swelling.  If someone is allergic to beestings, they should mention this to the doctor and avoid hyaluronidase.  I have not seen, nor heard from medical… more
 
Ronald Shelton, MD
Manhattan Dermatologist
+1

Use of hyaluronidase

I have used Hyaluronidase in the majority of my facial plastic surgery procedures since the 1970′s . It allows me to have very little swelling from the local anesthetic present while I am working. Therefore I feel I can be more precise in adjustments I make during rhinoplasty, blepharoplasties, facial implants  or face-lifting operations. I have never seen a problem related to Hyaluronidase other than the local anesthetic

July 23, 2011

I had an initial consultation w/ a urologist. re. penile injections. What is your view on this. I was given a mix of drugs and gained an erection the likes that I haven’t seen in years. Before I spend the money 1000.00 for a yearly supply, what is your opinion?  Mark

Good morning Mark,

Thank you for your interest in what we do.

I have a great interest in erectile function and all
the conservative ways (non-operative) to achieve that.

After reading the attached, if you believe I am the doctor
for you, please initiate a consultation over the phone with our office
by sending us your name, address, and telephone number
in an envelope along with a check for 250. We’ll
get started ASAP. We’ll have a lot to talk about.

Cordially,

Harold M. Reed
1111 Kane Concourse, Suite # 311
Bay Harbor Islands, Florida 33154
305-865-2000