May 5, 2012

Good morning Stan,

In medical school and residency there are many sayings you acquire that forms a basis of instruction and guidance on how to practice medicine.  One is “don’t be the first of the last doctor to try something new.”

PMMA is FDA approved for use in the hip joint to fasten a  hip prosthesis to the bone (like Duco Cement, if you will).   It does not have specific FDA approval to be used as micro particles in the penis, as far as I know, but the application can be extended.  So this makes it very experimental.  It is an FDA approved filler and sold as Artefill.

Could be the greatest thing since sliced bread, but as a rule US doctors may be more cautious, for medical legal reasons.   I had been receiving about one letter about every 3 weeks from gents like you, and could only say what I mentioned above, until in the past 2 months, we have had 2 patients say, all did not go well, and one patient’s chart about 1 and 1/2 inch thick, copies of records form another doctor  are on my credenza top for review this weekend (what went wrong?).

I do have a lot of confidence in AlloDerm.  Any injectable product (see silicone disasters on our web-site) has the propensity for settling in planes of least tissue resistance.  Despite manual molding in the operating room.   What happens when you turn your back on the patient for the next 24 hours is key.  So I would not be cautiously optimistic about PMMA, just plain super cautious (read wary).

Sincerely and have a restful weekend,

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

More on PMMA….  (from another web-site)

PMMA (polymethyl-methacrylate) fillers contain about 20 percent of tiny PMMA microspheres that are suspended in 80 percent of purified collagen gel. A few months after it is injected, the collagen gel breaks down and your body produces its own natural collagen to fill out the space under the skin.

This type of dermal filler is considered semi-permanent, and is most often used to treat medium-to-deep wrinkles, folds and furrows, particularly nasolabial folds. It can also be used to fill out pitted scars and to augment thin lips.

When a more permanent solution to facial wrinkles is desired, PMMA is often used instead of collagen replacement therapy or hyaluronic therapy. PMMA has been used for many years in permanent surgical implants. Because of this, your surgeon will likely under-fill on the first treatment, adding more later if needed.

One of the downsides of PMMA is that a number of injections are needed to create volume and it can take up to three months to realize the full effects. It may also be visible under the skin. To avoid any unwanted results, it’s key that your plastic surgeon is familiar with the proper technique, which involves injection at the dermal subcutaneous junction using threading or tunneling methods.

PMMA, properly delivered, offers long-lasting results.

The only brand of PMMA that’s FDA approved is Artefill.

PMMA injections are sometimes performed with no medical oversight, often in conjunction with facial spa treatments. You can avoid any risks or complications and achieve optimal results by visiting a qualified plastic surgeon. Although the surgeon may not perform the procedure, you can rest assured that the surgeon’s employees are properly trained and supervised.

May 5, 2012

Good morning Phillip,

Thank you for your in interest in what we do.

While no surgeon can give you an iron clad guarantee, fair to say in 2000 cases of penile lengthening, only one patient complained of some erectile impairment versus pre-op, and the patient was sent to a University based specialist in Boston for an independent opinion.  After further testing, the urologist concluded, my surgery did not cause his partial impairment.

Have a restful weekend,

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

Hi Dr Reed if I want both procedures, the lengthening and widening do you still charge the same as I have to travel from UK to USA twice as you recommend the procedure to be separated.

And so would you consider a slight discount to take into account my travel.

Adan,

Good afternoon Adan,

Thank you for your interest in what we do.  Yes, the procedures should be separated.  Do not have girth until you are happy with your length result.  Then I will place in an appropriately longer graft.

Your discount comes in when your return for lengthening and we can take 10% off.

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 300.  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

April 15, 2012

Good afternoon Mrs. Stirbridge,

Based upon what you are telling me, a circumcision is indicated for extreme phimosis.   There are conservative medical treatments but if your son cannot practice daily hygiene, why bother.

Chances are his glans is also chronically inflamed, balano-posthitis.   Sure there are risks involved in any surgery, but a board certified urologist should know exactly what to do and what not to do.   I wish your son the best.  I know if he had appendicitis you wouldn’t think twice.

