A Unique Set of Circumstances

[Headair123]

First, a deep thank you to everyone on this board. It has been incredibly important and crucial in helping me work towards a decision to have an implant.

The need for an implant is so remarkably similar to what so many of you went through in terms of treatment escalation. It is time to take the plunge. But, it will not happen for another three months due to personal scheduling matters.

Anyway, here is what makes my circumstances a bit unique:

My penis length used to be 6 inches about thirty years ago. I have since pumped it in a VED like crazy. Now, it is 7.00 to 7.25 inches long and its girth is 4.4 inches.
I still use a VED and my penis immediately attains a length of 8.25” after 5 minutes of pumping. A further 30 minutes of pumping gets me to 8.5 inches in length.
I also have cosmetic filler under the skin of the penile shaft. This results for my erect penis are a girth of 7.25 inches at the penis base, 6.5 inches at the midpoint of penis and around 5.75 inches right behind the glans. When flaccid, my girth remains around 0.25 inches less than the erect measurements at the same points.
My glans also has a minimal amount of filler which has caused its size to increase by about 25% relative to my original glans.

I needed to spend a huge amount of time trying to figure out which implant will work best for my personal set of circumstances. After a lot of research, I thought it might be the AMS CX. So, I prepared a good set of questions and dropped them into Chat GPT ver 4.5. Here is what I asked it:

My goals are:
1. attain maximum stiffness
2. maximize the penile length post-surgery (what is the likely outcome?)
3. Maximize the erection above the horizon while standing up (what kind of angles are most likely?)
4. Minimize the length of the RTE
5. Have a more natural looking hang and look while flaccid
Goals 1 through 3 are equally important.

Provide a post-surgery plan to maximize length.

What the is expected outcome immediately post-surgery, 6 months after surgery and 1 year after surgery for:
1- Erect length
2- Flaccid length
3- Erect girth
4- Flaccid girth
Provide the data for both my actual penis and my penis with filler.
Given the fact that my distal length is 7.0 to 7.25 inches and my proximal length can be anywhere between 1 and 2 inches, what size cylinder should the surgeon use while minimizing the RTE length. Also, how short can the RTE be kept?
What strategies exist to safely maximize penile length post implant of the AMS CX?

What should the cylinder length be while Minimizing the RTE length?
Can the RTE be kept to less than 1 cm? Or, are there reasons to extend the length of the RTE (for me specifically)?
How do you maximize the implant length in respect to the glans? How deeply should the cylinder be seated in glans? How can you maximize the size of the glans without introducing excessive stress?
Are there different thicknesses for the AMS CX?
I am worried that my real girth of 4.4” can result in lower rigidity and lower angle, especially in light of the filler I have. Should I be worried? What should I expect?

Prepare a table showing flaccid, semi-inflated, and fully inflated appearances. Include separate line items to reflect the impact of the filler on my final dimensions.

ChatGPT's answer to follow in the next post.

[Headair123]

Here is what ChatGPT came up with:

Here’s a comprehensive and detailed response addressing all your questions clearly and systematically:

⸻

Summary of Your Anatomy and Goals:
• Natural Penis Length: 7.0–7.25 inches erect; 8.25–8.5 inches inside VED.
• Actual Anatomical Girth: 4.4 inches.
• Penile Shaft with Filler:
• Base: 7.25 inches erect (7.0 inches flaccid)
• Midshaft: 6.5 inches erect (6.25 inches flaccid)
• Behind Glans: 5.75 inches erect (5.5 inches flaccid)
• Glans: ~25% enlargement from filler.
• Proximal Length Estimate: 1–2 inches.

Goals (Equally Important):
1. Maximum stiffness
2. Maximum penile length post-surgery
3. High erection angle above horizontal (standing)
4. Minimal RTE length
5. Natural-looking flaccid appearance

⸻

Recommended Surgical Plan (AMS CX):

1. Cylinder Sizing & RTE Recommendations:
• Ideal Cylinder Length: 21 cm (to accommodate distal + proximal length effectively, minimizing RTE use).
• Distal Length: Approximately 7 inches (~18 cm).
• Proximal Length: Approximately 1.5–2 inches (~3.5–5 cm).
• Total (ideal) = 18 cm + ~4 cm = ~22 cm; selecting the closest appropriate cylinder is typically a 21 cm cylinder, with minimal or no RTE.
• Minimal RTE Length: Ideally ≤1 cm (Preferably none if anatomy allows).

