Penile enlargement 2015

But studies show that most of the guys seeking penis enlargement are . WebMD Feature Reviewed by Melinda Ratini, DO, MS on March 24,
Table of contents

The aim is to increase girth, or width, as well as length, in some cases. The procedure carries risks. Side effects may include swelling and distortion of the penis.


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If a side effect is severe, the penis may require removal. Another method of penile augmentation involves grafting fat cells from elsewhere in the body onto the penis.

Me and my penis: 100 men reveal all

This is less invasive and can add an average of 2. However, the organ can lose 20—80 percent of the new volume within 1 year of surgery, so people may need multiple surgeries to achieve the desired result. The second main type of surgery is suspensory ligament release.

This ligament anchors the penis to the pubic area and provides support during an erection. If a surgeon cuts the ligament, this changes the angle of the penis, which can make it look longer. On average, suspensory ligament release can increase flaccid penis length by between 1—3 cm , but patient and partner satisfaction rates tend to be low.

The lack of support during an erection can make penetration difficult. Like the Urology Care Foundation, the American Urological Association state that penile augmentation surgery is neither safe nor effective. A study , which included 15, men from around the world, determined that:.

The authors estimated that 5 percent of men have an erect penis longer than 16 cm. In another 5 percent, the erect penis would be shorter than around 10 cm. The medical community only deems surgery necessary if a person has a condition called micropenis.

The Fast-Growing Business of Penis Enlargement Surgery

This term describes a penis that is 7. Penis enlargement surgery can cause several side effects, including swelling and infection. These can be so severe that the penis requires removal. In addition, overusing a vacuum pump can damage penile tissue, which can lead to weaker erections.

The Fast-Growing Business of Penis Enlargement Surgery - VICE

Negative feelings about penis size can inhibit a person's enjoyment. Most penis enlargement methods do not work, but counseling can help by building self-esteem and correcting distorted ideas related to body image. A person with a condition called penile dysmorphophobia disorder PDD may benefit from talking with a doctor. There are two types of the disorder, but both involve consistently underestimating the size of one's own penis, while overestimating the sizes of those belonging to others. This can lead to feelings of depression , sexual anxiety, and sexual dysfunction.

Some people with the disorder find it difficult to get or maintain an erection, and they experience a lack of sexual satisfaction. PDD is a form of body dysmorphia. This classification describes an all-consuming preoccupation with what a person perceives to be a flaw in their appearance.

People with this condition are often so concerned that others will consider their penis to be small that they do not want to get undressed around people. Many men are anxious about their penis size, and this has fueled a huge market for enlargement products and techniques. However, limited evidence suggests that any of these methods are effective, and many come with serious risks. Article last reviewed by Wed 14 November Visit our Men's Health category page for the latest news on this subject, or sign up to our newsletter to receive the latest updates on Men's Health.

All references are available in the References tab. Campbell, J. A review of penile elongation surgery. Translational Andrology and Urology , 6 1 , 69— Retrieved from https: Oderda, M. Fact or fiction? BJU international , 8 , — Penile augmentation. Penile augmentation surgery. Penis enlargement. Wiygul outlined the mean SPL in children as well as the diagnostic length for micropenis at each age Normal values for preterm infants born between the 24th and 36th week of gestation can be calculated using the formula: As mentioned, micropenis develops as a result of a central or local hormonal imbalance during fetal development.

True micropenis is a congenital anomaly and is different from acquired penile length abnormalities such as buried penis or trapped penis. Based on the etiology of the hormonal dysfunction, micropenis can be divided into three broad categories: Other, less common causes of micropenis have been documented and are listed in Table 1.


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Disorders of sexual differentiation may present with micropenis, although hypospadias is more common The majority of men seeking penile elongation treatment have a normal penile size, which is functionally adequate for sexual activity and micturition 14 , Men complaining of small penis, despite adequate length, typically suffer from either penile dysmorphophobia disorder PDD or small penis anxiety SPA. In both of these disorders, men consistently underestimate the size of their own penis and overestimate the mean size for other men Men are so preoccupied with their penis size and length, they may develop depressive episodes associated with social, occupational, and sexual dysfunction.

