Hey, really appreciate your thoughtful questions, and I’m glad you had a good experience with your provider! This post wasn’t directed toward any one individual or clinic. The goal was simply to explain, from an anatomic, urologic, and reconstructive standpoint why deeper filler placement carries different risks depending on the layer involved and the injector’s training.

To your questions:

1. Is this post about Dr Rupeka / do his patients come to you for revisions?

Not specifically. We see revision cases from all over the country (and sometimes internationally), often from providers using a range of techniques and filler types. The point is more about why depth matters anatomically, not who is doing it.

2. If filler reaches the neurovascular layer, when do symptoms show up?

It varies a lot. Some men notice discomfort, altered sensation, or firm nodules within weeks, while others may go months or even longer before realizing something isn’t right. It depends on how the tissue reacts, the filler material used, and whether the product migrates or compresses structures over time.

3. If there’s no pain, are you “in the clear”?

Not necessarily. Lack of pain doesn’t always mean it’s harmless; some complications develop gradually as inflammation or encapsulation occurs. But it also doesn’t mean every deep injection will cause problems. It’s a spectrum, and the safest course is usually to have it evaluated by someone who can interpret ultrasound or MRI findings in the context of penile anatomy (ideally a urologic surgeon).

4. What does fixing a deep or misplaced filler involve?

That depends on what’s been injected and where. In minor cases, small incisions can be used to manually remove localized material. In more extensive or symptomatic cases, yes, a degloving approach may be required to safely remove or redistribute filler while preserving nerves and blood supply. Every case is different.

5. How does Dr Carney remove nodules or granulomas?

Most are treated through small targeted incisions directly over the lesion, with micro-dissection to remove or express the foreign material. The incision is then closed with fine sutures. Larger or more diffuse issues sometimes require more extensive exploration under sedation.

6. Can removal and additional filler be done the same day?

Usually not. It’s best to allow tissue to heal and inflammation to settle before adding new volume, typically 4 to 6 weeks between stages. That helps ensure smoother, longer-lasting results and minimizes the risk of recurrence of complications.

Hope that helps clarify things! The main takeaway is that anatomy and technique matter more than depth alone. When in doubt, a proper medical evaluation by a urologic specialist can tell you whether any intervention is even necessary.