JCPM2021.10.06 PrematureEjaculation.3TypesOfWomen.WhyUseHAInsteadOfPRF?

Topics Discussed Include the Following…

*Premature Ejaculation treatment
*The Three Categories of Women Who Need Hormones
*What is Premature Ejaculation (how long is not long enough)?
*Why use HA instead of PRF sub q?

Video/Recording of CMA Journal Club, Pearl Exchange, & Marketing Tips

Relevant Research, Transcript, Relevant Links

Relevant Research

Abdallah, H., T. Abdelnasser, H. Hosny, O. Selim, A. Al-Ahwany, and R. Shamloul. “Treatment of Premature Ejaculation by Glans Penis Augmentation Using Hyaluronic Acid Gel: A Pilot Study.Andrologia 44, no. s1 (2012): 650–53.

Kwak, T. I., M. H. Jin, J. J. Kim, and D. G. Moon. “Long-Term Effects of Glans Penis Augmentation Using Injectable Hyaluronic Acid Gel for Premature Ejaculation.” International Journal of Impotence Research 20, no. 4 (July 2008): 425–28.

Martin-Tuite, Patrick, and Alan W. Shindel. “Management Options for Premature Ejaculation and Delayed Ejaculation in Men.Sexual Medicine Reviews 8, no. 3 (July 2020): 473–85.


Premature Ejaculation

Thank you for being here tonight. I had a request that we talk about premature ejaculation. So that’s the topic tonight. If you have an interest in that, hang with us. If you don’t, that’s the main topic, so you might want to go watch the news or something. And I hope you guys will jump in–I see some smart people on the call tonight. So I don’t want this to be about me.

I’ll show you some of the research I’ve looked at. I’ll tell you a story or two about the patients that I’ve treated, and then hopefully you guys will have some feedback. It has been something I’ve had an interest in. I’ll show you a quick thing, I threw this book together a few months ago.

It’s running pretty well. Even though this looks cool that [today] it’s number two, it’s number seven in men’s sexual health, whatever, you don’t get rich on that, but it does help. In the back of this book, it mentions the Priapus Shot® procedure, so hopefully, it helps people find us. And it gives one of the most, I think, effective tricks ever that I’ve never read in another book or in the research. I have no idea why no one has ever else ever written about this and I think it works better than anything.

How many of you ever had this happen? Like 20 years ago, when I was doing hormones and pellets before Suzanne Somers wrote the first book, I was doing testosterone pellets. And the lady gets her sex drive back, and then she comes in the office crying. I’m thinking of a particular woman in her mid-20s, married to an attractive, athletic, wealthy man in town, a gorgeous house, a pretty baby.

Everything’s perfect except she said, ” My sex drive is up, but I don’t even want to start a sexual activity because I know it’s going to be over so quickly.”

The analogy that popped into my head is, “If every time you cranked your Lamborghini you knew the engine was going to die before you got to the end of the driveway, you might still have a Lamborghini, but you’re just going to quit cranking the engine.

It sounds like a nuisance problem, but for many women, Premature Ejaculation (PE) is a major problem that breaks the marriage. The man starts to avoid the woman and it just breaks marriages.

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When I look at what’s written in the literature, which we’ll look at in a second, and hopefully you can get this thing, I purposely made it for free. If you’ve got a Kindle, you can read it for free. I’m not trying to hold out on you, I’ll cover it in a second. But I want to cover what I think is an overall plan that works and talk about what’s new about what’s happening with our PRP and what some of our providers are doing on the procedure side to help this problem.

So let’s just jump over. Oh, the other thing, and I’ll just tell you, I don’t want to give you TMI sort of thing, but the first time I had sex, it did last about maybe 30 seconds. But being the nerd that I am, I just read everything on the planet about it and came up with a system, and within a short time as a teenager, it was just a light switch, we can go all day or we can go 30 seconds, whatever you want. And I’m glad I had that experience because it made me figure it out.

