Over a 6-month period, the second study followed 54 patients who received traction therapy 6 hours a day for 4 months. This study demonstrated the efficacy of the penile stretching device in increasing penile length, but significant evidence of greater penile girth was not noted. Nikoobakht et al. evaluated the effect of penile-lengthening devices on penile size. Some surgeons offer cosmetic penis enlargement using many techniques. At best, surgery may give a slight increase in girth to the penis. Understanding your partner's needs and desires is more likely to improve your sexual relationship than changing the size of your penis. At Loria Medical Orlando, we understand our patients want to discuss male enhancement in an environment where they can feel comfortable discussing this private matter. The vast majority of series reported normal penile size. However, limited scientific evidence is available to support the effectiveness of these uncontrolled medicines, elongation devices, or surgical therapies in increasing penile size. Men are more concerned with their penis size and girth, and they seek methods to enhance their erections. Various medical, tractional, injectable, and surgical modalities have been investigated for penile augmentation. Loria Medical offers non-invasive penis enhancement that delivers results quickly and sustains for an extended period. The first step to safe and realistic outcomes is to understand medically backed choices and cooperate with trained specialists. There are many untested goods and dangerous treatments on the market that promise amazing outcomes but often fall short or hurt people. Making wise choices that safeguard your health while attending to personal issues is the key to safe penile growth. The Uncle Jim’s Wap is a much more gentle stretch – good for the penis to recover in…… when it penis recovers in this state, gains will come quicker. I truly believe the Uncle Jim’s wrap is the secret to getting your flaccid bigger the quickest way……. Loria Medical USA uses advanced injectable fillers for penis enlargement. Our innovative procedures are designed to prioritize safety, efficacy, and a naturally-appearing result. Penile lengthening procedures are more established, and satisfactory results can be achieved by experienced, large referrals’ volume, surgeons. When done with care, skill, & good prep, penile enlargement can be safe. Avoid unregulated products, overstated promises, and procedures that lack trustworthy safety data. Preoperative and 6-month postoperative data of patients and their partners were collected. In the operation, silicone pears were connected to form a ring-shaped implant, which was then implanted under the dartos fascia. This new multicenter study shows findings of high patient and partner satisfaction coupled with acceptable adverse outcomes similar to the single-surgeon study. A new scrotal method of implantation named “concealed” is emerging. Most patients (52%) reported nodularity, ridges, irregularities, indentations, or voids in the tissue fillers. Some irregularities in the implants were observed in approximately half of the patients, which did not cause any problems. Furthermore, for the first time, they demonstrated significant improvement in psychological distress among patients with micro penile syndrome. The authors noted that both HA and PLA fillers had significantly enhanced effects in patients with micro penile syndrome 24 weeks after HA and PLA injections, and encephalitis was a severe side effect without serious adverse effects. Surgeons who employ this new incision believe that it reduces visible skin scars, is faster, and has less postoperative swelling. The penis is then bent, and additional sharp stripping is performed to expose the surface of the suspensory ligament. The subcutaneous surface of the glans is then exposed through penile intussusception, further exposing the coronal sulcus. Although there is a large medical literature on vacuum devices for andro-rehabilitation of patients undergoing radical prostatectomy, there are few studies concerning its use for purely esthetic purposes . This suggests the psychiatric sphere must not be ignored before any treatment, because it sheds light to the reason leading most men to invasive surgery and on the right therapeutic option . The very same psychological reasons causing the patient to request surgery might also cause the patient to be dissatisfied even with the most successful surgical outcome . These patients often suffer from the “locker room syndrome,” which is a lack of self-confidence and fear of exposing their “small penis” in front of others, leading to social phobia . Review articles, editorials, commentaries, and letters to the editor were included if deemed to contain relevant information on cosmetic surgery of the penis. One case of penile hematoma and one case of glans numbness were reported, both of which resolved without medical intervention. In a 2005 study by Aghamir et al., 27 patients received vacuum erection device treatment. The off-label use of these products in patients who want to enhance their penile function should be approached with caution. Lastly, retrospective studies can be inherently affected by selection and recall bias; this was minimized by including all patients from multiple practices and recording measurements at the time of operation.Any treatment method for SPA must encompass significant psychological components, because the treatment of SPA is not merely physiological, but a complex interplay of psychological and physical factors.The technique involves inserting a collagen layering activation filler material into the the shaft, just beneath the penile skin.A lipectomy must then be performed, removing underlying adipose tissue and excess skin, being careful to ensure a tension-free closure, preventing the penis from telescoping back within the soprapubic tissue 28,29,30.Recognizing these challenges, the recent technological advancements and