Sincerely,

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

April 15, 2012
Good morning Eduardo,
Thank you for your interest in what we do.  Your p.nis is one of the most important functional and cosmetic features of your body.  A diabetic in good control no problem.  What has been your glycosolated  hemoglobin A1C?
We have performed over 6500 cosmetic circumcisions and revisions in the past 35 years and usually do several cases every week.

We have done sons of physicians, brothers, religious circumcisions, men who have not seen the heads of their penis for 20 years! This is your circumcision and we do it the way you want with respect
to 4 parameters.

Please don’t be like the patient who writes: “Dr. Reed I just got circumcised (elsewhere) two days ago, and my result was not what i expected. I was  wondering when i recover can i get a consultation with you.”   Photos sent and received.  Unspoken comment: “disaster zone.”

Be assured we will show you every courtesy,

All the best and have a blessed Sunday,

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

Good morning Flavio,

Please review the attached.  We cannot perform circumcision and penile lengthening simultaneously as you need to apply traction within
a few days after penile lengthening.  A lengthening result is 65% you  (with traction) and 35% me (partial release of the suspensory ligament).  If you apply traction too early, you’ll open your circumcision incision.

You may wish to make an appointment at the office for consultation as there is a lot of information we need to put out to you and surely many questions and concerns you will have.

Have a restful Good Friday and Easter weekend,

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

I see,  then I’m confused,  I thought the Acell product was Extracellular matrix derived from pig bladders, is that not right?
I notice you said you would contact this man Monday.  Are the any new developments to speak of? Sorry if I’m pestering you, Im just feeling anxious I guess, this is all very exciting as You might imagine.
Corey

April 6, 2012

Good morning Corey,

Acell is an extra cellular matrix and comes in sheets or powdered (pulverized) version.  As opposed to AlloDerm which is a decellularized matrix and used as a tissue scaffold for new cell growth, Acell’s value is not as a tissue scaffold but as a resource for stimulation of your progenitor system.  This encourages new cell growth.   Please confer directly with Acell technical support for more detailed answers.

Our patient continues to heal well, but is way too early to speculate on the final outcome.  However, thus far, no set backs.

Below is some general information on extracellular matrix.

Cordially,

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

Extracellular matrix

From Wikipedia, the free encyclopedia
Jump to: navigation,search
Extracellular matrix

Illustration depicting extracellular matrix (basement membrane and interstitial matrix) in relation to epithelium, endothelium and connective tissue
Latinmatrix extracellularis
CodeTH H2.00.03.0.02001
In biology, the extracellular matrix (ECM) is the extracellular part of animal tissue that usually provides structural support to the animal cells in addition to performing various other important functions. The extracellular matrix is the defining feature of connective tissue in animals.
Extracellular matrix includes the interstitial matrix and the basement membrane.^[1] Interstitial matrix is present between various animal cells (i.e., in the intercellular spaces). Gels of polysaccharides and fibrous proteins fill the interstitial space and act as a compression buffer against the stress placed on the ECM.^[2] Basement membranes are sheet-like depositions of ECM on which various epithelialcells rest.

Contents

[hide]

• 1 Role and importance
• 2 Molecular components
  • 2.1 Proteoglycans
    • 2.1.1 Heparan sulfate
    • 2.1.2 Chondroitin sulfate
    • 2.1.3 Keratan sulfate
  • 2.2 Non-proteoglycan polysaccharide
    • 2.2.1 Hyaluronic acid
  • 2.3 Fibers
    • 2.3.1 Collagen
    • 2.3.2 Elastin
  • 2.4 Other
    • 2.4.1 Fibronectin
    • 2.4.2 Laminin
• 3 Cell adhesion to the ECM
• 4 Cell types involved in ECM formation
• 5 Extracellular matrix in plants
• 6 Medical Applications
• 7 References
• 8 External links

[edit] Role and importance

Due to its diverse nature and composition, the ECM can serve many functions, such as providing support, segregating tissues from one another, and regulating intercellular communication. The ECM regulates a cell’s dynamic behavior. In addition, it sequesters a wide range of cellular growth factors, and acts as a local depot for them.^[1] Changes in physiological conditions can trigger protease activities that cause local release of such depots. This allows the rapid and local growth factor-mediated activation of cellular functions, without de novo synthesis.
Formation of the extracellular matrix is essential for processes like growth, wound healing and fibrosis.