And so I wrote … Okay, let me go back. I’m jumping around. Let me just go, I’m going to walk you through what’s worked for me. And when I wrote this other book, this one, this is actually the first, I’m almost embarrassed to call it a book. What happened was back 21 years ago when I’m doing hormones and this woman comes in and does that, and another woman, and another woman. And some of it was premature ejaculation, some of it was just man’s not interested. And if you remember, 21 years ago, only men doing hormones, women were taking Premarin and Prempro and Menthol back in the late ’90s, early 2000 that really only bodybuilders took hormones. So it was hard to get the men to come to see me after the women were fixed. Fixed doesn’t mean obviously their sex drive was back. That part was fixed and things were working and they lost 40 pounds, and now the man they love, or the woman, but the man, they love can’t keep up with them.

One of the hurricanes came through and it was the first time I’d been able to actually leave town because as an ER doctor, I was in the disaster committee, so I never got to evacuate. This is the one and only time I ever evacuated from a hurricane since I’ve lived at the Gulf, 1991. I watched Katrina from the back porch. I used to wonder why do people die and stay and die in hurricanes, it’s because they’re fun.

Hurricane sex is worth dying for almost.

I rode out Hurricane Sally on my little 43-foot yacht with my fiance. So yeah, hurricanes will kill you, but if they don’t kill you and rip up your town, they can be fun. I was bored. This is the only hurricane I left for and I was bored and so I wrote out what I would tell the husband of these patients, these women that were sad.

The Three Categories of Women Who Need Hormones

And remember women come in three flavors when they get hormones.

One flavor is they’ve been abused by their husband, so when they lose their weight and get their sex drive back, they’re leaving and there’s nothing you can do about it.

The other flavor is they have a very healthy husband and when they get their sex drive back and their figure back, they go live happily ever after, you never have to talk to the man.

But the third flavor is why lots of gynecologists are doing P-Shots® and doing hormones. It’s the woman who gets her sex drive and her health back and her figure back and her confidence back, and she loves the man, but he’s not healthy, and now he can’t keep up, but she doesn’t want to go to someone else, she wants him to catch up with her. That’s the troubling thing that happens.

And I’ve had women actually cry and say, “Just take me off the hormones because I love him so dearly, I’d rather just not have a sex drive. And he won’t come to see you, so just stop my testosterone.”

So I wrote this little book as a way to convince them to come to see me. And when I say I’m embarrassed to call it a book, I literally just wrote it out and put it in a three-ring binder and just gave copies to my patients.

And when the husbands and the women started saying, “Hey, this has changed our marriage,” I thought, well, I’ll just throw it on Amazon. And it ran as the best seller of sex books for about three, four years, 2004 through 2007, somewhere in there. And now it’s out there, I don’t publish it anymore, you just have used copies and there’s the PDF file of it. I’m going to give you the link right now. See, this was the web page back when I built my websites with Dreamweaver before WordPress. But there’s a PDF file if you just want to download this thing because the last part of it is about premature ejaculation. Let’s see if I can find it. Yep, this is it. So I’ll put the link in the chatbox. And there you go, you can download it (click)<–.

I got a little bit into my religious background in here [the book], but I think really it’s hard to talk about sex without talking about spirituality. So if that part bothers you, just throw it away. But the last part is where I talk about premature ejaculation. Okay? And it gives an outline. Now, I’ve recently expanded upon that and that’s what we’re going to now plunge into. But I’ve given you that PDF file, and now I’m going to walk through what’s … I’m making a bigger book. The book that I published was just one chapter in a bigger book coming.

So this is the first draft I’m showing you. And keep in mind, I have now treated thousands of people. I’ve decided to be a sex doctor and I’m still counting myself like I’m just an internist, is what I am, but I happened to have talked to thousands of people about sex. So one thing that happens that I don’t see talked about much by the sex therapist is just, when you have the guy that says, “I have an ejaculation early,” or, “I’m having sex and my erection goes away,” what you will find is often those guys are just aerobically not fit. Medium vigorous sex is the equivalent of walking upstairs. So part of the way I motivate men to get in shape is to tell them that, “Go walk up this flight of stairs, and at that point where you get short of breath and you want to take a break, that’s how long you’re actually good for with vigorous sex.”