There is a high prevalence of psychogenic erectile dysfunction and lack of sexual satisfaction in men with BDD, despite their normal libido Patient anxiety persists despite evidence from a clinical examination to negate their concern SPA may be an obsessive rumination or an aspect of psychosis which results in significant emotional distress and behavioral impairment Multiple scales and nomograms have been created by researchers to reassure patients that their length is normal.

Unfortunately, due to the nature of their anxieties, results of these studies are only minimally helpful to this patient population 9 , The idea of treating actual and perceived penile shortening with intervention is controversial. Most academic urologists have moved away from treatments such as penile elongation and therefore this has become strictly a market in the private sector Wessells created guidelines for penile elongation in , and not much has changed since. At that time, it was felt that only men with a flaccid length of less than 4 cm or a SPL of less than 7.

An ethical review on penile elongation procedures did report that after clearly hearing and understanding the risks and complications associated with each procedure, most men with a normal penis size will decline. All men undergoing penile elongation surgery with an SPL within normal limits, should undergo psychiatric evaluation In cases of true micropenis, the goal of treatment should be restoration of a functional penis size in order to improve body image and self-esteem, allow normal standing micturition and enable satisfying sexual intercourse. In children with true micropenis, the first step in management is always the least invasive, which includes the application of exogenous testosterone.

If insufficient penile growth is not achieved with replacement, multiple courses of replacement can be considered without significant reduction in stature 22 - In , the beneficial effects of hormonal therapy on penile growth in children with micropenis was confirmed. In this study, prepubertal children were treated with 25 mg of exogenous parenteral testosterone enanthate once a month for 3 months, and pubertal or postpubertal children were treated with intramuscular hCG once a week for 6 weeks.

Exogenous administration of hormone replacement in these boys resulted in a significant increase in SPL and suggests that these treatments could be the primary form of therapy for micropenis in paediatric patients In addition to exogenous testosterone, topical applications have been studied in the micropenis population. The administration of exogenous testosterone in childhood does not compromise ultimate penile length increase in adulthood, however, the long-term effects of testosterone administration in childhood are still not fully understood and long-term data are needed Although men on androgen deprivation therapy for prostate cancer have been observed to have a significant decline in penile length, there does not appear to be any beneficial effect in length with the use of testosterone in men without hypogonadal dysfunction Further studies could be done to look at this potential application for local benefits in the aging population.

Penile traction devices PTD have been explored both as an independent strategy to help with penile elongation and as an augment to surgery. These devices cradle the penis and gently apply tension in attempt to stretch tissue and increase length. Multiple brands of these devices have been created and studied including: Prospective studies have looked at men complaining of a subjectively small penis.

The duration of application of these devices has not been concluded, but usually ranges from 4—6 h per day 29 , In one study, after 2 months, men were asked to leave the traction device on for 9 h per day Compliance and patient selection is a significant issue given the time requirements for this minimally invasive treatment. Outcomes have been encouraging as patient satisfaction has unanimously improved after use for 3—6 months and flaccid or SPL has increased 1—3 cm in different studies 29 - Oderda and Gontero conducted a review which aimed to explore whether nonsurgical methods of penile lengthening may have some scientific background.

They concluded that penile extender devices seem to be non-inferior to surgery Limitations of these studies included non-validated patient satisfaction questionnaires, small patient populations, and selection bias More recently traction devices are being studied for their pre-operative and post-operative use to augment outcomes from surgical procedures.

A review of penile elongation surgery

Similarly, in early trials, pre-operative use of PTD has been shown to increase penile length prior to implantation of penile prosthesis and therefore allowing insertion of a larger caliber of cylinder Although limited data exists, there appears to be a role for use of PTD both independently in men not interested in surgery, as well as an augment to other surgical procedures.

