Penis Enlargement Surgery: History, Overall Risks, Effectiveness

penis surgery

A Brief History: Penis enlargement surgery first gained mass public attention in 1990, with the media announcement that two surgeons, both based in Miami, Florida had independently pioneered two new surgical techniques.

Firstly, Dr. Ricardo Samitier announced that he had developed a new girth enlargement procedure; whilst shortly afterwards, a urologist named Dr. Harold Reed revealed that he had been quietly working on a lengthening procedure which had shown some promise.

Since those public announcements almost twenty years ago, some specialists estimate that as many as 100,000 men have opted to undergo surgical penis enlargement. For many of these men, the result has been life changing, but unfortunately not always for the better.

In the early formative years, when surgeons were still getting to grips with this new surgery and before procedures had been thoroughly tested, medical mishaps were next to common place.

One California attorney, Keith Schulner, whose law firm represented 58 patients who had filed lawsuits after botched operations, quoted the top five problems experienced by men following surgery to be impotence, incontinence, pain, numbness, and disfigurement. Still despite all this negative publicity, men in their thousands chose to ignore the risks.

Since those early days, surgical penis enlargement techniques have evolved considerably and the pioneering surgeons have continued to gain expertise. But despite the advancements, penis enlargement surgery still remains highly controversial because the results each patient experiences can be very unpredictable and far from risk free.

This controversy has led to regulatory medical organizations including the American Urological Association and the American Society for Aesthetic Plastic Surgery to continually issue warnings stating that penis enlargement surgery has neither been found to be safe or effective. In accordance with these guidelines, the majority of reputable surgeons still refuse to perform these procedures.

Introduction

Over the next few pages I’ll outline the various surgical penis enlargement techniques available, and try to give some insight into the rewards and risks involved with each. This section of the website has grown far larger than I ever intended, but surgery is such a complex field that it deserves some in-depth attention. Objective and accurate information about penis enlargement surgery is near impossible to find on the Internet, and when considering the implications involved for any man contemplating surgery, this needs to be addressed.

The depth of information here is a direct result of the countless hours of reading I undertook when I was contemplating surgical enhancement. And you’ll find answers to many questions that it took a great deal of research to find.

The purpose of this section is neither to dismiss nor promote penis enlargement surgery. This remains a highly emotive subject and needs to be approached with a great deal of impartiality. Too many sources dismiss penis enlargement surgery to be all ‘doom and gloom’, happily quoting numerous mishaps and potential risks, without ever acknowledging the successes. The fact is, whilst surgery doesn’t always live up to its promises and yes, mishaps can occur; there are still many men who are happy with the outcome they achieved.

The important thing with penis enlargement surgery is to be fully aware of the pro’s and con’s and then to come to your own realistic conclusions as to whether it’s a route worth travelling. Undergoing surgery is a personal choice and whether the results are good or bad, there is no doubt that you’ll have to live with outcome long-term.

Surgical Techniques

Penis enlargement surgery is in fact a two fold process, involving separate procedures to increase penis length and girth. Most patients would obviously prefer to have both performed at the same time, but surgeons usually advise that the procedures should be staged in order to minimize post operative complications and to achieve the best results possible.

The recommended approach is to undergo penis lengthening first and to then wait for around six months before attempting girth enlargement. This two stage approach allows the penis and surrounding pubic area to fully heal from the lengthening operation, which in turn benefits overall results (as I’ll explain later).

Penis Lengthening Surgery

The term ‘surgical penis lengthening’ is actually slightly misleading. Although surgery may appear to lengthen the penis, in reality no additional length is created. In theory what surgery does do is to help expose part of the penile shaft normally hidden away from view.

To clarify what I mean involves a bit of an anatomy lesson I’m afraid:

When you look down at your penis, what you are seeing is just the tip of the proverbial iceberg. Hidden away from view behind the pubic bone, the penile shaft actually extends for another 3 – 4 inches inside the body. This hidden part of the penile shaft arches upwards and is held in place by two ligaments known as the fundiform and suspensory ligaments.

Surgeons found that by cutting the fundiform and suspensory ligaments, the internal path of the penis should be altered. Instead of arching upwards, cutting the ligaments resulted in the internally held penis straightening, which in turn caused more of the penis shaft to be exposed to the outside world.