And what I think happens is that as the person reaches their anaerobic threshold with vigorous sex, the blood just gets shunted away from the penis and they either have ejaculate because that means hard to have thoughtful control if you’re turning into anaerobe and you’re supposed to have oxygen in your brain. So they either ejaculate because they’re not focusing well or they just lose their erection. So the first part I think about premature ejaculation is that … and I’m going to tell you several things that are not in the book, but they work and I’m going to get around to the stuff about the procedure stuff that has to do with our platelet-rich plasma, hyaluronic acid, and how you can use that as a procedure in the penis. I’m getting to that. But if the man is short of breath, he has trouble breathing after a minute of sex, then you can inject HA all day long, he’s still going to lose his erection after a minute of sex.

What is Premature Ejaculation (how long is not long enough)?

Now that brings me to something else I should bounce back to which is, exactly what is premature ejaculation? So let’s look at, this was a review article, it was drawn in Sexual Medicine Reviews, which is put out by The Journal of Sexual Medicine. And let me just put this DOI number in the chatbox. And I want to see what I think as a man who actually talks to patients versus a researcher trying to gather data. Now, the people who gather data, don’t talk to husbands and wives, but it’s a different thing. So when you look at the definition of premature ejaculation, which we should think about, there’s this thing, well, if it lasts … they split it out here in this paper, so let’s just look at these bullet points. Ejaculation that always or nearly occurs prior to or within one minute of vaginal penetration from the first sexual experience. Or clinically significant … I’m going to give you what I think is the best definition in a second, and you’re not going to find it in a book. Or a clinically significant and bothersome reduction in latency time, often to about three minutes or less. Okay?

Then you got to number two, the inability to delay ejaculation on all or nearly all vaginal penetrations. Well, that’s kind of a vague, delay for how long and how do you know. And three, which is negative, personal consequences such as distress, bother, frustration, and/or they evoke avoidance of sexual intimacy. To me that was complex.

I guess you have to complicate it when you’re going to create quantifiable data. But my definition as a clinician is that are you able to have penis and vagina sex for as long as you or your lover may wish on that occasion? And there may be occasions when you’re running out the door and it’s almost like a kiss and you want a 30-second quickie. And there may be occasions when you’re off for the vacation for the weekend and you and your lover want to have the TV off and be in the bed until lunchtime, and then they leave the tray at the door because you want to keep going till dinner time.

I’m always going to have this disclaimer, I’m never claiming that just mindless, piston type of sex without any regard for the female is anything that anybody wants or should want, man or woman. But on the other hand, artful sexuality sometimes requires something way more than three minutes. And when you look at the research, what’s so frustrating about it or I think maybe even ridiculous about it is that the latency times are going from something like a minute to three minutes or three and a half minutes to six minutes. And I’m just telling you, or women will tell you that there are lots of times when the stars are right, and the music’s right, and six minutes is just getting started barely.

There was a study published in The Journal of Sexual Medicine that showed that our PRP causes the penis to grow in a small penis. But it’s still clinically not very useful because it’s taking a two-inch erection to two and a quarter-inch erection, which is not enough to make a difference in the marriage. So the definition that I like, which is just, you’re looking at a man and a woman, and the question is, can you give this woman sex for as long as she wants on any particular day? And if you can’t on the days you can’t, that’s premature. So you can’t really make a study about that, but you can actually achieve that result. And that’s what I’m about to show you. But that’s the typical definition. That’s the definition from the bible, basically, of sex, The Journal of Sexual Medicine, in the US.

Back to my outline, and hopefully I can give you guys a plan that actually works clinically, not just looks pretty in The Journal of Sexual Medicine. First, if they can’t breathe after five minutes of walking upstairs, I’m sorry, Bob, you’re not going to be having to sex longer than five minutes. It ain’t happening. I guess maybe if you’re in a hyperbaric chamber or something. But you’re not going to have vigorous sex longer than whatever you can walk upstairs, no matter what drug I give you. Okay? Let me take that back. I’ll just skip down. Unless maybe I give you a Trimix injection where even if you’re passed out from hypoxia, your penis is still stiff. That would be the one exception to that.

