Penis thickening surgery

Corrective surgery of the male genitalia, in particular, surgery to thicken the penis, as well as increase its length, refers to phalloplasty.

Indications for the procedure

The main goal of phalloplasty is to restore the normal anatomy of the penis and its functions after injuries or to correct congenital anomalies (including the urethra. But there are essentially no medical indications for penis thickening. That is, surgical methods were not initially intended for purely cosmetic use - increasing the length or thickness of the male genital organ. However, the development of aesthetic surgical plastic surgery has also affected the genitals. And this, according to most experts, is more likely to be related to the field of psychology and sexopathology: either men with low self-esteem and lack of confidence in their sexual performance (and no idea of the actual average penis size) or those who are dissatisfied with their sex life and decide that penis thickening or lengthening surgery will dramatically improve the situation undergo penis enlargement surgery. [ 1 ]

According to British experts, about 45% of men are dissatisfied with their genitals, even if they have normal size and function; according to information from ASAPS (American Society of Aesthetic Plastic Surgery) specialists, the number of dissatisfied people among Americans varies depending on age in the range of 17-38%.

Doctors also note that most men who want to increase the size of their penis have physiologically normal penis parameters, but are seriously concerned about its size, possibly due to the manifestation of pathological dissatisfaction with their external appearance, that is, dysmorphophobia.

So, aesthetic surgery of the genitals can increase the self-esteem of men with complexes, who, by the way, do not know that for seven out of ten women, the size of the penis of a sexual partner does not play such an important role.

Preparation

At the preparatory stage, blood tests (general, coagulogram, for STDs, HIV, hepatitis types B and C) and a smear from the urethra (to detect urogenital tract infections) are prescribed.

The patient is examined by a urologist-andrologist and the urogenital area is visualized, since in practice there are many cases where, along with unfounded concern about the size of the penis, there are certain functional disorders that negatively affect sexual life (for example, premature ejaculation).

The patient should receive all the necessary information regarding the upcoming intervention or procedure, including the actual results of a particular method (since most men have high expectations of phalloplasty), as well as possible complications.

Although plastic surgeons often assure that such operations are completely safe, the results of studies of available methods of penis thickening (and lengthening) in terms of their safety, effectiveness and patient satisfaction are mixed. Such operations are quite risky and not always effective, and patients should be aware of this.

Therefore, it is important to consult a psychotherapist and try to dissuade the patient if he does not have a real problem, but a manifestation of penile dysmorphophobia.

Technique Penis thickening surgery

The specific technique for performing emicircumferential phalloplasty, which increases the thickness of the penis, depends on the method – surgical or non-surgical. However, non-surgical procedures (but still invasive) have not yet been standardized.

Surgical methods include autoimplantation of an adipofascial (skin-fat) flap in the form of a strip, which is taken from the groin area or from the gluteal fold, and then transferred to the penis and placed between its Buck and Dartos fascia around the circumference. The operation lasts about seven hours and has many complications (including penile tissue compaction, its curvature and shortening, as well as transplant fibrosis). Therefore, it is now resorted to in rare cases. As well as the use of allografts such as Alloderm, which are acellular inert dermal matrices (obtained from human donor skin).

Also used is an absorbable acellular collagen matrix (collagen matrix such as Pelvicol or BellaDerm), implanted into the penis (around the shaft) under the Dartos fascia either through a transverse suprapubic incision or a subcoronal approach (with displacement of the penile skin). One year after the operation - due to the formation of endogenous tissue - the average thickening of the penis can be from 1.7 to 2.8 cm.

In practice, in most cases, lipofilling is used, as well as such a non-surgical method as subcutaneous injections of gel fillers based on chemically modified hyaluronic acid - a gel implant for thickening the penis. [ 2 ]

Under local or epidural anesthesia, lipofilling is performed to enlarge and thicken the penis - autotransplantation of adipose tissue, which is obtained during the first stage of the procedure - liposuction, that is, aspiration (pumping out) of fat from the lower part of the peritoneum (through a puncture in the suprapubic area). The adipose tissue is processed (decanted and filtered), and then with a syringe, using special injection methods, it is injected along the entire length of the penis shaft or around its circumference. Lipofilling can increase the circumference of the penis in a non-erect state by 2.5-3.2 cm (but the thickness decreases during erection).

