Background

I contacted both hospitals by email and within 2 days received positive responses. Both hospitals had the facilities and the doctors willing to perform the procedure. I opted for Bangkok Nursing Hospital as the hospital was more accessible and there was a lot more to see in Bangkok.

Finally I had a viable option, but I was still hesitant. I wanted to know more information about the procedure and the results.

Over a couple of weeks I traded numerous emails with Bangkok Nursing Hospital (BNH) trying to glean some important information about the procedure. However, it became increasingly frustrating and slow. Each email and each answer conjured up many other questions that needed answered.

Instead of continuing this frustration I decided to take the plunge and fly to Bangkok to see the doctor face to face and play it by ear. Even if I decided not to go through with the procedure at least I had made the effort and all my questions would be answered.

I immediately sent a request for an appointment with Bangkok Nursing Hospital and headed off within the week.

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Doctors Consultation

My appointment the day after my arrival was with a Dermatologist in the hospitals 'Dermatology and Beauty Centre' or 'Skin Clinic'.  

I was a little uncomfortable at the start of the consultation due to the subject manner, but gritted my teeth and revealed my problem. Once I began it was a lot easier. As it tuned out she was very understanding and respectful both during the consultation and during the procedure. A testament to the Thai culture.

Like most doctors the Dermatologist did not know much about pearly penile papules. She did know that they were "normal" and treatment was not really required. Knowing this would be her first comment I quickly established that I still wanted them removed.

The Doctor had never used CO2 laser on pearly penile papules before nor had she heard of previous procedures. This being the case she was not sure of the results. The only information she had, was the information I had located on the internet. Although vague references, I informed her treatment by CO2 laser had been used with success.

Her next stop was inspecting the papules. After seeing them in the flesh she was quietly confident that CO2 laser would be effective in the removal.

We then went on to discuss the procedure and the possible results in more detail. I won't go into all that we discussed right now as I believe the following description of the procedure and recovery will contain all the answers I was seeking and I am sure you are now.

Before continuing the Doctor felt it important to advise me of some "possibilities" due to her not encountering pearly penile papules before:

1. Possibility of minor scarring (maybe some redness)
2. Possibility they may grow back
3. Consider doing a test area first

Let me say now, that her "possibilities" did not eventuate. The results speak for themselves. After the healing phase there is no noticeable scarring, no redness and as at 8 months after the procedure there is no sign of regrowth.

She also assured me that my major concern, loss of skin elasticity, was not an issue. The skin would heal and maintain its elasticity after the procedure.

Extremely happy with what I was hearing I agreed to go ahead with the procedure. I wasn't going to turn back now. At worst a smooth slightly red penis was a billion times better than having pearly penile papules.

At this stage I agreed doing a test area would be the best option, then, if the results were good after 7days, she would remove the rest of the papules with a second procedure. 

Initially, she was only going to remove about one centimeter or so, but as you will see in the pictures below, she was so impressed with the results during the procedure she ended up removing all the papules that had been numbed by the anesthetic cream (a little more than half).

A note on lasers: There are a number of different lasers available to doctors such as CO2 laser, Sciton laser, fraxel laser etc. Sciton laser definitely does not work according to the experience of a member. Each laser performs in different ways and with different strengths. At this stage CO2 laser is the only laser that has been shown to be effective in removing PPP. So, it important that you insist on CO2 laser even if the doctor advises otherwise. Until more is known about PPP removal there is no need attempt other lasers which may not produce the desired result. CO2 laser has proven to be effective not only in my case, but in other cases as well, so stick with what works. Insist on CO2 laser!

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STAGE 1 - Application of Topical Anesthetic Cream

Product used - Elma Cream 5%
http://www.astrazeneca-us.com/content/products/productDisplay.asp?id=30

Note: The Elma website suggests that if you have allergies to amide-type local anesthetics or to tape, then another option should be used

Elma cream is used to numb the area before the laser treatment. Basically to ensure no pain is felt during the procedure. This is a simple and effective method. Another option that the Doctor gave me was to have an anesthetic injection. This idea I was not too keen on. I assumed it would be a local, meaning a needle in my penis...that was definitely a scary thought. The Elma cream it was then...

