Overview

Penile Lengthening

Increasing penile length requires releasing the suspensory ligament and the wearing of penile weights after the surgery. Releasing the ligament partially frees the penis from its pubic bone attachments, dropping it to a lower position, which may increase penile length or give the illusion of length gain. I usually perform the operation through a several-inch transverse (sideways) incision in the pubic hair. Many surgeons advance skin onto the shaft of the penis with VY advancement flaps. A V-shaped triangle of pubic skin is moved (advanced) to the base to the penis and closed in a Y-shape. However, a large VY flap based at the junction of the penis and pubic skin is not recommended, because it often produces a deforming hair-bearing hump at the base of the penis. It also is associated with a high incidence of wound breakdown. The low transverse incision does not cause such deformities.

HE PHALLOPLASTY PROCEDURE

Penis enhancement surgery is a relatively simple, safe operation performed on an outpatient basis under light general anesthesia. Surgery actually involves two separate procedures. Both are completely natural and do not involve the introduction of implants or other foreign materials.

In the lengthening procedure, the doctor releases the suspensory ligaments that attach the penis to the under surface of the pubic bone. This allows access to the section of the penis hidden behind the skin wall. He is then able to extend the length of the penis in proportion to the length of the internal portion.

The increase in length varies depending on a patient's anatomy. However, results generally range from 1-1/2" to 2." The limiting factor is the patient's own anatomy. There is no way to predict what that length gain will be prior to surgery. Post-operative stretching is essential to success.

PENILE ENLARGEMENT

The enlargement procedure involves a simple transfer of fat cells. The patient's own fat cells are used for augmentation because they do not run the risk of rejection of the body. The result is a penis of the same shape and length but greater in circumference. Because the penile shaft is narrower than the maximum diameter of the head, the doctor usually fills out the shaft slightly beyond the head's maximum diameter to maintain proper proportion.

Circumference can be increased by 50 percent or more, depending on the results desired by the patient. This is best achieved by a separate second stage fill procedure three months from the first.

In each procedure, increases occur in both the flaccid and erect state although length gain in the flaccid state is generally greater.

PENILE LENGTHENING

In this procedure, no actual length is created, rather, the internal portion of the penis is "advanced" or "externalized," exposing greater length. This is accomplished by resecting (cutting) a portion of the suspensory ligaments which hold the penis against the undersurfaces of the pubic bone between your legs.

We have developed and pioneered the use of the LASER to detach the ligaments. The advantages are: a smaller 1" incision therefore less pain, swelling and bruising and also quicker healing. There is less scar tissue produced to possibly obstruct the lengthening and therefore a better overall result is more likely. The ligaments are then reconstructed to prevent any change in the angle of erection and prevent scar retraction compromising the results. The use of the operating microscope also makes this a more precise operation.

Actually, another 3-4" of the penis is located INSIDE the body. This penile root actually arches upward inside the body and by resecting the suspensory ligaments, this upward arch is extended forward. A simple 1" curvilinear incision in the pubic area is all that is required to gain access to the ligaments. For overweight men, removal of some of the fat in the pubic area will also add to the perceived length increase of the penis. There is a small percentage (3-4%) of men who get no length gain at all in the erect state and rarely may even lose a bit of length due to scar tissue formation and retraction.


INFORMATION FOR MEN WITH PENILE IMPLANTS FOR ERECTILE DYSFUNCTION OR POST PROSTATE CANCER TREATMENT


We are often asked about MISL PhalloplastyT (Enlargement and Lengthening) in men who have had either solid or inflatable implants placed to treat Erectile Dysfunction (ED). These men often complain of loss of length or discomfort to their penis, or that the implant causes discomfort to their partner during sexual relations.

We can usually treat the discomfort by increasing the girth with our Free Fat Transfer procedure. This cushions the penis and has the added advantage of also enlarging the penis for added response by the partner. Depending on the type of implant, we can usually add length and restore what has been lost. However, these are done on an individual evaluation.

HERNIA PATIENTS

Generally referred to as a groin or inguinal hernia or a "rupture".

If you are known to have a groin hernia you should let your phalloplasty surgeon know about it.

Since these areas are intimately related, I feel that the hernia should be fixed before or even after the phalloplasty surgery (if it is a small hernia), but not as a rule at the same time as phalloplasty surgery.

" I examine every patient before surgery to see if there is a hernia and if it is significant.ain in length and girth seen immediately after completion of surgery. "

Penile Injection

This cosmetic surgery procedure takes fat cells from elsewhere in the body and injects them below the surface of the skin of the shaft of the penis to increase the thickness (but not length) of the penis. The penile shaft normally has little or no fat, and this method results in an unnatural appearance and feel, as well as risking radical shifting of the fat injected.

A related method involves injection of liquid silicone into the penis and scrotum. This technique can cause enormous increases in the girth of the penis (increasing the penis volume by over 900%) but is effectively irreversible and may have side effects including loss of sensation, inability to perform penetrative intercourse, scarring and deformation.

Inflatable implants

A further method is to replace the corpora cavernosa with inflatable penile implants. This is performed primarily as a therapeutic surgery for men suffering from complete impotence; an implanted pump in the groin can be manipulated by hand to fill these cylinders from an implanted reservoir in order to achieve an erection. The replacement cylinders are normally sized to be direct replacements for the corpus cavernosa, but larger ones can be implanted. However, the result is an uncomfortable stretching of the other penile tissues which can have a number of complications.