If the last two paragraphs sound like double Dutch, then try this:

Bend one of your fingers so that it forms an inverted U shape. This is how the internal penis naturally looks due to the harnessing effect of the two ligaments. Now straighten your finger. What happens? Your finger extends forwards and therefore covers more distance. It takes some imagination, but if you transfer that same principle to your penis, you’ll see how the surgical lengthening procedure should theoretically work.

These days, surgeons tend to make a small (but deep) horizontal incision in the pubic area about an inch above the base of the penis. This is generally regarded as the least invasive way of gaining access to the ligaments. In earlier years, surgeons would use far more elaborate incisions including the infamous V-Y incision, which often resulted in deformity. This provides just one example of how penis enlargement surgery has evolved over the last 20 years and offers an initial word of caution: be wary of any surgeon who uses intricate, large incisions to access the ligaments as these have proven over time to produce far from satisfactory results.

Results Immediately After Surgery

When surgeons show examples of the results of penis lengthening surgery, they often do so by comparing a picture of a patient prior to surgery with one taken immediately after. This type of ‘before and after’ photography often depicts quite impressive results.

Straight after surgery, flaccid penis length can be significantly improved, sometimes by as much as an inch. But unfortunately these initial increases are somewhat deceptive and can’t be taken as an accurate indicator of the eventual results a patient will achieve.

Permanent increases in both flaccid and erect penis length are in reality only achieved during the healing process, through the consistent use of a penile traction device (see picture).

Worn for several hours a day for up to six months after surgery, the device places a constant stretching force on the penis that gradually encourages more of the internal penile shaft to be exposed. So although the surgery theoretically frees the penis from its pubic anchoring, it is the physical act of stretching the penis that produces permanent gains.

Typical Eventual Increases in Penis Length

When talking about the ‘average’ gains patients make after undergoing penis lengthening surgery, it’s important to remember that these gains are only made possible through traction. Without consistently wearing a penile traction device, men rarely experience any positive results. In fact, even the initial gains in flaccid length made at the time of surgery are usually lost.

Those who do follow their traction routine to the letter however, tend to experience greater gains in flaccid length, rather than erect length. By the end of the typical six month post operative treatment a patient can on average expect to have achieved a permanent increase of around an inch to an inch and a half in flaccid length.

As far as increases in erect penis length are concerned, results tend to be far more modest with the average increase being less than half an inch.

Clinical Studies

There have been two interesting independent clinical studies into the effectiveness of penis enlargement surgery that confirm the averages mentioned above.

In 1999, the Electronic Journal of Human Sexuality (EJHS) published a clinical study that reported on the progress of 58 men who had undergone surgical penis enlargement. The patients, aged between 22 and 67, achieved on average an increase of 1.2 inches in flaccid length, whilst erect length gains averaged only 0.3 inches.

More recently in July 2005, the European Urology journal published the results of a study performed at the Naval and Veterans Hospital of Athens in Greece, which involved 11 men ranging from 25 -35 years of age.

The study entitled, ‘Augmentation Phalloplasty Surgery for Penile Dysmorphophobia in Young Adults’ followed the progress of men suffering from a condition known as penile dysmorphophobia. Those suffering from this condition perceive their penis to be inadequately small although in reality, they fall well within the normal size range.

The study reported that the patients, none of whom experienced significant post operative complications, achieved an average increase in ‘flaccid stretched penis’ length of 1.6 cm (0.6 inches). Flaccid stretched penis length was recorded because it provides the same measurement as when the penis is erect.

As you can see, neither study recorded a particularly significant increase in erect penis length. According to the 1999 EJHS study, 69 percent of the 58 men stated that their length increases had not lived up to their expectations, whilst the 2005 European Urology study concluded that ‘penile size alteration was not spectacular or satisfying the patients’ “great” expectations’.

Drawbacks of Lengthening Surgery

Penis lengthening surgery is a relatively simple procedure, which in the hands of a competent surgeon and with strong patient motivation can provide modest gains in penis length. However, there are a number of drawbacks intrinsic to the procedure that most patients will experience regardless of how well the operation goes.

Once the penis is fully healed from the surgery, one problem that is commonly noted is that the penis is not as stable as before. Cutting the Suspensory and Fundiform ligaments literally removes the anchors that keep the penis firmly in place. When the penis is flaccid this doesn’t present much of a problem. However, during sexual activity, the erect penis is in affect left floating without support; and the movement of the penile shaft which occurs as a result, increases the odds of the patient suffering a penile fracture.