The doctor applied a thick layer of the cream directly on the pearly penile papules and then covered the area with a thin clear dressing that kept the cream contained and in place.

I then had to wait 40 minutes for the cream to deeply saturate the area and work its magic.

TIP: I suggest you check every 5 - 10 minutes to ensure the cream remains in a thick layer on the papules. If you have a foreskin, like me, it is even more important to check regularly as your foreskin can push the cream away from the area.

RECOMMENDATION: Comments in the Members Forum suggest that having a penile block (injection) is a much wiser choice, instead of just the cream. The penile block plus the cream for extra protection is an even wiser choice. The injection is not a dramatic as many will picture. It is a tiny size needle that is injected at the base of the penis (where the penis and groin meet). One member said it can hardly be felt. This will allow the doctor to do his/her work without you moving and without you feeling any pain. If I knew this information before I had my procedure I would definitely have taken the penile block.

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STAGE 3 - Recovery

Ointment used - 'Fucidin' sodium fusidate antibiotic ointment 2%
http://www.medicines.ie/emc/assets/c/html/displayDocPrinterFriendly.asp?DocumentId=5486
http://www.medbroadcast.com/drug_info_details.asp?brand_name_id=1551

Note: This ointment should not be used by anyone allergic to fusidic acid and its salts or to any of the ingredients of this medication. Anyone allergic to lanolin should not use the ointment.

The Doctor prescribed 'Fucidin', an antibiotic cream to be applied to the lasered area 2 times daily -morning and evening. It would take approximately 7 days to heal and during this period it was important to keep the area clean and dry.

TIP: If you have a foreskin that covers the area you will not have any problems with the area "rubbing" against your pants. If you don't have a foreskin you may need some sort of light dressing to act as a barrier.

To facilitate a clean and trouble-free recovery I used the following:

• Alcohol wipes - to clean and disinfect the area before applying the antibiotic ointment. They were also very convenient to use.
• Cotton ear buds - to apply the antibiotic ointment. I initially tried to use cotton balls and cotton pads but the individual fibers came off and kept sticking to the wound. The cotton ear buds were by far the best.

I was very surprised with how quickly the wounds closed up. Within 5 days the wounds had basically sealed and well on its way to a scar free recovery. Beyond day 7 it was just a matter of waiting for the tiny "scabs" to disappear and for the skin to toughen up.

I might mention at this point that I was also taking a few vitamins that have shown to contribute to a fast recovery time after surgery. I can not definitively say that these vitamins played a part or not. However, I think it is better I mention all the variables. I also made sure I was drinking at least eight glasses of water every day. The vitamins I was taking are:

• Vitamin C
• Zinc
• Fish Oil Capsules (can substitute with Vitamin A or E)

I have taken these vitamins on a daily basis for a number of years as part of my own health regime. If you want to go down the path of taking vitamins, I would suggest you start taking them a week or two before the procedure.

Links
Zinc - http://www.blackwell-synergy.com/doi/abs/10.1046/j.1365-4362.2002.01567.x;jsessionid=aTzpFH6ijfehvMEu3W?cookieSet=1&journalCode=ijd
Vitamin C/A/E -
http://www.woundhealer.com/e_nutrition/nutrition_in_wound_healing.htm
http://www.svcmc.org/112869.cfm

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DAY 1 - The day of the procedure

The appearance of the lasered area was dramatically better than how I thought it would look. Instead of black and blue like I expected, the area was slightly red with whitish dots where the papules used to be and a little swollen. The burning effect of the laser had sealed the wounds close, resulting in a pretty clean look without any weeping.

Immediately following the procedure I felt some noticeable discomfort for about 1 to 2 hours after the procedure. I was a bit tentative not knowing what to expect. It was nothing dramatic. I was able to get back to my hotel on public transport without any problems. I was also able to urinate during this period without any problems or pain.