innovations in surgical techniques are promising.There were no complications related to hypertrophic scarring or changes in erectile, orgasmic, or ejaculatory function.Augmentation procedures range from invasive to noninvasive. The key is to tailor interventions on the real needs of patients, carefully evaluating the history, the psychological background, and possible surgical advantages. In this scenario, cosmetic surgery of the penis must be versatile complying with the various problems increasingly affecting this area of surgery. A non-systematic literature review using the PubMed and Scopus databases was conducted to retrieve papers written in English on cosmetic surgery of the penis published over the past 15 years. Eight (72.7%) articles concerning injection therapies showed a significant increase in penile girth (p pYou can be sure that noninvasive produces are expected to be completed within an hour.It should be trimmed to fit the unique anatomy of each patient for optimal cosmesis and to mitigate any possible pressure points that could lead to erosion.Regarding expectations and patient satisfaction, the former must be managed realistically.A new scrotal method of implantation named “concealed” is emerging.At 6 months postoperatively, penile circumference enlarged by 2.29 ± 0.82 cm, with only 1 patient developing nodularity.This procedure injects excess fat cells from any part of the body into the area to be filled, and the fat cells regrow and fuse with the tissue at the site. Complications and outcomes following injection of foreign The study also reported 5 cases of mild, transient acute encephalitis, but no severe acute cerebrovascular accidents. The visual analog scale was used to rate satisfaction, with scores increasing from 51.6 ± 14.7 mm before the procedure to 64.8 ± 19.3 mm, 3 months after the procedure. Poly L-lactic acid is a biodegradable, absorbable synthetic polymer widely used for cosmetic expansion. All complications were treated accordingly, and no further deterioration or serious sequelae were observed. The mean increase in girth was 22.74 ± 12.60 and 20.23 ± 8.73 mm in the HA and control groups, respectively. From these results the Penuma® implants could achieve both girth and length enhancement with a high long-term satisfaction rate. Using a non-validated but well-structured questionnaire (e.g., Augmentation Phalloplasty Patient Selection and Satisfaction Inventory “APPSSI”) the authors reported 81% of patients with high or very high levels of satisfaction . Penuma® is a soft silicone subcutaneous implant placed, after infra-pubic access to the subcutis, on ¾ of the back of the penile shaft and secured to the glans with a polyester mesh . There were two cases of necrosis of the overlying skin, which was treated conservatively, whereas no alterations in erection or sensitivity were noted with high satisfaction from patients . The mean circumference gain was 1.1 (SD 0.4) cm in the flaccid and 1 (SD 0.3) cm in the erect penis after the second surgery at a mean follow-up of 38 months. In summary, the penis is crucial in sexual function through stimulation and pleasure during heterosexual interactions. They argue that this emphasis is rooted in the eroticization of the body within various gay cultures, along with the ‘dual presence’ of the penis in homosexual relationships and encounters. Drummond and Filiault examine the increasing significance of penis size among men who have sex with men. Research by Bogaert and Hershberger corroborated this finding in which a sample of 4000 men, those in the gay community generally had larger penises than their heterosexual counterparts. A study conducted in the United States in 2011 revealed that mutual masturbation, oral sex, and anal sex were the preferred sexual behaviors among gay and bisexual men.23,39 In male-male anal intercourse, the penis is inserted into the partner's rectum. Choose The Treatment You Are Interested In Using a ACE bandage in a completely flaccid state wrap your penis in a stretched position from base to tip. I think In the beginning I didn’t use this as my flaccid size was so small that the wrap didn’t stay on…… so I kind of just gave up on it…… However, for some people, surgery may be an option especially if they have issues with urinating, sexual intercourse or hygiene. If you’re not satisfied with how your penis looks and you’re considering penis enlargement, make sure you spend enough time talking with your surgeon about the outcomes. The type of procedure you had done will dictate how long you are home from work or school and how long you have to wait to be able to resume sexual activity. & Djinovic, R. Penile girth enhancement procedures for aesthetic purposes. A total of 29 studies were included (3 reporting non-invasive approaches, 11 injection therapies, and 15 surgical procedures). Many enhancement options on the market, such as temporary fillers or free fat transfer procedures, require ongoing maintenance or come with complications. For patients underwent fat grafting, a total of ml of fat was injected for penis enlargement. A multidisciplinary approach is often necessary, especially with patients with psychiatric disorders, to better assess patients’ eligibility for these kinds of treatments and eventually fulfill patients’ expectations. This could include enhancements to the shaft, glans, or scrotum. The treatments would depend on what you want to be done. They set a new standard for male enlargement solutions. The surgical approach should be tailored to the subject’s unique anatomy and underlying conditions. Say goodbye to ineffective products and explore our trusted, non-surgical options. In the 400 patients, the medial circumference increased from a mean of 8.5 ± 1.2 to 13.4 ± 1.9 cm. Another new type of scrotal incision implantation involves making a 1- to 2-cm longitudinal incision in the upper scrotum on the left or right base of the penis. The distal end of the penile implant can be aligned with the episcleral and