Penis enlargement filler materials: fat, decellularized allogeneic dermis, hyaluronic acid and Penuma?Which one is better? At present, the materials that are recognized worldwide for penile enlargement include autologous fat, decellularized allogeneic dermis, hyaluronic acid and Penuma. Autologous fat transplantation Autologous fat is a good material for penile enlargement, and its advantages include convenient extraction, no additional cost, no allergic and rejection reactions because it is its own tissue, harmonious and natural penile shape after injection, easy to shape after surgery, etc. The advantages include easy access to the material, no allergic reactions and no allergic rejection. However, everything is not perfect, and there are inevitable defects of autologous fat filling. First, the survival rate after fat transplantation is low, about 30% according to current clinical statistics, and in order to achieve satisfactory results, multiple supplemental injections are needed (for penile enlargement, personal experience is 3-4 times); second, the operation takes a long time. Since the surgery includes two major steps, liposuction and fat injection, it takes a long time; thirdly, there will be some pain after the surgery. The penis enlargement surgery requires 15-20ml of autologous fat injection each time, usually from the lower abdomen of the candidate. Although anesthetic drugs will be injected at the aspiration site, friends with a low pain threshold will still feel more obvious pain during the surgery; fourth, post-operative care is relatively tedious. Especially for the liposuction site, it should be kept clean and dry, and the shaping band should be applied to compress it. Due to the poor permeability of the shaping band, fat aspiration is not suitable in summer; fifth, fat tissue is softer than other filling materials and may not meet the expectations of some men for penile hardness. Hyaluronic acid Hyaluronic acid (hyaluronicacid), also known as hyaluronic acid and vitellogenic acid, is a glycosaminoglycan composed of the basic structure of disaccharides (D-glucuronide and N-acetylglucosamine). As an acidic mucopolysaccharide, hyaluronic acid is one of the main components of the extracellular matrix and is widely found in the connective tissue, epithelial tissue and nerve tissue of the human body. The main advantages of hyaluronic acid for penile enlargement include: short procedure time, minimal trauma, almost painless injection, rapid recovery around the procedure, etc. The main disadvantage is that hyaluronic acid will eventually be completely metabolized by the body, therefore, in order to maintain a satisfactory penile shape, it is necessary to repeat the injection periodically, and the cumulative cost may be higher than that of fat fillers, which requires better treatment compliance in the long run. Humanacellulardermalmatrix (HADM) is taken from healthy donor skin tissue, and through the process of removing the epidermis and decellularization, the extracellular matrix with the same structure as human tissue is preserved intact. In recent years, HADM has been widely used for penile enlargement surgery and has achieved more satisfactory results. In 2004, the Chinese Journal of Plastic Surgery on “Application of decellularized allogeneic dermis implanted under Bucks fascia to enlarge the penis” HADM for penile enlargement has the following advantages: First, it does not contain allogeneic antigenic components, has good histocompatibility, no immune rejection after implantation, safe and reliable; Second, HADM can provide an ideal environment and place for host tissue cells to multiply, and can also Third, the main components of HADM are collagen and matrix protein, which have a certain tissue volume and volume, and the absorption rate is relatively low (about 15%-20% in long-term follow-up), and the effect of thickening is relatively long-lasting, and the literature reports that the average circumference of the penis can be thickened by 2.5-3.0cm. HADM is generally smaller than the long axis of the penis, so the area not covered by HADM will not show the effect of enlargement, and will have the effect of thickening the distal end (glans side). The appearance of a thicker distal end (glans side) and thinner proximal end (penis root) is more obvious when the penis is erect. If you encounter some poorly skilled surgeons, you will not only fail to achieve the effect of penile enlargement, but also bring unnecessary troubles to the candidates. Diagram of HADM surgery The picture shows the HADM filling material Finally, let’s discuss Penuma. Invented by American doctor JamesElist, Penuma? is a medical grade silicone in a semi-circular shape, which can be implanted under the skin of the penis to achieve lengthening and thickening effects. penile lengthening and enlargement procedures. Penuma® Product Appearance In 2018, Dr. Elist published an article in TheJournalofSexualMedicine reviewing the treatment efficacy and safety of Penuma.ElistJJ,ValenzuelaR,HillelsohnJ,etal.ASingle- SurgeonRetrospectiveandPreliminaryEvaluationoftheSafetyandEffectivenessofthePenumaSiliconeSleeveImplantforElectiveCosmeticCorrectionoftheFlaccidPenis .JSexMed.2018;15(9):1216-1223. doi:10.1016/j.jsxm.2018.07.006 The paper included 526 study subjects who underwent Penuma?implant surgery successively from 2009-2014 and underwent postoperative follow-up ranging from 2-6 years In terms of efficacy, the mean circumference of the middle penile corpora was 8.5 ± 1.2 cm before surgery, which increased to 13.4 ± 1.9 cm after surgery, an increase of 56.7%, and 81% of the patients were satisfied or very satisfied with the results of the procedure. In terms of the incidence of complications, the highest incidence of hematoma was 4.8%, followed by scar growth and fibrosis, and the adverse events were generally manageable. dr. Elist concluded that the procedure was safe, the results of enlargement were definite, and patient satisfaction was high, and Penuma could be one of the optional options for penile enlargement. I think the biggest advantage of Penuma is that as a silicone product, it does not absorb after implantation, the effect can be maintained for a long time, and because different models can be chosen according to the size of the candidate’s penis, the disadvantage of uneven penile enlargement after HDMA can be avoided. However, Penuma has not been introduced into China yet, and the surgery is expensive ($15,000), so domestic candidates cannot choose Penuma yet. Finally, let’s summarize the characteristics of four types of enlargement materials: fat, decellularized allogeneic dermis, hyaluronic acid and Penuma. Material Absorption or not Surgical time Surgical complexity Post-operative recovery time Single price Post-operative results Domestic availability Autologous fat Mostly absorbed Long Complex Medium Medium Good Yes Hyaluronic acid Completely absorbed Short Simple Fast Low Good Yes HADM Partially absorbed Medium Medium Medium Medium Medium Medium Medium Yes Penuma® Not absorbed Medium Medium Medium Medium Medium High Good No