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Hi, Dr. Sullivan! I’m sharing a case with a patient who was treated with silicone years ago and developed granulomas. Here’s what they look like: you’ll notice a firm bump like this one here. Granulomas often result from using non-HA fillers like silicone or PMMA. Why do granulomas form? 🤔 It’s the body’s reaction to permanent materials that it can’t eliminate, so it "walls them off" with a process called granuloma formation. Fillers like PMMA (e.g., Bellafill) are designed to reduce granuloma risk, but it can still happen—about 2-3% of patients in clinical trials. Silicone, especially if not FDA-approved, carries a much higher risk because it tends to trigger the immune system more aggressively. 💡 Key takeaway: Think carefully about what you inject into your body. Materials matter when it comes to safety and side effects. Now, how do we treat granulomas? 1️⃣ Kenalog: A powerful anti-inflammatory. 2️⃣ 5-FU: An anti-metabolic agent to reduce granuloma formation. 3️⃣ Physical disruption: I often use a no-core needle (commonly used for acne scarring) to break up the granuloma physically. It’s an effective method to treat and improve the condition. Granulomas are manageable, but prevention starts with informed decisions about fillers. Stay educated and cautious!

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I lose my erection with condoms! Help! So, whilst everyone is delighted to warn you about STD and unwanted pregnancy risks, NO ONE thought to tell you that condoms can make you lose your erection, or what you can do about it when you’re trying to be sexually responsible. Am I the only one who can’t keep it up with condoms? Condom-related erectile dysfunction is very common. It actually happens to more than half of the men while using condoms. But men are too shy to talk abou it, so they leave other men thinking they’re alone in this problem. Why do you lose your erection with condoms? It could be for different reasons.. Halting oral stimulation to put a condom on before switching to penetrative intercourse may result in a loss of erection due to abrupt lack of sensation. A simple solution: ask your partner to keep stimulating you orally or with the hand while you are busy opening the packet , or, stimulate yourself while you apply the condom. Wearing condoms that are too big or small may contribute to erection loss. Get the right size for you. Is the condom dulling penile sensation? If so, choose the thin ones, and you can also use lubricant inside and outside of the condom to maximize sensation. Are you feeling anxious? Exercise to destress. Worries about unplanned pregnancy? Consider talking to your partner about using an additional form of contraception. Are you using any medications or durgs that might be of negative effect on your sexual life? In fact, some medications used to treat anxiety and depression can reduce a person’s sex drive. Remember, sex takes many shapes and forms, and intercourse doesn’t have to be the main event. Relax, and enjoy the intimate moments, and don’t forget to have fun. It’s not a test. What can I do to get my erection back? Masturbate while putting on the condom and right afterwards, or ask your partner to keep stimulating you with the hand or mouth while you’re busy opening the condom packet. So it’s very important to stop separating the condom application time from the sexy time. Make it part of foreplay. The most important thing is to COMMUNICATE about it. Make it fun, laugh and talk to your partner so you can both work at maintaining your erection.