Now, this 30 seconds trick was the thing that I’ve figured out as a teenager. And again, I’ve never seen this in the research directly, but it’s there indirectly because there’s cause to innovation. And I put that research in that little book, let me give you a link to that while I’m thinking about it. Because you can read it for free on your Kindle. Let’s see. And this is what I’ve practiced for the past 40 plus years. Let’s see. Let me show you what I’m giving you the link to. This. And it works. For many people, assuming they can breathe. Again, all this is out the window if you can’t breathe. But assuming you have good endurance, which I did and do because I’ve always been an endurance athlete. And in high school, I was the two-mile runner, which means you don’t have to be fast, you just have to be able to not get short of breath.

Okay. So assuming you have that going for you, this next trick, which is in nobody’s book, as far as I know, except for mine, that I figured out as a teenager, is simply that there’s some cross innervation between the bladder and the ejaculatory sensation. So what I discovered or noticed about my own body, what I’ve taught a lot of men, is that if you have any urine at all in your bladder, it makes it much more difficult to avoid ejaculation. And a completely, totally completely empty bladder makes it much easier. Okay? That’s the summary of that whole little book that’s on Amazon, but there’s some nuances about it that are worth show. Just get that Kindle book for free to your people that have PE. And remember in the back of it, it tells them about the P-Shot. So I put it out there and not to make a fortune on the book, but to help people find the other things we’re able to do.

Now, the next thing again, I’ve never seen it in a book, but I call it the safe zone. And it’s basically that same sensation that you feel when you need to urinate, when you’re going down the highway, but you can’t stop, for whatever reason, you got to get to the meeting or whatever, and then the sensation goes away. But you were not allowed to urinate just somehow it attenuated. And then it comes back, it comes in waves, and when it comes back, it’s more strong, but there you go. I think this little paper right here supports that. No, this is something else, whatever. But the point I’m making is that when people do other things like interruption … and this, if you think about it is a form of interruption, except instead of stopping with your activity, you stop and you urinate. And you think, well, shoot, if I’m having to stop every five seconds or 30 seconds or a minute or whatever, this is not enjoyable.

But what really happens is you reach the safe zone. And for most guys, when I talk with them, this is no study, this is just talking to a few thousand people, most guys, probably it kicks in at about the five-minute mark, maybe 10, and then the urge just goes away and they can enjoy the sensation. It’s not like they have to think about yesterday’s meal or what they did. Take their mind … Who wants to have sex would not be thinking about sex. So they actually reach the zone where they can enjoy all the sensations and not have to worry about there’s no sensation or very attenuated sensation to ejaculate.

The sex positions, I go into this. Again, some of these is things that I’ve never read. What I see in the literature is mostly or what I see recommended by the sex therapist … You know I’m a contrarian if you’ve ever heard me talk for more than 30 seconds, but I’m not a [new guppy 00:20:40] either. So what I have found personally, and from counseling a few thousand men, is that what really better is not woman on top, and I think the theory is that man can be still and makes him less likely to have an orgasm, I have found that what works much better … because the woman can sometimes move when man’s not ready for him to, there’s also, if he’s ever had the experience at all, there’s also that worry about women coming down and fracturing hitting on the end of the thing. But more importantly, he doesn’t have control. And I’ve found that if the man is actually in any position where he’s standing and the woman is supine or prone, or doggy style, whatever, but if he’s able to stand the sensation and the urge to ejaculate goes down tremendously.

Which brings this thing, which is mostly, I call it advance interruption, but it’s just interruption, but you’re using all these other things. You’re not just stopping because you have the urge to ejaculate, you’re stopping and you’re doing the things I’ve mentioned already plus the other things I’m about to mention. And one of them is that, you have to think about your lover. And it’s amazing how many men are jealous or insecure about something in the bed, like a vibrator or whatever, all the different sex toys that you guys know other than his penis. Where something like that can help keep the mood going. And I usually tell my patients just to go to Amazon to buy their sex toys because it’s … But we will have our own brand eventually with our O-Shot brand. But for now, they go there, it comes in a box, it looks like books. An that can be used during the time the man is taking a break.