Apart from the above functional problem, there are also a couple of aesthetic drawbacks to consider. Firstly, the loss of the Fundiform ligament has a significant impact on the angle of the patient’s erection. Once cut, the patient’s erect penis will never again point upwards, but will instead protrude horizontally or even downwards.

Depending on the type of incision the surgeon uses, the positioning of the penis following surgery can also sometimes look somewhat abnormal. Although relatively rare these days thanks to technique advancements, the penis can sink downwards towards the scrotum. When flaccid, the penis may have shifted so far south that the base of the penile shaft is surrounded by flaps of scrotal skin on either side. This syndrome has rather descriptively been nicknamed ‘scrotal dog ears’.

Scar Contracture

The biggest concern for any patient who has undergone penis lengthening surgery is posed by the development of scar tissue within the pubic incisional wound. In fact, the level of scar tissue that develops during healing can make or break the success of the procedure.

One of the characteristics of scar tissue is that it has next to no elasticity (unlike normal skin and muscle tissue) and tends to toughen and shrink as part of the healing process. As the scar tissue contracts, it effectively pulls the penis back into the body.

Depending on the severity of both internal and external scarring, gains in penis length can be significantly hindered as a result. In fact, scar contracture can actually lead to the patient ultimately losing penis length in the worst case scenario.

The real problem is that it’s impossible to determine the level of scarring that will occur, no matter how skilful the surgeon that performs the procedure. Each individual’s healing processes are unique and even for patients who closely follow post operative instructions, scar tissue can cause concern.

However, in order to limit the amount of scar tissue formation as much as possible there are a number of post operative guidelines that a patient should follow. These include taking high dose Vitamin E supplements, refraining from sexual activity for at least 6 weeks, and for those who smoke, quitting for at least 6 months prior to and following surgery.

The most important action the patient can take to combat the negative effects of scarring is again however, the consistent daily use of a penile traction device. The stretching force this places on the penis and surrounding tissues helps to maintain tissue elasticity and goes a long way to preventing the sort of tissue contracture problems mentioned above.

Summary of Penis Lengthening Surgery

When done properly, penis lengthening surgery can produce modest gains – typically around 1 – 1 ½ inches in flaccid penis length and maybe up to ½ inch in erect length. Achieving these gains however, requires the skills of a competent specialist surgeon and a high degree of motivation on the part of the patient during the recovery phase.

Following surgery, patients must be motivated enough to consistently use a penile traction device; both to slowly pull the penis further out of the body and to minimize the development of scar tissue. Those who don’t, usually find that they make no gains at all. In fact, some find that they even lose penile length because of the development of scar contracture which literally pulls the penis back into the body.

Even if all goes well and gains are achieved, the lengthening operation still has its intrinsic drawbacks. After cutting the ligaments that support the penile shaft, the patient’s erection will no longer point upwards and the erect penis will be more susceptible to injury.

All in all, penis lengthening surgery should be seen more as a cosmetic rather than a functional operation. Whilst flaccid increases in length can appear quite prominent, men are often left feeling extremely disappointed with the erect gains they achieve.

The general consensus seems to be that if you’re looking specifically to increase your erect penis length, penis lengthening surgery is best avoided. In contrast, those who are already happy with their erect size but suffer a degree of anxiety about their flaccid length can sometimes experience quite positive improvements in their self image and esteem. However, considering the complications that can arise through surgery, I’m personally unsure as to whether the rewards justify the risks.

It’s worth remembering that recent clinical evidence suggests that penile traction alone can produce gains equal to if not better than surgery. With this in mind, penis lengthening surgery may soon prove to be an outmoded procedure, superseded by a more natural, safer and less costly alternative.

Penis Girth Enlargement Surgery

At its most basic, surgical girth enlargement involves inserting either fat or skin tissue (or a combination of the two) beneath the penile skin to add bulk to the penile shaft.

There are several surgical techniques available to achieve this, which provide varying degrees of success. These techniques have evolved one after another over the last couple of decades in an attempt to provide better aesthetic and more permanent long-term results.

Below you’ll find information on the very first of the modern surgical girth enlargement techniques, followed on the next pages by the more advanced dermal fat and Alloderm grafting procedures.