After this initial 1 to 2 hour period, the discomfort subsided and I did not feel any pain at all. Later that night I was able to get an erection without any pain and was even able to masturbate. This I had to do a little more cautiously than normal and not pull my foreskin back all the way, but everything functioned well without pain. I mention this to demonstrate how painless the recovery period is and how it is not necessary to suppress your sexual desires. You definitely have to abstain from sex, just not from masturbating.

For the first night I did not touch or clean the area as the doctor had already put the antibiotic cream on at the end of the procedure. I also thought it needed just a little extra time to recover from the procedure.

The pictures below show the appearance after the laser treatment. You will notice in the pictures the right side is the lasered side. 

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DAY 2

Today the white lasered tops that appeared as dots disappeared somewhat overnight and the area looked more like small open wounds. They still did not weep.

My foreskin protected the wound area from water when I was having a shower, which was good. If you do not have a foreskin or your foreskin does not cover the area entirely, you may have to take some other measures (ie wrap it up in plastic).

After my shower I cleaned the wound area using alcohol wipes. I had to be very light and gentle. I felt that typical alcohol on open wound type sting for a few seconds afterwards. Bouncing my leg up and down while gritting my teeth seemed to work for me. I put up with the pain as I wanted to ensure that I kept the area clean. This was definitely not an area I wanted an infection to take hold. If this is too much for you could maybe use sterilised water or a diluted alcohol solution. Once clean I used the cotton ear buds to apply the antibiotic cream. It was not painful to apply.

I went through about 3 to 5 alcohol wipes and about 3 cotton ear buds each time.

During the day I did not feel any discomfort or pain at all. I was able to do all the activities that I planned to do. Everyday normal activities were no trouble at all. I was walking around, sitting and standing. I even had a workout at the gym, which involved a run on the treadmill and lifting weights. No matter what I did I felt no pain in the area what so ever.

After my workout and again before I went to bed, I cleaned the area and applied the antibiotic cream. I thought there was no harm in applying the cream more than the 2 times requested by the Doctor.

Sleeping was absolutely no problems. Whether rolling around, sleeping on my stomach or side nothing caused any pain or discomfort.

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DAY 3

Despite the appearance of the pictures, today there was a noticeable positive difference in the healing. There was a small amount of blood coming to the surface, however this seem to contribute to the closing of the wounds.

In the morning I showered, cleaned the area and applied the antibiotic cream. The alcohol wipes "stung" a little less today.

Today I was a bit concerned that I was not allowing the wound to breathe. Being it was always covered in the cream and concealed under my foreskin. I was drawing on a couple of experiences I had a number of years back. About five years ago two individual papules came off during rough masturbation. They were very slow to heal, but when I made the effort to let the wound air dry they quickly healed. They also never grew back.

I decided to apply this method today. In the afternoon after cleaning the area I let the wound breathe. I held my foreskin back for about 15 minutes then let it "hang" for two to three hours. Every now and then I would hold my foreskin back for about 5 minutes to air dry. You can take this time to admire the your new look with a huge grin on your face.

This definitely helped the area to heal a lot quicker.

Before bed I again cleaned the area and applied the antibiotic cream for the night.

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DAY 4

Again the pictures are a little deceptive. By day four the wounds had closed up with a crust or scab forming over the wounds. The appearance of some blood the day before made this a natural progression. The individual red dots became more apparent instead of the whole area looking like a wound.

I decided to extend my "allowing the area to breathe" method mentioned in Day 3. From today onwards I only left the antibiotic cream on for an hour or two then cleaned it off and left the area dry. In my opinion with the wounds closed there was minimal risk of infection.

Today, I was desperate to get in the pool. I was staying at an exotic location with a great pool. I just could not resist. Being that the wounds were closed and my foreskin protecting the area somewhat, I felt it was okay to risk the pool. I spent a few very relaxing hours in the pool and had no problems at all.

Even though the wounds are closed it is still important to keep the area clean and sterile until the area is completely healed. So, once out of the pool I cleaned the area and applied the antibiotic cream.

Later in the afternoon I masturbated and a small area re-opened and began to bleed. However, this closed up again within the hour. Nothing serious at all. This just goes to show how thin and delicate the area is at this stage.