2. Strategies to Maximize Length and Erection Angle:
• Aggressive Pre-surgical Protocol:
• Continue daily VED usage up to surgery to ensure maximal penile tissue stretch.
• Cylinder Positioning:
• Cylinders seated deeply in glans (~1.0–1.5 cm below the coronal ridge), maximizing glans stability and length.
• Minimal or No RTE:
• Maximizes stability, rigidity, and erection angle by anchoring the cylinder base directly to the pubic bone.
• Glans Optimization:
• Deep cylinder placement under glans provides stable, maximally filled appearance. Avoid excessive pressure; aim for moderate snug fit to optimize glans circulation and avoid tissue erosion or injury.
• Consider adjunctive intraoperative or postoperative protocols (gentle VED therapy post-surgery after clearance by surgeon).

3. AMS CX Rigidity and Girth Considerations:
• AMS CX cylinders: Single standard thickness—built for rigidity.
• Girth and Rigidity Impact:
• Actual anatomical girth (4.4 inches) well-supported by CX cylinders.
• Filler Impact:
• Cosmetic filler adds substantial soft-tissue thickness (up to ~7.25 inches at base).
• This does not diminish rigidity provided cylinders are correctly sized (larger cylinders recommended to provide firm, stable support).
• Potential concern: filler may add downward gravitational force on erection, slightly affecting erection angle.
• AMS CX (vs. Titan) offers very good rigidity, generally sufficient for your situation given correctly sized cylinders.

Screenshot 2025-05-12 at 6.00.58 PM.png (328.95 KiB) Viewed 1041 times

Notes on Outcomes:
• Immediate length slightly reduced initially post-surgery due to tissue trauma and swelling.
• Length incrementally restored/improved over 6–12 months through consistent cycling and gentle VED therapy post-clearance.
• Erection angle gradually improves over time as tissues heal, cylinders stabilize, and capsule formation around cylinders strengthens.

Screenshot 2025-05-12 at 6.02.40 PM.png (112.93 KiB) Viewed 1041 times

Additional Considerations:

RTE Length Justification:
• Shorter RTE (≤1cm): Recommended for best erection angle, stability, and rigidity.
• Reason to Lengthen RTE (rare in your case):
• Anatomical constraints (deep proximal measurements, fibrosis).
• Usually minimal or no RTE preferred to maximize rigidity and angle.

Concerns Regarding Real Girth (4.4 inches) & Filler:
• Your actual anatomical girth is suitable and well-supported by AMS CX cylinders.
• Cosmetic filler adds significant girth but generally does not negatively affect rigidity substantially; careful selection of correct cylinder length and diameter mitigates these concerns.

How to Maximize Cylinder Placement and Glans Stability:
• Cylinder tip placement ~1.0–1.5 cm into the glans for stability and maximum effective length.
• Avoid overly aggressive seating to prevent glans erosion.
• Gentle postoperative cycling and consistent use of VED post-recovery period (after clearance) encourages maximum length and health of tissues.

⸻

Final Recommendation:
• Cylinder: AMS CX, 21 cm (ideally no or minimal RTE).
• Postoperative Therapy: Regular cycling and gentle VED usage after surgeon approval.
• Surgeon Dialogue:
• Clarify proximal measurement accuracy (preferably via intraoperative dilator measurement).
• Confirm precise cylinder seating into the glans.
• Minimal RTE use and discuss explicitly the postoperative VED/cycling regimen.

⸻

This detailed response and the strategic recommendations provided will position you optimally to achieve your outlined goals with the AMS CX implant, taking into careful consideration your anatomical specifics and personal priorities.

[Headair123]

Does this make sense to you? Or, is ChatGPT hallucinating?

[ready2go]

First, a deep thank you to everyone on this board. It has been incredibly important and crucial in helping me work towards a decision to have an implant.

The need for an implant is so remarkably similar to what so many of you went through in terms of treatment escalation. It is time to take the plunge. But, it will not happen for another three months due to personal scheduling matters.

Anyway, here is what makes my circumstances a bit unique:

My penis length used to be 6 inches about thirty years ago. I have since pumped it in a VED like crazy. Now, it is 7.00 to 7.25 inches long and its girth is 4.4 inches.
I still use a VED and my penis immediately attains a length of 8.25” after 5 minutes of pumping. A further 30 minutes of pumping gets me to 8.5 inches in length.
I also have cosmetic filler under the skin of the penile shaft. This results for my erect penis are a girth of 7.25 inches at the penis base, 6.5 inches at the midpoint of penis and around 5.75 inches right behind the glans. When flaccid, my girth remains around 0.25 inches less than the erect measurements at the same points.
My glans also has a minimal amount of filler which has caused its size to increase by about 25% relative to my original glans.