Of course, there’s always using other things. If he loves his lover, obviously he wants to taste her as well. And that goes on. But the idea of something other than his penis. And then this part, which is somewhat esoteric and harder to teach to people. But just the idea that what I handed to earlier, which is that sometimes three hours sex is not what your lover wants, and it’s a nuisance, but sometimes it is. And it’s not just about, of course the time, but this idea of lovemaking actually being an art, which I don’t hear doctors talk about much. We get clinical about everything, and I guess the course is hard to teach that. But if it’s truly an art, you never quit. And that’s part of what makes something an art, you never master it. You get good at it, but you’re never satisfied with where you are, and so you’re never satisfied with what you know about your lover and you’re never satisfied with … you’re satisfied but you always want something more through a better understanding and a better connection. So there’s this positive feedback loop.

What happens the other way, especially with women, and this is in research, is a negative feedback loop where if there’s a negative experience, it’s not just arousal, plateau, orgasm, refractory period, with women it’s much more complicated, especially. And it’s arousal, and if something goes sideways, then the next encounter, it’s harder to do the arousal part. But if it goes very well and whether it’s a 30 seconds encounter, this is from the research, 30 seconds encounter or vacation all day sex, if the counter is positive, there’s a positive feedback loop, so the next time it’s easier for her to be aroused…easier for her to have an orgasm.

This part is just some techniques I do think it helps to have. If you remember the Richard Gere movie where he plays the gigolo, you can’t be mindless, I don’t think, and control your ejaculate. Which is why I think alcohol is probably not the best if you want extended sex, at least for the man. And there are some tricks that I will teach in the upcoming book, and that you’ll see in the PDF file I gave you, for still enjoying the sensation, but focusing in the mind, such that you can enjoy, but yet ride the edge of ejaculation without ejaculation.

This part gets talked about a lot. You can see I haven’t even written about it. I mean, I have, but I haven’t even put this in the first draft of the book because it’s everything, right? You go get the [inaudible 00:25:42] cream and you spray your penis, and then you have less … it’s in the freaking condom machines at the gas station, right? It numbs your penis down. And they sell it on Amazon. And I don’t tell people to not do this, I actually tell people to do everything on this list and then back it off as they learn better their body and their lover’s body. And as you guys know, if you’re counseling women and men about sex, you can have people who’ve been married 40 years that don’t really understand each other’s body yet. So if you’re teaching them to do that eventually this is not needed, but it can be helpful at the beginning.

Now we’re at the part where I promised you I would talk to you some about our procedures and what’s happening, and then we’ll shut this thing down. And how it relates to the … Well, actually I want to get some feedback from you guys before I shut it down. But how it relates to premature ejaculations and our procedures. I’ll put the link and the little DOI number in here. So this is an old article, you can see 2011, so 10 years ago. And the reason I put it up here is just so you know, this is not a new idea to use an HA filler to somehow decrease the sensation and help extend sex. And the reason I use extend sex versus premature … And I’ll just put a link to this article in your chat box. I use extend sex rather than treating premature ejaculation is because that premature ejaculation definition is so vague, and going from three minutes to six minutes might be great on Friday before you head out to work but it may not do much to make things better on Saturday afternoon when you want the extended lovemaking.

Anyway, if you look at the results from here, this one, and then they had a follow-up study. Well, okay, here we go, so the intra-vaginal ejaculation latency time increased significantly. It went from 2.12 minutes to seven minutes. So you got an extra five minutes of sex. And maybe on some days, that’s enough for the woman to have the orgasm she wants, but a lot of days, maybe it isn’t. And I think what happens with a lot of women who come in with anorgasmia and they say, “I want an O-Shot so that I can have sex with penis in vagina sex.” Well, she might be one of those ladies that needs 30 minutes or an hour of activity before she has an orgasm. And you can give her an O-Shot all day long, but if she has a husband that goes for five minutes, it’s not happening. Which is why that’s one of the harder things for us to treat with an O-Shot, because we’re not controlling this part of the thing. So they drop back to about five minutes plus or minus three minutes. So it’s helpful.

Now the cool thing about it, and actually what I think a lot of people are doing it is the side effect is you have a larger glans, I’ll show you some pictures in a moment. And so you can envision that some people might use their supposed premature ejaculation as a reason to get treatment and expand the size of their glans.