Tonight I cleaned the area and slept without any antibiotic cream. This definitely seemed to help it heal better so continued this practice from this night onwards.

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DAY 5 and 6

The wounds completely closed up during Day 5 and Day 6 and the skin began to regenerate. The only noticeable signs of the papules were small red dots.

I continued to clean the area two to three times a day and applied the antibiotic cream only once during the day, whilst leaving the area clean, dry and cream free during the night.  

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DAY 7 - Follow-up and procedure to remove remaining pearly   
               penile papules

Today was my follow-up appointment with the Dermatologist and the day of the second procedure to remove the remaining pearly penile papules.

The doctor was very impressed with how the first half was healing. In fact she said it was "perfect" and expected "no scarring". I had come to this conclusion as well.

She was happy to go forward with the second procedure to remove the remaining papules. The area that was to be treated was where the papules were most dense or concentrated.

I was a bit lazy in making sure the Elma cream remained on the area for the second procedure. This resulted in me feeling some pain during the laser process. Most of the pain was bearable but at times it was not, so the Doctor had to apply more Elma cream and leave it on for another 20 - 30 minutes. This did the trick. Hence my TIP.

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DAY 10

The skin continued to toughen up and by DAY 10 the area was looking good. Only pin prick size dots on some areas. No real signs of the laser treatment or that there were even pearly penile papules there in the first place. It was seriously like they were never there in the first place. The skin was very smooth. No bumps or rough spots.

I deemed it was probably safe to have sex, though left it a few more days to be on the safe side.

Today I masturbated lightly with baby oil just to get the feel of it. It was still very sensitive, but felt incredibly smooth. A totally different sensation without the papules.

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DAY 14 - Trial run

By day 14 the skin had toughened a little more. The area was still a little delicate but the skin had toughened up enough to try gentle sex. My partner gave me a head job and commented on how it was so smooth. It was just like a "normal" penis.

During the headjob and sex I noticed the sensation was different to what it was before. It was still pleasurable but it was like a new feeling. Before, the papules seemed to heighten sensitivity in a different, quite in your face way. With the papules gone it was a totally different sensation. It was definitely something I knew I had to experience more and get used to the feeling.

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Life Beyond Removal

 In the third and fourth week a section of the skin broke open and began to bleed, however it closed up within the hour. This has not occurred since. The skin needed more time to thicken.

As I write this it is ten weeks since Day 1. It is noticeably tougher and more thicker than at Day 14. The skin has definitely toughened up enough for aggressive wear. See [Before & After Pictures]. My penis now looks just like a 'normal' penis.

I have had sex on a regular basis since the third week. It took a few turns at the wheel (so to speak) to learn to appreciate the new sensation...and I can say it feels just as good. In fact I would say it feels even better now that I can sit back and enjoy a head job and have sex not having to think about pearly penile papules. For those worrying that there will be loss of sensation, I can definitely confirm this is not the case.

I am enjoying sex a whole lot more. I can relax and concentrate on enjoying the pleasures and the sensations instead of feeling ashamed or being worried. It feels liberating. It is like I am exploring a different aspect of sex. And blow jobs are great!!

NOTE: I might add that it is probably not wise to engage in any unsafe sex for the first month or two due to the skin still being delicate. Well it is not wise to engage in unsafe sex at all.

Going through all this has lifted a great deal of stress of myself. Like a huge weight has lifted of my shoulders. This has carried on into every aspect of my life. It is something I do not have to worry about anymore.

Well, that's it. I hope this answers all your questions and gives you the courage to go through with the Procedure with the confidence and knowledge that it will all work out. With all the information you now have there is no reason to suffer in silence any longer!

Update: It is now almost 8 months since I went through with treatment. There is absolutely no signs of regrowth (as I had expected). I have had no troubles, problems or concerns since I last wrote about the healing phase. It is like they were never there in the first place.

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The forum already has some great success stories, tips and further advice from other members who have gone through with treatment, are actively seeking treatment or are going through with treatment. There is some valuable information within the posts which may help you further, so I encourage you to join in on the discussions. It is also a great place to raise questions, concerns or just get some support.

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