I needed to spend a huge amount of time trying to figure out which implant will work best for my personal set of circumstances. After a lot of research, I thought it might be the AMS CX. So, I prepared a good set of questions and dropped them into Chat GPT ver 4.5. Here is what I asked it:

My goals are:
1. attain maximum stiffness
2. maximize the penile length post-surgery (what is the likely outcome?)
3. Maximize the erection above the horizon while standing up (what kind of angles are most likely?)
4. Minimize the length of the RTE
5. Have a more natural looking hang and look while flaccid
Goals 1 through 3 are equally important.

Provide a post-surgery plan to maximize length.

What the is expected outcome immediately post-surgery, 6 months after surgery and 1 year after surgery for:
1- Erect length
2- Flaccid length
3- Erect girth
4- Flaccid girth
Provide the data for both my actual penis and my penis with filler.
Given the fact that my distal length is 7.0 to 7.25 inches and my proximal length can be anywhere between 1 and 2 inches, what size cylinder should the surgeon use while minimizing the RTE length. Also, how short can the RTE be kept?
What strategies exist to safely maximize penile length post implant of the AMS CX?

What should the cylinder length be while Minimizing the RTE length?
Can the RTE be kept to less than 1 cm? Or, are there reasons to extend the length of the RTE (for me specifically)?
How do you maximize the implant length in respect to the glans? How deeply should the cylinder be seated in glans? How can you maximize the size of the glans without introducing excessive stress?
Are there different thicknesses for the AMS CX?
I am worried that my real girth of 4.4” can result in lower rigidity and lower angle, especially in light of the filler I have. Should I be worried? What should I expect?

Prepare a table showing flaccid, semi-inflated, and fully inflated appearances. Include separate line items to reflect the impact of the filler on my final dimensions.

ChatGPT's answer to follow in the next post.

where did you get your fillers and what type ? and i wonder how having fillers will affect having an implant placed ? maybe not at all . idk ,they use dilators to expand the area the rods will be inserted into .so the squishy fillers just expand with the implant? maybe with ipp's they are not that large since they are deflated when placed .

[Headair123]

I got the fillers in Miami, FL with Dr. Loria.

He uses a product called silicone 1000 aka Alcon 1000. It is a permanent dermal filler that is used on the face and the lips. Obviously, using it on the penis and the scrotum is "off-label". But, the health issues/assessment are the same as using them on the face.

My urologist has examined the fillers and sees zero issues with them interfering with the surgery or use. Remember, my real girth underneath the filler is going to be the same. And, I got the filler long before my dick started embarrassing me in front of my wife...

[ready2go]

I got the fillers in Miami, FL with Dr. Loria.

He uses a product called silicone 1000 aka Alcon 1000. It is a permanent dermal filler that is used on the face and the lips. Obviously, using it on the penis and the scrotum is "off-label". But, the health issues/assessment are the same as using them on the face.

My urologist has examined the fillers and sees zero issues with them interfering with the surgery or use. Remember, my real girth underneath the filler is going to be the same. And, I got the filler long before my dick started embarrassing me in front of my wife...

great ! im a bit afraid of permanent fillers . While ideal , if there is an infection etc ,it's a bad scene getting rid of it . But you didn't have any issues, I assume ,thankfully .
how about smoothness, was there any lumping that was needed to be massaged out ?

[Headair123]

Sadly, there is lumping.
It feels like a few pieces of lentil here and there.

[ready2go]

Sadly, there is lumping.
It feels like a few pieces of lentil here and there.

i read that can happen sometimes and migration . with HA filers also . but massaging is supposed to help . Maybe that's only good for early on ,IDK .
Ill try the HA fillers and go for touch ups if needed . i saw dr perito say that with implants the filler last longer . That is a side benefit if true .

[Headair123]

I later decided to find out if the Coloplast Titan is a better choice. So, I asked ChatGPT and this is what it had to say:


Given your detailed anatomical characteristics, specific goals, and concerns regarding erection angle, rigidity, and the presence of substantial cosmetic filler, a careful comparison between the AMS CX and the Coloplast Titan OTR is critical.

Here’s a structured comparison highlighting why the Titan OTR might indeed be a better option for your specific situation:

⸻

1. Stiffness & Rigidity:
• AMS CX:
• Good rigidity, suitable for standard girths.
• Offers rigidity adequate for typical anatomy (~4.4” actual anatomical girth).
• Potentially compromised rigidity and erection angle due to large filler volume (7.25” girth at base).
• Titan OTR:
• Maximum rigidity available in implants, specifically engineered for larger girth penises.
• Higher rigidity support will better accommodate the large filler-induced girth.
• Likely better at maintaining a higher erection angle given the heavy filler.

