Techniques & Expectations
Surgical techniques used for penile enlargement (enhancement phalloplasty) -- penile lengthening and penile widening (girth enhancement) -- have been in the urologic literature for many years.
There are various ways of enlarging the penis. In my practice, patients either have a lengthening or widening alone, or a lengthening and widening in a single session. Glanular enhancement may be performed alone or combined with any procedure.
Click to see before and after photos of lengthening procedures:
Approximately one-third to one-half of the penis is inside the body, and is internally attached to the undersurface of the pubic bone. Penile lengthening involves the release of the fundiform ligament and the suspensory ligament that attaches the 2 erectile bodies to the pubic bone. The suspensory ligament makes the penis arch under the pubic bone. Release of this ligament allows the penis to protrude on a straighter path, further outward to give more functional length. I use a 1" to 1½" lower abdominal incision in the pubic hair area for concealment or a new incision in the penile-pubic crease for concealment. This is a relatively minor procedure. There will be no scar on the penis and there is no possibility of pubic hair on the penis. I highly recommend use of specially designed penile weights to maximize penile lengthening.
Penile length gain in the flaccid state.
Average expected length gain is 1 inch. Well motivated patients may gain up to 2 inches. After Allograft Dermal Matrix Graft (Alloderm ®) widening, the penis does not shrink to its original small flaccid length, but stays slightly longer.
Penile length gain in the erect state.
Usually there is a slightly smaller penile length gain in the erect state than in the flaccid state.
PENILE WIDENING (PERICAVERNOSAL) Click to see before and after photos of widening procedures:
We have noticed a permanent increase in penile girth (circumference) in the flaccid state with our pericavernosal (P/C) Allograft Dermal Matrix Graft (Alloderm ®) technique. While a 40 to 50% gain in girth (flaccid state) may be achieved, most men get an increase of about 30%. An approximate 10 to 15% gain in girth is obtained in the erect state.
Because autograft dermal fat grafts for penile widening require a donor site(s) and, therefore, incision(s) and scar(s) --- 6 years ago I stopped using autograft dermal fat grafts and since then only use Allograft Dermal Matrix Grafts (Alloderm®) in my patients who wish penile widening.
The advantages of Allograft Dermal Matrix Grafts (Alloderm®) over autograft dermal fat grafts are: it eliminates the need for incisions and scars at the donor sites (because there are none) and it significantly reduces the length of surgery.
With the Allograft Dermal Matrix Graft (Alloderm ®) technique we are adding multiple layers of Allograft Dermal Matrix Graft (Alloderm ®) under the penile skin on top of the erectile chambers to give thickness by "stacking" or "folding" the grafts. I do not use strips of Allograft Dermal Matrix Graft (Alloderm ®), but create a conjoined graft. There are no contour defects and appearance and feel are normal. A penile stretching device is suggested after the widening procedure to combat Allograft Dermal Matrix Graft (Alloderm ®) contraction that might occur.
I have found this technique to be effective with a high satisfaction rate.
PENILE WIDENING (ALBUGINEAL/CAVERNOSAL)
Some men wish a wider penis in the erect state. In the last 7 years several techniques of albugineal/cavernosal penile widening have been introduced that allow an increase in the volume of the tunica albuginea in the erect state. These techniques have utilized: dermal grafts, vein grafts and porcine grafts. Because of my experience with Allograft Dermal Matrix Graft (Alloderm ®) for pericavernosal girth enhancement in the flaccid state, I am now offering albugineal/cavernosal (A/C) penile widening using Allograft Dermal Matrix Graft (Alloderm ®) to obtain a wider penis in the erect state. Because albugineal/cavernosal penile widening is a new surgical technique, efficacy is not known and the risks and complications are not known. We expect an approximate 30% gain in girth in the erect state and 10 to 15% gain in the flaccid state. A vacuum device is advised postoperatively.
COMBINED PENILE WIDENING PROCEDURE (PERICAVERNOSAL AND ALBUGINEAL/CAVERNOSAL)
For men wishing a wider penis in the flaccid and erect state, I combine my standard technique of penile widening (P/C) in the flaccid state using Allograft Dermal Matrix Graft (Alloderm ®) with the new albugineal/cavernosal (A/C) penile widening technique using Allograft Dermal Matrix Graft (Alloderm ®) for flaccid and erect penile widening. Because the combination is a new surgical technique, efficacy is not known and the risks and complications are not known. We expect an approximate 30 to 40% permanent increase in penile girth in the flaccid state and an approximate 30 to 40% gain in the erect state.