The procedure for introducing dermal gel fillers based on hyaluronic acid, used for contour plastic surgery, is carried out under local anesthesia (an injection of lidocaine is made into the nerve at the base of the penis). The fillers used are Perlane, Restylane, Juvederm, and also the stabilized gel Macrolane.

Such an injection can make the penis 2.5 cm thicker, but due to the biological degradation of hyaluronic acid – no longer than 10-12 months (with Macroline gel – up to one and a half years). [ 3 ]

Contraindications to the procedure

Any corrective phalloplasty procedures are contraindicated:

• under 18 years of age and over 60 years of age;
• if the body temperature is elevated;
• there is bleeding of any localization;
• if patients have infectious diseases, as well as chronic or acute inflammatory processes;
• for sexually transmitted diseases;
• if the level of platelets in the blood is low, that is, with poor clotting;
• if you have diabetes;
• in cases of dermatological diseases (including fungal diseases) localized in the urogenital area;
• in diseases of autoimmune etiology;
• for psychogenic conditions and mental illnesses.

The use of hyaluronic acid gel has additional contraindications, including: anogenital papillomas, atopic dermatitis, cutaneous collagenosis, active form of systemic lupus erythematosus or scleroderma, chronic discoid lupus erythematosus. [ 4 ]

Consequences after the procedure

The most likely negative consequences of penile plastic surgery for the purpose of thickening are the formation of soft tissue edema, hematoma, secondary infection (with a focus of inflammation), proliferation of connective tissue with the formation of scars.

Complications of autoimplantation of the skin-fat flap include compaction of the penile tissue, its curvature and shortening, as well as fibrosis of the transplant.

The use of allografts for penile thickening is complicated by the formation of erosion, as well as the development of fibrosis and skin resorption, which can shorten the length of the penis and impair its function.

According to clinical data, severe penile edema and the development of ischemic ulcers are complications after implantation of the collagen matrix.

Lipofilling does not provide a long-term stable result (maximum - two years), since gradual resorption of adipocytes occurs. And mechanical trauma to the penis during the procedure can cause fat necrosis.

In addition to complications of liposuction, the introduction of fatty tissue into the penis can cause complications such as the formation of cysts, lipogranulomas and seromas, as well as tissue microcalcifications. As a result, asymmetry of the penis and a bumpy surface are observed.

Immediately after the procedure of introducing the gel with hyaluronic acid, the skin color temporarily changes, swelling occurs and local numbness occurs. With superficial introduction of the gel filler (or exceeding its volume), granulomas may form. After some time, this procedure can not only reduce the sensitivity of the penis and lead to erectile dysfunction, but also provoke fibrosis.

Therefore, to date, cosmetic fillers are not approved by the FDA for use on the penis, and experts from the International Society for Sexual Medicine also do not recommend their use in phalloplasty.

Care after the procedure

The recovery period – care and rehabilitation after the procedure – does not last long when performing lipofilling or filler injections. In the absence of obvious complications, patients can go home on the second day. The main care is maintaining hygiene and maximum limitation of physical activity.

To reduce swelling, use an ice pack (5-6 minutes three to four times a day). And to facilitate venous outflow, it is recommended to put the penis in a vertical position in underwear.

After lipofilling, intimate life is interrupted for two months, but with gel injections, sex resumes after a month.

Reviews

In the middle of the first decade of the 21st century, no more than 35% of patients gave positive feedback on the results of penis lengthening and girth enlargement surgery. By the end of the second decade, plastic surgeons say that 72-75% of patients are satisfied with the result 12 months after the introduction of hyaluronic acid gel. Although, according to the European Association of Urology, almost 78% of patients are not satisfied with the aesthetic result of this procedure.

So, first of all, you should take into account the opinion of urologists and andrologists, who note that there are no completely safe and 100% effective methods for thickening the penis.