Filler Complications in Penis Surgery

This blog will address the management of complications of filler in the penis.  I often see men who have had filler in their penis and are unhappy with the result.  Different fillers cause different reactions, so the nature of the problem does vary from patient to patient.

Hyaluronic acid is probably the most common filler in use in the penis.  While it’s known to be a temporary filler, I have seen many men in whom a portion of it remained.  This leaves them with bumps in their penis and even their scrotum because the filler was injected in the loose areolar layer which is continuous into the scrotum.  Hyaluronic acid can be dissolved with an enzyme known as hyaluronidase.  It’s generally effective, but may only partially dissolve the material, leaving unwanted lumps.  Most of the patients in my practice that I see with hyaluronic acid problems have had at least one attempt at dissolving the material and require surgery.

The product known as Sculptra disappears but causes a reaction that is basically scar tissue.  This scar tissue is firm and not all connected, so there are many nodules or lumps in the penis that require surgical removal. Depending upon the method of injection the lumps can be superficial or quite deep.

PMMA and silicone fillers are even more difficult to remove.  They cause scar tissue to form, and act as foreign bodies resulting in granulomas. These masses of cells can be of varying sizes and firmness.  The end result of these treatments can create a thickened penis that feels like gravel. These granulomas can be adherent to the skin and difficult to remove.  Silicone, in particular, is not approved for use as a filler by the US Food and Drug Administration.

When patients come to my office, they ask what options I have for treatment.  They assume that because they had a nonsurgical method of treatment, they won’t need surgery to remove the filler.  In my experience, this is not true.  Some men are told to have injections with something called Kenalog, an injectable long acting steroid. It can cause thinning of the skin along with pigment changes and is a weak method of dissolving collagen, the main component of scar.  When used after PMMA or silicone injection, it will soften the skin and may dissolve some of the granuloma, but the silicone and PMMA are permanent and will remain, along with the possibility of stimulating more reaction.

My role has been to operate to remove as much of the silicone or PMMA as possible.  These are operations that will change the anatomy of the penis and cause scar tissue to form beneath the skin.  Most often, this is not a problem, however some men need more than one operation to achieve their goal.

If you’ve had filler and it is causing you problems, I am available virtually or in person for consultation. I also have links on my website to peer reviewed articles in plastic surgery journals that I have written that discuss these issues in greater detail.

If you’d like more information on penis surgery, please contact my office at 310-299-3553 or email at [email protected].