Fat Transfer through Liposuction

Developed in 1990 by a plastic surgeon called Ricardo Samitier, ‘fat transfer’ was the first surgical girth enlargement technique to gain any degree of popularity. Today, the technique is still performed by some surgeons, although many specialists in the field consider it to be outdated and somewhat unreliable.

Fat transfer is a very simple procedure that can be performed under a local anaesthetic. During the procedure, fat cells are liposuctioned from either the abdomen or inner thighs of the patient, and are then injected into the penile shaft just beneath the skin. The surgeon then uses his hands to mould the injected fat cells symmetrically around the penile shaft in order to provide a normal looking end result.

Immediately following the procedure, the results of the fat transfer technique can appear to be quite impressive. It’s easily possible to insert enough fat under the penile skin to add two to three inches to the circumference of the flaccid penis.

Complications

However, whilst these initial gains can seem quite satisfactory, in the long-term the procedure is prone to a number of complications that can lead to both aesthetic problems and a loss of a significant level of this newly acquired girth.

One of the main complications associated with the injection of liposuctioned fat cells is that they tend to be easily reabsorbed back into the body over the course of just a few months. It’s been suggested that this re-absorption occurs either due to damage sustained to the fat cells during the liposuctioning process or because of their inability to establish a new blood supply once transplanted. Either way, the net result is that the majority of the injected fat cells eventually die and are therefore, assimilated back into the blood stream.

Statistics suggest that up to 70 – 80 percent of the initial girth increase is typically lost within the first year due to this fat re-absorption problem.

To compound the problem further, the fat cells that do survive often clump together, leaving the penis with a rather uneven, lumpy appearance.

Some surgeons continue to defend the fat transfer technique by stating that fat re-absorption complications can be minimized by not ‘overfilling’ the penis at the time of surgery. Those who do so, recommend that several fat transfer procedures are performed every few months or so to gradually build up penis girth with successive layers of liposuctioned fat.

However, the general opinion these days is that fat transfer very rarely provides stable long-term results regardless of the quantity of fat used.

It’s also worth mentioning that fat tissue is soft to the touch, and its feel doesn’t change once injected into the penis. This is in stark contrast to the penile shaft, which is obviously hard when erect. As a result of this, it’s often stated that the penis feels somewhat abnormal during an erection, with the soft transplanted fat tissue feeling strikingly similar to breast tissue.

Of course, the tempting side of penile fat transfer is that it’s a relatively quick, painless and cheap method of girth enlargement in comparison to the alternatives, costing around U.S. $3000 – 4000. However, the initial cost of treatment rarely includes the numerous ‘top up’ procedures that are routinely required to maintain long-term girth increases and to ensure that the penis remains free of lumps and bumps.

Whilst in theory, fat transfer may seem to offer a simple, viable method of surgical penis girth enlargement; in practice, the evidence over the years has shown it to be a far from perfect solution.

Dermal Fat Grafts

In the mid 1990’s, a new surgical girth enlargement technique was developed called dermal fat grafting. The technique was hailed as a vast improvement over Fat Transfer as it was said to overcome the problems of graft tissue re-absorption and would therefore, provide far more stable long-term results…

Dermal Fat Grafting Procedure

Dermal fat grafting is a two stage surgical procedure which is far more complex than liposuctioned fat transfer. The first stage of the procedure involves the removal of two solid tissue grafts from the patient’s body, which are later inserted into the penis to provide additional girth.

These two tissue strips are taken from one of three areas on the body: the crease between the buttocks and the top of the thighs (known as the gluteal folds), inside the buttock cheeks or alternatively from the lower abdomen. Each of these strips of tissue has to be about 6 inches in length, 2 inches wide and a quarter of an inch deep and consists of both skin and fat layers.

Not surprisingly, the removal of these solid tissue strips leaves rather large incisional wounds which first have to be sewn up before the grafts can be inserted into the penis.

During the second stage of the procedue, an incision is made all the way around the penile shaft just below the head, enabling the surgeon to then roll back the penile skin all the way to the base. With the underlying erectile chambers totally exposed, the dermal fat strips are then wrapped around the penis lengthways. After properly positioning the grafts and trimming them to the precise length of the patient’s penis, the grafts are then firmly stitched in place and the penile skin is rolled back along the shaft.

The whole procedure including the removal and insertion of the grafts is quite labour intensive and takes anything up to three hours to complete. Not surprisingly, considering the complexity of the surgery, the operation is performed under a general anaesthetic.