Non-Surgical Ways To Increase Penis Size

Trimming the pubic hair often gives the impression of a larger penis. Similarly, if you are overweight, losing weight will often have a similar effect in increasing the apparent penis size.

Post Operative Complications and Penis Enlargement

As with any form of surgery there are a number of potential risks both psychological and physical.

Answers To Some Commonly Asked Questions

Q. How Much And For How Long Will The Fat Survive?

A. This varies from person to person, but usually at least 80% to 90% of the injected fat survives long term, in our experience. The first patients were done over 10 years ago and have very satisfactory results. There is good reason to assume this enlargement will be permanent. The best part is that this is your own tissue and the process may be repeated in the future (if needed). We are now recommending that two transfers be done - 3 months apart.


Q. Are There Any Guarantees?

A. No. Unfortunately, no one can predict the amount of the fat survival in the fat transfer procedure or the length gain.


Q. What Can I Do As A Patient To Help The Results?

A. Everyone should realize that for the best results a full COMMITMENT to the program for four to six months is necessary. Sad to say, those who don't follow instructions can compromise initial good results.


Q. Are There Any Long Term Ill Side Effects?

A. Presently, there are no known long term ill side effects related to the fat transfer procedure or the lengthening.


Q. How Much Larger Can I Be?

A. This varies in every patient, however, an increase in diameter (thickness) of 50% is the usual goal.


Q. Why Is Width More Important Than Length?

A. During sexual intercourse an excessively long penis can be painful to a woman. However, with an increased girth, the increased sensation along the vaginal walls increases the pleasure of the partner, since the sensory nerves are more concentrated in the lower end and sides of the vagina.


Q. How Much Time Do I Need Off Work And Why Must I Wear A Bandage?

A. The procedure is performed on an outpatient basis and most patients can return to work the following day. The support bandage must be worn to ensure that the skin heals smoothly and to reduce swelling. One week is usually sufficient.


Q. When Can I Return To Sexual Activity?

A. Sex may be resumed 4-6 weeks after lengthening and/or girth enlargement. However, it takes three to six months to achieve maximum erection length.


Q. Will I Still Be Able To Have Children?

A. Yes. If you were able to have children prior to having surgery you will be able to have children after. This surgery does not interfere with the ability to have children.


Q. How Much Pain Is Involved?

A. Most patients find the post operative course quite tolerable. There is minimal pain in the penis and most patients complain of discomfort rather than pain, which is easily controlled with pain pills.


Q. Is There Any Loss Of Feeling And How Does The Penis Feel When It Is Erect?

A. There has been no reported loss of sensation from the procedure. When erect, the penis remains firm with a thick cape of fatty tissue surrounding it. In about 5% of patients, the fat can form small nodules that can be easily taken care of as a minor outpatient procedure under local anesthesia.


Q. Why Is Free Fat Transfer (Fft) Used And Not Dermagraphs Or Alloderm?

A. Despite what you may have heard or read about Free Fat Transfer (FFT) - it doesn't work, it disappears, it leaves cysts or nodules, or "lumpy-looking," distorted penises - this simply isn't true anymore if FFT is done correctly.



To understand what has brought about this misinformation, we need to examine the beginnings or early years of Penile Enlargement (P.E.). Knowledge was gained through our experience with transferring or grafting free fat from liposuction to other areas of the body (such as the face) that some of the fat graft, for various reasons, would disappear. To compensate for this loss, a little extra "over fill" was done. This usually worked well in areas where a small amount of fat was used such as the cheeks, lips or deep facial wrinkles. For the best results we found that repeating this method in a few months worked well.

The problem arose when a few very high profile doctors, using this theory of "over fill," put excessive fat in the penis and the body could not develop a blood supply to the grafted fat quickly enough. Some of the fat died and was absorbed into the body. Unfortunately the fat was not evenly absorbed, and this resulted in lumpy, distorted penises which were difficult to correct.

Improperly performed lengthening procedures which did not apply good Plastic Surgery principles (such as Z plasties, Y-V plasties, U plasties, etc.) left unsightly visible scars and created unacceptable results, thus causing Phalloplasty to be legitimately criticized by many unhappy patients. Unfortunately, this "bad press" has still persisted.

Several years ago at Aesthetic Plastic Surgery International (APSI), I abandoned these techniques and quickly discovered that the best results in FFT could no longer include the practice of over filling the penis. I then fabricated surgical instruments to take the appropriate size pieces of fat and developed techniques for placing them properly in the penis in two stages at least three months apart. Along with adding a combination of special nutrients to prevent the fat from being absorbed and to promote increased blood supply to the graft, I found this to be the simplest and safest answer to the problem.

At We Care India partner hospital, we are continually working along these lines to keep improving results. I am happy to report that results are very good and getting better. The incidence of cyst, nodules or any other complications with this procedure is now very, very low and easily fixed.

Let me share a few words about Dermal Fat Grafts (DFG) and AlloDerm. I have seen and repaired many cases where the DFG have twisted, shortened, become infected and have ultimately caused permanent loss in penile length. Unsightly large painful donor site scars have also occurred. Many times it is very difficult to control the size of the thickening with these DFG and, as a rule, you only get one chance at a good result.

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