Penis thickening surgery

Corrective surgery of the male genitalia, particularly penile thickening surgery, as well as penile length enhancement, refers to phalloplasty.

Indications for the procedure

The main purpose of phalloplasty is to restore the normal anatomy of the penis and its functions after injury or to correct congenital anomalies (including the urethra. But the medical indications for thickening of the penis, in fact, are absent. That is, initially surgical methods were not intended for purely cosmetic use - to increase the length or thickness of the male genital organ. However, the development of aesthetic surgical plastic surgery has touched the genitals. And this, in the opinion of most experts, rather belongs to the field of psychology and sexopathology: men with low self-esteem and uncertainty about their sexual prowess (and having no idea about the real average penis size) or dissatisfied with their sexual life and deciding that surgery to thicken the penis or lengthen it will dramatically improve the situation go for penis enlargement surgery. [1]

According to British experts, about 45% of men are dissatisfied with their genitals at normal size and function; according to ASAPS (American Society for Aesthetic Plastic Surgery), the number of dissatisfied Americans ranges from 17-38% depending on their age.

Also medics note that most men who want to increase the volume of the penis, have physiologically normal parameters of the penis, but are seriously concerned about its size, possibly due to the manifestation of pathological dissatisfaction with their external data, ie dysmorphophobia.

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

Preparation

At the preparatory stage, blood tests (general, coagulogram, STD, HIV, hepatitis B and C) and urinalysis (to detect urogenital tract infections) are prescribed.

The patient is examined by a urologist-andrologist and visualization of the urogenital zone, because in practice there are many cases when along with unreasonable 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 surgeries are completely safe, the results of research on available penile thickening (as well as penile lengthening) methods with regard to their safety, efficacy 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 or she has a manifestation of penile dysmorphophobia rather than a real problem.

Technique Penis thickening surgery

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

Surgical methods include autoimplantation of an adipofascial (skin and fat) flap in the form of a strip, which is taken from the inguinal region or gluteal crease and then transferred to the penis and placed between the Buck's and Dartos' fasciae around the circumference of the penis. The operation takes about seven hours and has many complications (including thickening of the penile tissues, curvature and shortening of the penis, and fibrosis of the graft). Therefore, it is now resorted to in rare cases. As well as the use of allografts such as Alloderm, which are cell-free inert dermal matrices (derived from human donor skin).

A resorbable cell-free collagen matrix (collagen matrix such as Pelvicol or BellaDerm) is also used, implanted into the penis (around the shaft) under the Dartos fascia either through a transverse suprapubic incision or by subcoronal access (with displacement of the penile skin). One year after surgery - due to the formation of endogenous tissue - the average thickening of the penis can range 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 - gel implant for penis thickening. [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, i.e. Aspiration (pumping) of fat from the lower part of the peritoneum (through a puncture in the suprapubic area). The fatty tissue is processed (decanted and filtered) and then injected along the entire length of the penile shaft or around the circumference of the penis using a syringe using special injection techniques. Lipofilling can increase the circumference of the penis in the non-erect state by 2.5 -3.2 cm (but the thickness decreases during erection).

The procedure of insertion of dermal gel fillers based on hyaluronic acid, used for contour plasty, is performed under local anesthesia (a shot of lidocaine is given into the nerve at the base of the penis). The fillers used are Perlane, Restylane, Juvederm, and stabilized Macrolane gel.

Such an injection can make the penis 2.5 cm thicker, but because of the biological degradation of hyaluronic acid - not longer than 10-12 months (Macroline gel - up to a year and a half). [3]

Contraindications to the procedure

Any corrective phalloplasty procedures are contraindicated:

• under the age of 18 and after the age of 60;
• if your body temperature is elevated;
• there's bleeding of any localization;
• in the presence of infectious diseases and chronic or acute inflammatory processes in patients;
• for sexually transmitted diseases;
• if the level of platelets in the blood is low, i.e. With poor clotting;
• in the presence of diabetes;
• in cases of dermatological diseases (including fungal diseases) localized in the urogenital area;
• in diseases of autoimmune etiology;
• in psychogenic conditions and mental illness.

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 penis plastic surgery to thicken it - the formation of soft tissue edema, hematomas, secondary infection (with a focus of inflammation), proliferation of connective tissue with the formation of scars.

Complications of skin-fat flap autoimplantation include penile tissue thickening, penile curvature and shortening, and graft fibrosis.

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

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

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

In addition to complications of liposuction, the injection of adipose tissue into the penis can lead to complications such as the formation of cysts, lipogranulomas and seromas, as well as microcalcifications of the tissue. As a result, there is asymmetry of the penis and bumpiness of its surface.

Immediately after the procedure of hyaluronic acid gel injection, the skin color temporarily changes, swelling and local numbness occurs. If the gel filler is injected superficially (or exceeds 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 FDA approved for use on the penis, nor do the experts at the International Society for Sexual Medicine recommend their use in phalloplasty.

Care after the procedure

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

To reduce swelling, ice bladders are used (5-6 minutes three to four times a day). In order to facilitate venous outflow, it is recommended to put the penis in an upright position in underwear.

After lipofilling, intimate life is interrupted for two months, while with gel injections sex is resumed after one month.

Testimonials

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

So, first of all, you should take into account the opinion of urologists and andrologists, who note that absolutely safe and 100% effective methods of thickening the penis does not exist.