Different types of injectable materials have been used for penile augmentation including liquid silicone, polyacrylamide, hyaluronic acid and mineral-oil 35 - However, there is a significant risk of foreign body reaction, swelling, penile distortion, granulomas and need for removal This is a much less invasive procedure compared to flap reconstruction or V-Y advancements. To obtain a fat graft, fat is liposuctioned from areas of excess, placed in 10 mL syringes and then centrifuged for 3 min at g. The superior oil layer and lower aqueous layers are removed and the middle adipose layer is collected as the purified fat graft.

The fat is transferred into smaller syringes for injected in multiple layers to improve fat graft survival. This technique has been refined by Sydney Coleman in recent years 38 , Panfilov described his technique for penile augmentation with fat grafting in 88 patients. Incisions are made radially through the frenulum preputial and approximately 40—68 cc of fat is injected between the superficial penile fascia and the profunda, down to the root of the penis.

The average length and circumference increase was 2. In one patient, the penis gained 3 cm in length at 6 months, but due to fat graft resorption, the stable length was 2 cm at 7 years. This technique can be combined with suspensory ligament release to further increase length. Unfortunately, it was not specified which patients had just the autologous fat grafting versus both procedures and the resulting gain in length.

Penile augmentation with fat grafts also increase the weight of the penis, which can itself increase the length by 2—3 cm Dermal fat grafting has also been described to increase girth and length of the penis, which may have better fat retention and decreased contour irregularities at the expense of a larger donor-site scar 37 , As discussed, the suspensory ligament anchors the penis to the pubic symphysis and while providing support, acts as the mobile point for the penis during erection.

This attachment prevents the penis from moving further outward and creates an arched angle to the penile base The suspensory ligament is composed of the suspensory ligament proper and the arcuate subpubic ligament that attaches the tunica albuginea to the midline of the pubic symphysis. Surgical release of this ligament changes the acute angle of the penis to the pubic symphysis to an obtuse angle which allows the penis to lie in a more dependant position and therefore gives the perception of lengthening Division of the suspensory ligament, with or without bulking agent, fat pad excision or V-Y plasty is the most widely accepted surgical technique for penile elongation The suspensory ligament can be accessed through a V-Y incision or a subcoronary circumcision technique Complete release of the corpora from the pubic ramus has been described to further increase length, but is associated with significant risk to the neurovascular bundles of the penis, causing denervation and devascularisation of the penis Outcomes from suspensory ligament release have not consistently been favourable.

On average, the surgery increases flaccid penile length by 1—3 cm, especially with post-operative use of a PTD 45 , Many patients in early studies had a recurrence following surgery, which resulted in penile shortening. Therefore, optimal surgical technique now involves placing a buffer in place of the ligament. Buffer options have included a vascularized flap from the lipomatous tissue of the spermatic cord or a small testicular prosthesis 45 , Srinivas et al. After the inverted V-Y incision and suspensory ligament release, a silicone sheath from a penile prosthesis was inserted in the soft tissue defect created between the base of the penis and the symphysis pubis.

They achieved a lengthening of 2. Dermal fat grafts have also been described to fill this space Paradoxically, the main side effects of this procedure are recurrence, penile shortening, and the lack of penile support during erection, resulting difficulty with sexual intercourse and penetration Poor satisfaction rates make this surgical technique not favourable for many patients. Penile elongation using a dorsal V-Y incision in the congenital or acquired short penis was first described over 40 years ago. A dorsal V-shaped incision was made, combined with partial detachment of the crura from the pubic ramis, which were then re-approximated in the midline and the dorsal incision was closed as a V-Y advancement flap.

The V-Y incision and subsequent V-Y advancement is commonly used in conjunction with a suspensory ligament release. The incision is typically an upside down V, which is closed in an upside-down Y-shape, which lengthens the dorsal skin by bringing lateral tissue to the midline Figure 1. The flap is distally based, and poor wound healing, flap dehiscence and distal flap loss can occur if the flaps blood supply is compromised during dissection Bulging of the penoscrotal transition can also occur, which can be treated using bilateral Z-plasties It is difficult to determine the average length achieved by V-Y advancement as it is typically combined with other procedures.