Winner: Titan OTR ✅

⸻

2. Length Maximization:
• AMS CX:
• Length is fixed (no length expansion), limited primarily by original surgical sizing.
• Does not significantly expand or lengthen over time.
• Titan OTR:
• Larger initial sizing potential due to slightly greater cylinder diameter and more robust construction.
• Supports aggressive sizing strategies, beneficial for your longer VED stretched length (8.25–8.5 inches).
• Superior length optimization when aggressively preconditioned with VED therapy pre- and post-surgery.

Winner: Titan OTR ✅

⸻

3. Erection Angle:
• AMS CX:
• Typically provides angles around 75–95° standing.
• May struggle with high filler-induced weight (downward gravitational force may lower angle).
• Titan OTR:
• Offers excellent rigidity/stability, particularly important with heavier filler-loaded penile shaft.
• Superior capacity for achieving higher erection angles (>90° consistently achievable with minimal RTE use).

Winner: Titan OTR ✅

⸻

4. Minimal RTE Length:
• Both AMS CX and Titan OTR can accommodate minimal RTE use if appropriately sized.
• Titan OTR cylinders available in numerous incremental sizes (20, 22, 24 cm, etc.) allowing more precision with minimal or no RTE use.

Winner: Titan OTR ✅ (slightly better due to sizing flexibility)

⸻

5. Flaccid Natural Appearance:
• AMS CX:
• Offers a relatively softer, more natural feel flaccid (due to silicone construction), favored for subtle appearance.
• Titan OTR:
• Slightly stiffer when deflated compared to AMS.
• Usually more pronounced rigidity in flaccid state but provides a full, substantial look—potentially advantageous given filler-induced fullness.

Winner: AMS CX ✅ (Titan slightly behind but acceptable)

⸻

6. Cylinder Diameter and Filler Consideration:
• AMS CX:
• Fixed standard girth cylinders, ideal for standard anatomical girth.
• Titan OTR:
• Offers larger-diameter cylinders capable of effectively filling and supporting the additional soft tissue volume from filler.
• Better at compensating and controlling potential tissue mobility from filler presence.

Winner: Titan OTR ✅ (strong advantage given extensive filler)

⸻

7. Glans Maximization:
• Both devices require careful, deep seating into glans to stabilize and maximize glans size safely.
• Titan’s firmer cylinder tips may provide superior stability for enlarged glans due to filler.

Winner: Titan OTR ✅ (slight advantage)

⸻

Final Recommendation & Justification:

Given your specific concerns—particularly the large filler-induced girth (7.25” base), your aggressive VED regimen with high maximal length, and your clear prioritization of rigidity, erection angle, and maximum achievable length—the Coloplast Titan OTR is likely the better choice compared to the AMS CX.

Titan OTR Key Advantages for Your Situation:
• Higher maximum rigidity, better supporting large girth induced by filler.
• Better erection angle maintenance (≥90° consistently achievable).
• Slight advantage in length maximization due to robust structure.
• Greater flexibility in cylinder sizes (20, 22, 24 cm increments), facilitating minimal or zero RTE usage.

⸻

Screenshot 2025-05-12 at 8.59.29 PM.png (223.15 KiB) Viewed 963 times

Suggested Surgical Approach & Post-Operative Protocol (Titan OTR):
• Cylinder Selection: 22–24 cm cylinder, ideally no RTE (or minimal <1 cm).
• Preoperative Conditioning: Continue rigorous VED routine to maximize tissue elasticity and cylinder accommodation.
• Cylinder Seating: Cylinder tips placed deeply (1–1.5 cm beneath coronal ridge) to stabilize and maximize glans appearance.
• Postoperative Therapy: Gentle cycling after healing; structured postoperative VED therapy (under surgeon guidance) to ensure tissue preservation, cylinder placement stability, and maximization of length.

⸻

Final Decision Recommendation:

Given your anatomical specifics, extensive cosmetic filler, and clearly stated goals—particularly achieving maximum rigidity, maintaining excellent erection angle, and optimal length outcomes—the Coloplast Titan OTR is strongly recommended over the AMS CX for your particular case.

This recommendation is tailored precisely to your unique anatomical, cosmetic, and functional priorities.

[Nico_from_belgium]

Yo, a lot of info there to give

First of all rte choice depends on your fat pad. If you're skinny you can probably avoid them if you have some fat probably need them.
I think you'll probably get a 24cm implant without rte or a 22 with rte if not too fat.
For the angle it's a matter of point it up while healing and anatomy.
Based on your size and that you have fillers (heavier dick) I'll go for titan with no doubt.

But most important thing, get a high volume surgeon!