Here’s a follow-up study where they injected, they used Perlane, which is similar to our Juvederm. And you can see the results of it at six months and at five years. There wasn’t much change at five years, side-effects were basically nil and satisfaction, you can see was somewhere around 70, 80%. And if you look at the time, here they’re measuring seconds, they went from a little over a minute to about six minutes. I don’t know, maybe that’s enough to make mama happy, but there’s a lot of mamas out there that six minutes is still not going to make them happy. Nowadays a lot of mamas, they don’t want daddy at all, right? Watch Game of Thrones and leave me alone. But I’m assuming they actually love each other and the woman wants intimacy. And there will be times when 30 seconds is beautiful, but I think with most women, they’re going to be times when six minutes just isn’t enough. So that’s why I’m not downplaying the results of this or that it might have an effect, but I wouldn’t count on this being the magic bullet that makes couples with premature ejaculation well.

Now, the nuance that we’re using, and probably the pre-people in our group that have done this the most, there may be others I don’t know of. But the ones that I know that have done this the most are George Ibrahim, he’s a urologist that taught at Duke, and Dr. Bill Song and Anne Truong. Those are probably the three I know of that are actually injecting and teaching injecting HA in the penis. You can also inject it in the shaft subdermally with the side effect causing increased girth. I don’t teach this. The reason I don’t teach it, even though I’ve done it to myself and it’s noticeable and it’s immediate, the increase in girth when you put it in the shaft, is that it’s hard to get it smooth and if you don’t know what you’re doing, you can cause a mess. So if you’re going to do this, I think you should go do a hands-on training with someone, preferably one of the people I just mentioned in the group. And if there are others on the call that are teaching this, let me know, and I’ll unmute you and you can tell us about your class.

Let’s see. So I think that covers everything I wanted to talk about. There’s of course a lot more with all these different topics, but that’s a basic outline. And frankly, of all the things that I’ve taught my patients over the years, the thing that’s helped the most is to tell them to go get in shape. Because you’re not going to have sex longer than you can walk up the stairs. And if you want to know how good you’re for sex, go find yourself the Empire State Building or something with lots of stairs in it and start walking and time yourself, there you go. So probably that my rule of thumb, which is work your way up to 21 to 25 miles on foot walking or jogging is going to do more to fix this than anything else we can do.

Next, I think my experience has been my little 30 seconds trick works well. Now, I didn’t mention the prescription drugs that’s covered in this one. I think I gave you all the DOI on that one, let me give you the link for it. This is the review article we talked about a moment ago, and I’ll just put that one in the chat box. They go into detail about the drugs. And you got the SSRIs. They also makes the mention oxytocin, and yohimbine. There used to be a medicine that was prescription called [Yokan 00:33:32] that actually worked very well, and that was a pharmaceutical grade yohimbine, and I’ve not been able to find a duplicate for that. And it works almost half the time. This was before we had by Viagra. But at the over-the-counter, it causes chills and all sorts of weird side effects with people. Anyway, they go over the drugs here. I have found I’ve never really needed the drugs with my patients. Doing the things that I just talked about, but probably the SSRIs are the ones that people use mostly.

Okay. I’m stopping. And I see a couple of questions. One is, inject only the glans? No. Well, I left that part out with our procedures. One of the things that Bill Song did, which I have tried, and it works well, and others in our group have done it, and it’s what it did to my own self, is that he saw me do a mixture of PRP with HA under in the tear trough. And by doing that mixture, you can get a smoother flow of the HA and less chance of lumpiness and a much more broader and even distribution and probably a longer, more effective result because the PRP recruits stem cells to the area that build on the HA, which we know from our wound care studies. The two studies I showed you were about just injecting the glans, but there are others out there about injecting subdermally in the shaft. Again, I’d recommend as simple as it looks that you hit up one of those three people I talked about to learn that technique.

But the thing that our group is doing, that’s innovative and you’re not seeing in the literature anymore, or anywhere is that mixture of PRP with the HA. So even if I were doing the shaft, most of us are mixing it 50/50. And it takes usually a lot of volumes, so if you’re going to inject five or six, 10 syringes of HA … Because if you do the math on it, simple math, right? Calculate the volume of a cylinder with a circumference of five inches, and then calculate with six inches, is a noticeable amount of volume. But if you take 10 Juvederm syringes or five or whatever you’re going to start off with, and then you take the same number of milliliters of PRP and using the right technique, you cause an emulsion, and then you inject that subdermally. And I would do the same thing with the glans. The worry about the glans of course, is there’s an actually intravascular space and there’s always that chance of PE from the HA, and you should just not be injecting HAs in the corpus cavernosum for that same reason. So that’s the possible nuance reported, that injecting the glans that I know of. But that’s the possible side effects.