Initial Gains in Penis Girth

Using quarter inch deep dermal fat grafts generally produces an overall increase of between ¾ and 1 inch in penis girth immediately following surgery.

Although this is significantly less than the initial gains produced through liposuctioned fat transfer, the long-term permanence of this girth increase is said to be far better.

Improved Long Term Gains

Whereas as much as 80 percent of liposuctioned fat can be reabsorbed within the first year, dermal fat grafts tend to fair significantly better. Most surgeons state that if the operation is performed correctly, the patient can expect to experience only around 20 percent re-absorption over the first year.

In other words, much of the girth increases achieved at the time of surgery through dermal fat grafting tend to be permanent (in the medium time-frame at least).

The reasons why dermal fat grafts seem to give far more stable long-term results are two fold:

Firstly, the graft tissue sustains far less damage during the transplantation process. Liposuctioned fat cells on the one hand go through the trauma of being both liquefied and purified before being injected into the penis, which significantly reduces their survival rate. Dermal fat grafts on the other hand, suffer very little damage because they are solid strips of skin that undergo very little processing before insertion.

Secondly, and maybe more importantly to their survival, dermal fat grafts are removed as solid strips of tissue with all the blood vessels within the grafts still intact. By maintaining their original blood vessel structure, the grafts are able to more quickly establish a new blood supply following insertion. With reduced interruption to their blood supply, the newly inserted dermal fat grafts receive far more of the oxygen and nutrient rich blood they require to effectively survive in their new environment.

In comparison, liposuctioned fat cells have no established blood vessel structure to rely upon once transplanted and find it more difficult to get this vital nourishment.

Aesthetic Improvements

It’s often stated that dermal fat grafts also provide a more aesthetically normal looking end result in comparison to liquefied fat cells. The likely reason is because the solid strips of tissue are firmly held in place under the penile skin and aren’t as susceptible to movement. Liposuctioned fat cells on the other hand can almost shift around unhindered during the healing process.

In addition, any re-absorption of the graft that does occur (as mentioned above about 20 percent or so over the first year) tends to be equal along the entire length of the graft. As a result of this uniform re-absorption, the lumps and bumps that often develop under the penile skin when liquefied fat cells are used, are far less likely to occur.

Drawbacks of Dermal Fat Grafting

Generally, dermal fat grafts give moderately stable, although somewhat modest results over the long-term. Most men will achieve about an inch in permanent additional flaccid penis girth and probably around ½ inch improvement in their erect girth.

However, the procedure does have its drawbacks and for some, these may well out way the positives.

Most of the problems associated with dermal fat grafting revolve around the two grafts that have to be taken from the patient. Each graft is typically 6 inches long, 2 inches wide and ¼ inch deep and their extraction leaves quite large incisional wounds that can be extremely painful during healing and prone to both infection and scarring.

Particularly when the incisions are made in the gluteal folds, many men state that the pain can be excruciating in the days following surgery. In fact, in the first post operative week, walking and even sitting can be almost impossible tasks. This discomfort obviously lessens in the following weeks and can be controlled to a degree by painkillers, but the incisional wounds usually remain quite sore and tender for several weeks following the operation.

Due to their location, the incisions are also quite susceptible to infection. Dermal fat grafts are purposely taken from inconspicuous areas on the body such as the gluteal folds or inside the buttock cheeks in an attempt to hide any potential scarring. However, these moist, warm areas of the body are also prime breeding grounds for the bacteria that cause infections.

Wound infections are of course a possibility with any surgical procedure, but here the risks are multiplied. And an infected wound, depending on its severity, can lead to a multitude of symptoms ranging from severe pain to life threatening complications such as septicaemia.

In addition to the discomfort and increased chances of infection, scarring to a lesser or greater degree is also inevitable. In order to limit the appearance of scar tissue, surgeons try to take the dermal fat grafts from parts of the body that are usually hidden from view. But sometimes, even an inconspicuous location can’t keep them hidden to the satisfaction of the patient.

Obviously, a skilful plastic surgeon who works well with the skin will be able to reduce the potential for scarring, but ultimately, the amount of scarring is determined by the patient’s own unique healing process.