glans sulcus connections before alignment. Despite a standardized surgical approach and rigorous postoperative care, the complications of combined prostaglandin E and ADM were severe, suggesting that it is not an ideal or safe method. The authors highlighted several advantages of decellularized dermal matrix grafts for penile girth augmentation over autologous dermal fat grafts. However, few complications related to the use of synthetic products (herniation, foreign body reactions, infection, or erosion of surrounding tissues) have been described . Another approach is based on filling the infra-pubic space resulting after ligament release between the pubic symphysis and the base of the penis . Li et al confirmed this length gain, reporting an increase from 1 to 3 cm, but mostly with postoperative penile traction therapy . Postoperative measurements included flaccid penile length and girth; these were measured before the patient emerged from anesthesia. Fitness to participate in implant surgery was determined by the guidelines published in Elist et al.2 These are the same criteria used in the study by Siegal et al.6 Exclusion criteria included uncircumcised patients. The penile silicone sleeve implant, also known as ‘Penuma’ or ‘Himplant’, is the first subcutaneous soft silicone sleeve penile implant FDA-cleared for cosmetic augmentation and correction of penile deformities. Complications are mainly cosmetic and may be corrected, however, patients should be appropriately counseled on the risk of erosion, which appears to be higher than previously reported. Complications are mainly cosmetic and may be corrected; however, patients should be appropriately counseled on the risk of erosion, which appears to be higher than previously reported. The World’s Most Experienced Male Enhancement Permanent Filler Expert The innovative use of natural collagen production means that results not only appear more authentic but also contribute to overall penile health, providing a holistic approach to male enhancement. Furthermore, Max X enhances not only size but also confidence, as many men report significant improvements in their self-esteem post-procedure. The Max X procedure offers numerous benefits that make it a preferred choice for men seeking enhancement. Autologous tissue engineering on a biodegradable scaffold is a novel, safe, and effective treatment for penile enlargement. Therefore, the superficial circumflex iliac artery and vein flap is a reliable option for penile girth lengthening, and flap enlargement helps preserve the intrinsic blood supply, thereby improving viability and tissue thickness. In 2021, Khalil et al. investigated a new adjuvant surgical technique for graft-less penile girth restoration and thickening through assisted expansion of the tunica albuginea. As such, AMS™ LGX 700® IPP insertion and postoperative vacuum device treatment is a safe and highly satisfactory combination approach to maintain penile size. Surgeons often seek a combination of prosthetic implants and other procedures. A buried penis refers to a penis hidden under the skin from your stomach, thighs or scrotum. The solution to your concerns about penis size may be as easy as talking with your partner or getting in shape. But chances are your penis is within the typical size range. Many men believe that increasing the size of their penises will make them a better lover or make them more attractive. However, it seems reasonable that, if possible, non-invasive techniques should be proposed as a first-line treatment. These procedures vary in complexity and require specialized training and experience. Both invasive and non-invasive techniques achieve similar improvements in penis length. We included the results of 14 papers in the review that gathered the experience obtained in a total of 1661 patients. The principal author was invited to provide an update on the usage of the Penuma® implant for penile aesthetics. A psycho-physical evaluation along with accurate patients’ selection and counseling are mandatory steps to achieve optimal outcomes. The results obtained with hyaluronic acid and PMMA in terms of circumference gained are very interesting, avoiding most of the historic complications of this surgery. Today, the use of soft tissue fillers has rapidly spread, thanks to the inexpensiveness and simplicity of the method compared to other procedures . Although all such problems are well known, self-injections remain a common means of increasing penile girth for Eastern Europe and Eastern Asia people . The penis is then stripped before further dissection of the distal Dartos and Buck's fasciae to expose a shiny white membrane. This approach is performed through a short dorsal incision at the base of the penis such that the scar is hidden in a pubic hair–covered fold; therefore, the incision is virtually invisible. Human acellular dermal matrix (HADM) is an extracellular matrix and 3-dimensional framework structure of the human dermis used in the treatment of various urologic diseases. Techniques for increasing penile girth In addition, the advent and refinement of artificial intelligence, various surgical techniques, and products are anticipated not only to improve male SPA and small penis syndrome but also to enhance treatments related to female sexual function and satisfaction. This enlargement exceeded that of most previously published surgical procedures. However, penile prosthesis surgery does not affect the size of the penis but may indirectly help the penis grow larger. In 2018, Antonini et al. conducted a study of postoperative vacuum therapy after AMS™ LGX 700® inflatable penile prosthesis placement in 74 patients with medically refractory erectile dysfunction. In a 2014 study by Hsu et al., 35 patients underwent extensible penile implantation. Studies have been published worldwide to evaluate and establish normal penile sizes. The normal penis size and the methods of determination of the normal penis size must be defined. Many