Dr. I am a biological male who underwent a bilateral masectomy several years ago to correct gynocomastia. I have scaring and areolic depressions. I am interested in reconstructive surgery

Marcel

April 1, 2012

Good morning Marcel,

Always a nubbin of tissue must be left under each areola (this is normal for men), and some fat must be left under all skin as this is the under-padding that makes an expensive carpet lie flat (same for skin).

Please send some well focused photos: face on, sideways (laterals), and even leaning over.

Sincerely,

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

Dear doctor,

I was reading your website with interest but I’m a little confused about some things:

1) my penis is almost 7 inches when erect but was considering the lengthening procedure to possibly get another inch. will this be realistic?
2) when erect, my penis is a straight line and if I am standing, it will be 90 degrees to my body. I have heard that the lengthening procedure affects the anchoring and the penis will be weaker and point down a little lower. Is this true?
3) there seems to be several thickening procedures (alloderm, belladerm, dermal-fat grafts ) What are the differences between them in terms of longevity, maintaining sensation and evenness. I have heard about fat injection. is this another procedure? Is the girth negated when the penis is erect or does it add to the erect penis?
4) is it right that the girth procedure is more pleasurable to a woman than the lengthening?
5) is it possible to get post op patent testimonials, references or discussion forum?

Many thanks

Adail

March 31, 2012

Good morning Adail,

I would not recommend you have a lengthening procedure done as your stats are already well above normal.  You can rest on your laurels.

Our preference is for AlloDerm.  Once you become an established patient we can go into detail.

Cannot respond to what is most pleasurable to a woman, but can tell you a recent article shows women have deep receptors and length will provide pleasure in that area.

Girth and clitoral stimulation has always been acknowledged as part of the female orgasmic process.

You are welcome to post a question on our blog and see who replies.

HIPAA laws prevent me from revealing our patients’ contact information.

Sincerely,

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

Dear Dr. Reed,

I understand that the suspensory ligament is detached from the pelvic bone to help pull the portion of the penis out. Once that is done, do you reattach the suspense ligament? There’s a urologist that reattaches it, just wanted to be sure you do the same.

Secondly, after doing the lengthening and the girth with alloderm or Belladerm, how will it reflect recover/post op exercises for lengthening?

Thirdly, how is sensitivity of the penile shaft after the girth process and can any strange displacement occur if the penis were to be grabbed and squeezed?

Thank you for your time and I look foward to the possibility of scheduling the procedure soon. 

Bradley

March 31, 2012

Good morning  Bradley,

Once you become an established patient by sending in your consultation fee there is a lot more information I can provide about others.

Q.  I understand that the suspensory ligament is detached from the pelvic bone to help pull a portion of the penis out. Once that is done, do you reattach the suspense ligament? There’s a urologist that reattaches it,  just wanted to be sure you do the same.

A.  I do not know of any doctor who completely detaches the suspensory ligament from the pubic bone lest you have a free floating penis, and with great risks to your neuro-vascular bundle as well.

Once at a certain depth of release is accomplished, just that portion which retains the penis in an arched position under the central pubic area, further release will provide no more added length, and will promote penile instability.  We do not reattach nor put in artificial spacers.  We do bring the loose fibroareolar tissue from side to side to find in that space so your penis will not reattach, which would accomplish absolutely nothing.

Think this way, although the cardboard on the back of a canary yellow pad is not glued fully to the sheet above.  If you lifted the sheet from the back without tearing it off, would the sheet be any longer.

Q.  Secondly, after doing the lengthening and the girth with AlloDerm or BellaDerm, how will it reflect recover/post op exercises for lengthening?

A.  We do not perform girth and lengthening together.  Only have girth once you are happy with your length result.  Once you are, even if you are not opting for girth enhancement there is no maintenance required as the length gain is predicated upon new cell growth.

Q. Thirdly, how is sensitivity of the penile shaft after the girth process and can any strange displacement occur if the penis were to be grabbed and squeezed?

A. While this is a theoretical concern, in our experience this has never happened in over 2000  cases.
This is an operation above the penis, not on the penis.

Sincerely,

Harold M. Reed, M.D.