Some patients are very fortunate, and the incisions heal showing no more than very faint hairline scars. But others, even in the hands of the same surgeon, might find that they are left with very visible permanent skin discoloration or markings along the incisional lines that never properly fade. Because of the resulting scar tissue, some body conscious patients find that they rather unfortunately end up substituting one anxiety for another.

Further Problems with Dermal Fat Grafts

All the problems mentioned above relate to the incisions that are left from the removal of the dermal fat grafts. However, the grafts can also sometimes cause additional complications after insertion in the penis.

Particularly in the first few days after surgery, the dermal fat grafts can potentially shift out of place under the penile skin. This can cause various visible disfigurements along the penile shaft which can only be resolved through the later removal of the grafts.

Furthermore, either part of the graft, or in the worst scenarios, the entire graft may fail to survive. This usually only happens when grafts that are too thick (more than ¼ inch) are used. This is because an overly thick graft is likely to be compressed by the overlying penile skin, which doesn’t have enough elasticity to properly accommodate it.

The compression of the penile skin prevents blood from reaching all areas of the graft and therefore, the graft is unable to survive. Graft failure of this nature can again cause disfigurement along the penile shaft including a noticeably uneven appearance or penile curvature.

The above two problems are quite rare when the procedure is performed by a skilful surgeon, but should be considered nevertheless.

Finally, all patients will experience some degree of graft contracture (shrinkage) during healing. In order to combat this problem, a penile traction device must be used in the following months. Failure to do so would ultimately lead to a degree of penile shortening. This again, as with penis lengthening surgery, highlights the importance of post operative penile traction.

Dual Augmentation – Combining Length & Girth Procedures

Men considering penis enlargement surgery tend to think that the obvious option is to have both penis lengthening and girth enlargement surgery performed at the same time. And whilst some surgeons are prepared to undertake such ‘dual augmentation’ procedures, most would advise against it.

The recommended approach is to have the lengthening operation done first, with a break of about six months before then undergoing girth enlargement. This two stage process allows the penis and surrounding tissues to entirely heal from the lengthening operation before subjecting the same area of the body to further trauma.

The ‘lengthening first, girth enlargement later’ approach is recommended regardless of the girth enlargement technique chosen by the patient, whether it is liposuctioned fat transfer, dermal fat grafting or Alloderm grafts. Unfortunately, surgical lengthening and girth enlargement have a habit of counteracting one another and performing the two procedures simultaneously is likely to have a detrimental effect on both overall length and girth gains.

Simultaneous Lengthening and Liposuctioned Fat Transfer

Performing penis lengthening with liposuctioned fat transfer can lead to aesthetic abnormalities. One of the problems with injected fat cells is that they are very susceptible to movement under the penile skin during healing; and any movement that does occur can leave the penis covered in lumps, bumps and depressions.

When the patient starts to use penile traction a week or so after surgery (in order to aid the lengthening process), the parts of the traction device that come into direct contact with the penis place pressure on the underlying fat cells. As a result, the fat cells are forced from their original position and depressions or ‘thumb prints’ are made on the penile shaft where contact occurred. This problem is noticed most prominently just behind the penile head, where the silicone loop of the traction device fastens firmly to hold the penis in place.

The fact that liposuctioned fat can be so easily disturbed during healing is one of the many reasons that this method of girth enlargement is not recommended.

Simultaneous Lengthening and Dermal Fat/Alloderm Grafts

The more sophisticated dermal fat and Alloderm grafting techniques don’t suffer from the above mentioned problem, because the grafts comprise of solid tissue as opposed to liquid fat. However, there are again, several significant reasons why neither of these girth enlargement procedures should be combined with lengthening. Ultimately, to do so may well hinder both penis length and girth gains.

One of the main problems here is caused by the length of the grafts used at the time of surgery. When the grafts are inserted into the penis, the surgeon trims them to precisely fit the patient’s current stretched flaccid penis length. Obviously, this doesn’t take into account any length gains the patient might make in the following months through the application of penile traction. Neither can the grafts be cut with ‘room to spare’ to accommodate potential length gains because it is impossible to predict the length increases the patient will ultimately achieve.

Because the grafts are designed to fit perfectly at the time of surgery, length gains will be compromised to two distinct ways in the following months.

Firstly and most obviously, the grafts will have to physically stretch to accommodate any additional length increases. As any former patient will state, gaining additional length is hard enough on its own without having to contend with further restraints as well.