An additional suspensory ligament release and partial release of the corpora cavernosa is depicted. Suprapubic lipectomy has been performed to increase perceived penis length, particularly for patients with a buried penis. In these patients, weight loss does not always reduce the problem of a large overhanging fold, or mons pannus. These folds can cause problems with hygiene, directing the urine stream and sexual function Removal of the skin and fat concealing the penis can be performed as a suprapubic lipectomy or limited panniculectomy.

The skin is removed as a trapezoid incision. The inferior portion of the incision is marked 2 cm above the penis to allow closure of the base of the penis to the pubic symphysis periosteum, and the superior portion should not interfere with the waistline sulcus This technique increases the exposed penile length. This can be combined with removal of diseased shaft skin, which may be inflammatory due to the buried condition and chronic infections.

The shaft skin can be closed with a skin graft taken from the lateral thigh, or from the removed mons pubis skin to avoid a donor site If there is need for further length, release of the suspensory ligament can be performed along with the suprapubic lipectomy If the buried penis is secondary to cicatrix post circumcision, which is more common in children but can present in adults, either Z-plasties or removal of the entire penile skin with skin grafting and vacuum assisted closure with a negative pressure wound dressing can be performed.

Suction lipectomy, or liposuction, is considered inadequate to treat a buried penis unless it is used in conjunction with suprapubic lipectomy If no significant buried penis is present, but there is a moderate pubic fat pad, then liposuction may help to increase perceived penis length Rolle et al. The penis is degloved and the neurovascular bundle is mobilized.

After subtunical dissection, traction is applied to slide the distal penis away from the proximal shaft to perform the lengthening, the limit of which is the length of the urethra and neurovascular bundles 55 Figure 2. A prosthesis is then inserted into the tunical defects that are created by this technique. The authors report an average penile lengthening of 3.

The same group previously described this method of lengthening the penis with similar tunica incisions and subsequent pericardial grafting of the resulting tunical defect after lengthening, but felt that the grafting was time consuming and unnecessary A prosthesis is inserted into the tunical defects that are created by this technique. Perovic and Djordjevic describe a technique similar to sliding elongation, which they have used to treat short penises and congenital penile anomalies. Their procedure involves separating the penis into the glans cap with neurovascular bundle dorsally, the corpora cavernosa, and the urethra ventrally.

Thus, the corpora are separated completely from the surrounding structures. A space is created between the glans cap and the tip of the corpora cavernosa, on which an autologous rib cartilage graft is placed, and then the penis is reassembled 58 Figure 3. The cartilage is covered with the glans cap and the urethra and neurovascular bundles are sutured to the tunica. This technique was performed on 19 patients with a short penis with an average increased length of 2—3 cm and 3—4 cm in 13 and 6 patients, respectively There was no evidence of cartilage extrusion, erectile dysfunction or urethral damage at a mean follow-up of 3.

A The penis is degloved and the neurovascular bundle and corpus spongiosum are separated from the corpora cavernosa; B the glans cap is separated from the tip of the corpora cavernosa, and a space is created between these structures; C an autologous rib cartilage graft is placed, between the tip of the corpora cavernosa and the glans cap and the penis is reassembled. Local, regional and free flap options exist to lengthen the penis. ISAPS is the only organization that collects this type of data on a global scale, and the study is viewed as a valuable resource in the field. The International Society of Aesthetic Plastic Surgery is the premier global organization for board-certified plastic surgeons.

Regarded as the leading global educator in aesthetic procedures, ISAPS offers its more than 3, members in countries over 30 courses, workshops and symposia each year conducted by a world-class faculty with the primary goal of teaching aesthetic best practices and ensuring patient safety. Media Contact: Sign up for free newsletters and get more CNBC delivered to your inbox. Get this delivered to your inbox, and more info about our products and services.

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