Why use HA instead of PRF sub q?

Okay. The second question was, Sub-Q PRF instead of Sub-Q HA filler, and it helps a lot. You know the cool thing about PRF is … and a lot of people asking you about PRF and people love it. I’m not saying don’t do it, and it’s obviously cheaper than buying an HA, and PRF is going to help. To me, and at least my observation in the face, I’ve done a lot more face injections with HA than I have penises, you can design a shape with HA that stays. You can’t design a shape with … So to answer your question, what’s PRF, I went into that psalm and the short answer is that instead of platelet-rich plasma, you have platelet-rich fibrin, and it’s a quicker way. You’re basically making a clot that then you can … the dentist use it mostly to patch wounds and such. But I reviewed some of that literature, maybe three webinars ago. And is something that people are using.

I’m no one bias, and the verdict that was what was in the literature, the verdict’s still out about, do you activate, how do you activate, how do you make the PRP? That’s always the disclaimer and the criticism in the med analysis reviews, because there’s not a consensus about PRP what it is and PRP versus PRF. And so there’s just no way to get to a conclusion to that at the present moment with the research. And it becomes like arguing the difference between a Ford or a Chevrolet or whatever, a Lamborghini or Ferrari. So I don’t want to get too sidetracked about that. But back to using PRF versus HA. The reason people are putting HA in the penis is the reason it’s the fricking gold standard with the face.

I saw a woman today who came and went and cheated on me and got some Sculptra. And Sculptra is great for building volume, but you cannot control it. I can control to the millimeter when I have an HA filler in the mouth, I can control how I’m sculpting the cheek. I have absolute control. I don’t have absolute control with what the results is going to be three weeks from now with Sculptra or PRF. So I’ve found making the shape you want with an HA, which is going to be a solid structure. And there are those that are permanent, which you don’t use obviously until you get the hang of this, but there are those who are using the permanent fillers for the penis after they get the hang of it. But with an HA, you can create a shape. Maybe you want it wider at the base, or maybe you want it wider near the glans where it has the effect of a larger glans or some variations. You can actually become the Calvin Klein of penis shafts. But even if you’re not getting that esoteric with it, you have more control over making it smooth versus irregular and unpredictable.

You can tell I’m a big fan of HAs which is why I keep using them in the face and combining them with the PRP and all the research that involves PRP recruiting stem cells, or at least almost all of it involves the PRP. If you’re going to add a filler the PRP recruits themselves onto the scaffolding, which is the words that’s used in the wound care literature, onto the scaffolding of an HA and the effects can be really beyond belief. I don’t even like showing everybody my before and afters. Because when you’re treating scars and such and in the vampire breast lift, the results can be beyond belief.

Okay. If anybody else has a question, I’ll answer it as best I can. Or if you want to jump in. Okay. I see Julia has her hand up. Let’s see if she wants to jump in and teach us something. Hey Julia, I think … Let’s see. Let me try again. I’m trying to unmute you. All right. You’re un-muted if you want to go for it. Right there. Let me see, it looks like you’re on here. Nope. Maybe your mic’s not working. Let’s see.

Okay. I guess that’s it. Thank you guys. I’m always honored that you have an interest and I hope this has been helpful. Remember, you can go onto the websites and go to the search bar, if you put in PE, you’ll find not just this one once I get it posted, but at least three other times we’ve talked about it. And most other, we have over 400 videos, like the ultimate Wikipedia of PRP treatment. So jump in there and contribute, when you see something comment. And thank you, David. One of the smartest people I know. That’s always an honor to see that you have an interest in something I had to say. You guys have a great night and hopefully I’ll see you guys soon down here in Fairhope. Bye-bye.

Relevant Links

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Charles Runels, MD






Cellular Medicine Association

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