The lengthening process is already made difficult because of the post operative development of scar tissue, that shrinks during healing and tries to pull the penis back into the body. Combine this problem with the additional resisting force created by grafts that are too short and the lengthening process becomes no mean feat.

Another problem that affects length gains is caused by the dermal fat/Alloderm grafts fusing into the pubic area during healing. As you’ll remember, lengthening surgery involves cutting the ligaments that hold the penis against the pubic bone, and this is achieved by making an incision in the pubis. However, if dermal fat grafts are inserted at the same time, the ends of the grafts (which are pulled into the pubic region by the surgeon) will fuse inside the incision made to cut the ligaments. This creates, what is in affect a ‘false ligament’ which virtually acts as the same way as the previously cut ligaments by tethering the penis back to the pubic bone.

All the above processes result in the patient making slower length gains and ultimately, will probably prevent him realising all the gains he would have achieved if lengthening surgery had been performed on its own.

What about the dual augmentation procedure’s effect on penis girth?

Here again, unfortunately it isn’t good news.

The only way length gains can be achieved is through physically stretching the dermal fat/Alloderm grafts in tandem with the penis. The result of this is that the grafts will gradually thin as they are progressively stretched, which in turn will lead to less pronounced penis girth gains.

Conclusions

By staging the penis lengthening and grafting operations all the above problems are avoided. By performing surgical lengthening first, the patient is able to achieve his full potential length gains without the resisting force of the dermal fat/Alloderm grafts. After six months or so, once maximum length gains have been achieved, dermal fat/Alloderm grafts that exactly fit the patient’s new found penis length can be inserted without complication.

The basic message here is that lengthening and grafting operations contraindicate one another and lead to poorer overall results than when each technique is performed individually. Despite this, numerous surgeons will perform simultaneous lengthening and girth enlargement procedures, possibly motivated more by money rather than any concern for their patient’s welfare. Without a doubt many men are put off by the thought of undergoing two lots of surgery, and surgeons are aware of this. As such, they may well try to dismiss or trivialize the pit falls of dual augmentation.

At present, I’m aware of only one reputable specialist penis enlargement surgeon (see surgery resources) who claims to have pioneered dual augmentation techniques that avoid such problems. However, I have no idea how effective his techniques are. But considering his substantial reputation in the field, I doubt it is just a cynical marketing ploy.

As far as cost is concerned, most reputable penis enlargement surgeons will be more than happy to negotiate a price from the staged procedure that will be comparable with the cost of having lengthening and girth enlargement done at the same time. Usually, all that they require is that you are willing to put down a non refundable deposit for the second procedure. A surgeon who either refuses to perform the procedures separately or is unwilling to negotiate a discount for an advance booked staged procedure, is in my mind best avoided.

Summary of Penis Enlargement Surgery

When performed by a competent surgeon using up to date techniques, penis enlargement surgery offers the potential of modest gains in both penis length and girth for most patients. I use the word ‘potential’ for good reason though, as these gains can only ever be achieved through strict adherence to post operative instructions (particularly, the consistent use of penile traction) in the healing months following surgery.

In this respect, a patient must be committed to following the whole process through to the end. Going under the surgeon’s knife can otherwise be a futile task that results in not only limited gains, but also the distinct possibility of deformity, a loss of penile size or function.

Unfortunately, penis enlargement surgery comes with no guarantees of success even in the hands of an extremely competent surgeon and when post operative instructions are followed to the letter. You just have to read any one of the surgeons ‘consent to operate’ forms to see this spelt out – although the print may be quite small on some.

However, for those patients who do manage to sail through the operation without complication and do stick to the post operative treatment, the following gains can be expected:

Typically, a successful lengthening procedure will result in an increase of between 1 and 1 1/2 inches in flaccid penis length, and an erect increase of around 1/2 inch. Dermal fat grafting may increase flaccid penis girth by 1 – 1 1/2 inches, whilst Alloderm grafting will typically result in a slightly less pronounced 3/4 inch gain in girth.

Both dermal fat and Alloderm grafts may additionally make the penis look slightly longer when flaccid, as the grafts prevent the penis from fully retracting back to its pre operative flaccid size. It should be remembered, that these are only average gains however, and many factors can influence overall end results.

Costs

As far as cost is concerned, penis enlargement surgery is quite an expensive proposition. Lengthening surgery will typically cost around U.S. $5000 when performed on its own.