These procedures are performed in an outpatient ambulatory setting, either at a hospital or in a private surgical facility. State licensed personnel use a combination of anesthetic techniques that will assure you a painless experience.
SECONDARY PENILE WIDENING
Click to see before and after photos of widening procedures:
Sometimes a patient who has had penile widening by: liposuction/lipotransfer (fat injection) or autograft dermal fat graft or Allograft Dermal Matrix Graft (Alloderm ®) wants additional girth enhancement.
During the last six years I have used my Allograft Dermal Matrix Graft (Alloderm ®) penile widening technique to insert Allograft Dermal Matrix Graft (Alloderm ®) above or below the previously inserted graft with very satisfactory results in patients who had one or a combination of the above widening procedures.
Click to see before and after photos of glanular enhancement procedures:
Glanular enhancement is a relatively new surgical technique. Very few surgeons around the world are performing it. However, it can be done successfully with the Allograft Dermal Matrix Graft (Alloderm ®).
A reasonable expectation is between 15% and 20% increase in the flare of the glans. If performed with penile widening, no additonal incision is required. A penile stretching device is not necessary after this procedure.
If the scrotum extends along the underside of the penis it may make the penis appear short on the underside, like a "turkey neck." This can be corrected by a Z-plasty or an inverted V to inverted Y plasty scrotal adjustment under local anesthestia, or at the same time as penile lengthening or penile widening or glanular enhancement.
Click to see before and after photos of correction of penoscrotal webbing:
REDUCTION OF INFRAPUBIC AND SUPRAPUBIC FAT PAD
If the pubic area has excess fat due to increased pubic or suprapubic fat the penile shaft may be partially or completely hidden. Various procedures can make the penis more visible. These procedures are usually performed at the same time as penile lengthening or penile widening.
LIPOSUCTION AND FAT INJECTION TECHNIQUE
Since 1991, surgeons have performed liposuction and fat injection into the penis. While this can temporarily widen the penis, in the long run, I find this procedure unpredictable. It often results in penile irregularity and the augmentation always decreases with time. During an erection the injected fat will be softer than engorged tissue that hardens the penis.
Men who are particularly poor candidates for this technique are those with litte body fat (lean men). These men are often: bodybuilders, weight lifters, models, actors, and dancers. Often these men require several injections over time to have more fat injected into the penis.
I do not perform this procedure.
The frequency of complications is not known because there are no large-scale studies reported in the medical literature. Consequently, some physicians consider these procedures to be experimental or investigational.
The following complications from penile lengthening and Allograft Dermal Matrix Graft (Alloderm ®) widening (pericavernosal) are theoretically possible:
- Loss of erect upward angle of the penis. This has occurred in one of my patients.
- Keloid scars (a thick scar). This is unusual but can often be treated by injections of medication.
- Scarring causing a shorter penis. I have never seen lasting shortness in my patients who use a penile stretching device.
- Absorption of the Allograft Dermal Matrix Graft (Alloderm ®) with loss of thickness. I have seen one patient who had partial absorption and some loss of thickness.
- Contracture of the Allograft Dermal Matrix Graft (Alloderm ®). I have seen one patient with partial contracture of the graft.
- Separation of the Allograft Dermal Matrix Graft (Alloderm ®). I have seen one patient with proximal graft separation.
- Failure of the Allograft Dermal Matrix Graft (Alloderm ®) to "take". This has not occurred any of my patients.
- Skin incision separation. I have seen slight temporary skin incision separation in a few of my patients.
- Loss of some penile skin. This rarely occurs.
- Bleeding. I have seen one patient with a collection of blood under the skin that was easily managed.
- Fibrosis of superficial vein. This rarely occurs and usually resolves by itself.
- Infection. I have seen one patient who developed an infection and lost the graft and one patient who lost part of the graft, and two patients who did not lose the graft.
- Ecchymosis (bruising). This occasionally occurs and resolves by itself.
- Nerve injury resulting in decrease of penile sensation. This has not occurred in any of my patients.
- Edema (temporary swelling of the skin). I have occasionally seen this in my patients.
- Seroma (collection of serum under skin). This has not occurred in any of my patients.
- Erectile dysfunction (difficulty with erection). This has not occurred in any of my patients.
If some of these complications occur, further surgery may be required.
Some penile length may be obtained by significant weight loss (greater than 35 lbs.) if a large infrapubic fat pad is present or by a penile stretching device. Complications may be associated with these forms of treatment. Also review Frequently Asked Questions about penile enlargement surgery ( phalloplasty ).
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