As far as girth enlargement is concerned, liposuctioned fat transfer is by far the most economical procedure costing around U.S. $4000, although most agree that the technique is unreliable and should be avoided.

The more stable alternatives of dermal fat grafts (typically $6000) and Alloderm grafts (typically $8000) may be significantly more expensive, but should produce far better results in terms of both permanence and aesthetics.

These are classified as elective cosmetic procedures and as such, are unlikely to be covered by either medical insurance or where applicable, national health care services. The only exception to this rule might be in circumstances where a prospective patient has a penis considered to be abnormally small in medical terms. This usually refers to a man with a penis of less than 3 inches in erect length (known as a micro penis), and here, penis enlargement surgery may well be covered in order to correct a ‘congenital abnormality’.

For those not suffering from a medically acknowledged small penis, financing must be arranged privately. Apart from personal savings, there’s the obvious option of either taking out a bank loan or dumping the bill onto a credit card. But this kind of credit can be an expensive, particularly when considering that combined lengthening and girth enlargement surgery is likely to cost $10,000 – $12,000.

A second option is to consider a lender that specializes in financing cosmetic surgery procedures. Such lenders typically offer interest rates lower than traditional credit cards and provide moderately low monthly payments repayable over several years.

However, one of the main disadvantages of opting for this type of credit is that such cosmetic surgery financing companies next to always insist that you choose one of their approved physicians. Considering the sensitive nature of penis enlargement surgery combined with a severe lack of competent surgeons specializing in the field, I personally would feel reluctant to entrust my penis to a surgeon of whom I have little knowledge just to satisfy the terms of a loan agreement.

In my mind, the first step is to choose a surgeon with whom you feel comfortable and who inspires confidence. Arranging how to pay for the surgery should come second to this, not first. Once you feel comfortable with your choice, your surgeon will no doubt be able to recommend financing options.

Specialist Surgeons

The following list is far from exhaustive, but I’ve only included links to surgeons I know to be reputable, qualified in either plastic surgery or urology, and who have proven to produce good consistent results over the years. Internationally, there are very few specialist surgeons in this area and the following are either based in the U.S. or Canada:

Gary J. Alter, M.D. – One of only a handful of surgeons who is Board-certified in both urology and plastic surgery. At present Alter only performs penis lengthening surgery, noting the significant potential complications associated with surgical girth enlargement procedures. He has practices in both Beverly Hills, California and in New York.

Harold M. Reed M.D. – Reed was one of the early pioneers of penis lengthening surgery, and claims to have been performing the operation since 1986. He is a Board-certified urologist who apart from penis enlargement, also specializes in gender reassignment surgery. Reed recommends the ‘two stage’ approach to surgical penis enlargement (i.e. lengthening first, girth enlargement later) and uses either dermal fat or Alloderm grafting techniques depending on patient preference. Reed’s clinic is located in Miami, Florida. (Beware of the annoying ‘Mission Impossible’ theme tune when you visit his website).

Gary W. Rheinschild M.D. – Rheinschild is a Board-certified urologist who’s specialized in penis enlargement surgery since 1991. He claims to have perfected a ‘dual augmentation’ technique that allows for simultaneous surgical lengthening and girth enlargement. Rheinschild prefers the use of dermal fat grafts for girth enlargement, stating that Alloderm grafts have a higher potential for infection and rejection by the patient. The ‘Rheinschild Male Enhancement Clinic’ operates out of Beverly Hills and Orange County, California.

Robert H. Stubs M.D. – Stubbs is a Board-certified plastic surgeon working in Toronto, Canada, where he has practiced surgical penis enlargement since 1993. Stubbs again recommends staging lengthening and girth enlargement, and uses both liposuctioned fat transfer and dermal fat grafts for girth enlargement. His website includes some pretty impressive before and after photographs (taken several months post-surgery) of some of his work.

E. Douglas Whitehead M.D. – A well known specialist penis enlargement surgeon operating out of New York. Whitehead is a Board-certified urologist and president of an organization called the American Academy of Phalloplasty Surgeons (AAPS) – set up in the mid 90’s to regulate physicians who perform penis enlargement surgery. Whitehead exclusively uses Alloderm grafts for penile girth enlargement, and is the only physician I am aware of who claims to have successfully developed a penis girth enlargement procedure that noticeably increases erect, as well as flaccid girth.

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