unproven methods to increase penis size are available on the Internet; these include lotions, pills, stretching devices, vacuum pumps, and home massage techniques. Penile hematoma, exacerbated in hypertensive patients or by nocturnal erections, was rarer. Edema, paraphimosis, seroma, and pain on erection are the most common, but are also reported deformities such as curvature and shortening of the shaft due to graft fibrosis, ulceration and necrosis of the skin, immune reactions against graft, infections and hypoesthesia 82, 86. Thus, should not be offered to men who are concerned with inadequate flaccid appearance, but rather to men who are motivated to augment erectile girth. The implantation can be realized in two ways through albugineal or peri-cavernosal surgery. Unfortunately, there are still few studies with long-term follow-up and with a complete evaluation of the sexual e psychological distress before and after treatment. Initially developed for patients with severe penile shortening secondary to Peyronie’s disease, this intervention is based on a double incision, one ventral and one dorsal. These methods should be recommended in first instance to patients with true micropenis for whom the methods previously considered could be ineffective. More invasive surgical techniques up to total phalloplasty can be used to increase the effective length and width of the penis. After liposuction of the pubic region, the procedure continues gaining access to the suspensory apparatus through sub-coronal circumcision, detachment of the penile skin from the deep fascia and subsequent complete resection of the subpubic ligament and partial resection of the suspensory ligament. The release of the suspensory ligament, with or without the association of other procedures, has represented for many years the most commonly used penile lengthening technique . Among 25,592 surveyed men, most respondents wanted a larger penis, and around a third wanted a longer penis. A large penis has long been celebrated as an indication of masculinity, power, prestige, fertility, and stamina. An increasing number of men with healthy and normal penises want to enlarge their penis. During a consultation session with us, our staff can assess if this procedure matches your expectations and goals. There's no guaranteed safe and proven way to enlarge your penis. When the suspensory ligament is cut, the non-erect penis may look longer because more of it hangs outside the body. Surgery is typically reserved for men whose penises don't work because of a problem present at birth or an injury. Regarding penile enlargement, there are no guidelines, nor a standardization of the procedures so far recounted in the literature. For patients with true micropenis the sliding technique could be a good solution but the RAFFF phalloplasty is accepted as the standard technique for best results in penile reconstruction . In addition, lipoplasty could be functional in obese patients, with or without double-belly or a moderate pubic fat pad, giving a better cosmetic result with low risk of complications. Developed by the renowned Dr. Loria, Max X is a revolutionary technique in non-invasive male enhancement, offering permanent results with minimal discomfort. This strategy is his newest iteration of a lengthening techniques without grafting accompanied by penile prosthesis implantation. Therefore, pearls implantation is possible to enhanced sexual experiences both for man and their partners. The total TSS scores of patients with fat grafting increased by 16.7%; meanwhile, scores of their partners had not obvious improvement. The penis diameter, penis appearance score (PAS) and treatment satisfaction scale (TSS) were evaluated. The 2 types of studies both suggest that Penuma results in a rapid, durable increase in penile girth and generally improves the flaccidity of the penis. The growing market for male genital esthetics has brought new surgical procedures, devices, and implants. Given the seemingly high rates of complications with ADM grafting, grafting does not appear to be viable despite the successful enhancement of penile girth. However, 47, 12, 10, 8, 7, 4, and 3 patients experienced erectile discomfort, delayed healing, insignificant enhancement, wound hematoma, foreskin edema, wound infection, and dorsal skin necrosis, respectively. This technique shows an average increase of erect penile diameter varying from 1.1 to 2.1 cm and no change in flaccid penis. With an attempt to shed light on possible differences between the two fillers, Yang et al. with a multi-center randomized study on 69 patients, compared the mean circumference outcomes at 6 and 18 months between the newly synthesized cross-linked HA and PMMA. Casavantes et al. subjected 729 men to 2–3 sessions of injections, achieving not only an increase in average girth of 2.21 (SD 1.16) cm, but also an increase in average flaccid penis length of 0.7 cm, likely due to PMMA’s ability to create a stiffer shaft at rest. The use of autologous fat is still an experimental method, patients should be informed on possible complications and about the need of new injections to preserve the thick gained. A summary of studies reporting outcomes of soft tissue filling, grafting and biodegradable scaffolds implantation for penile girthening, in presented in Table 2. Many potential patients have questions regarding the Max X procedure, ranging from its effectiveness to safety concerns. By adhering to these guidelines, patients can maximize the benefits of their enhancement while ensuring a smooth recovery experience. Recovery after the Max X procedure is notably swift, with most patients resuming their normal activities within a few days. In the future, more precise and efficient surgical and nonsurgical therapies may be developed, thereby expanding the range of options for patients with SPA. With these advancements, penis enlargement surgery might become safer and more effective, benefiting from new technologies such as gene editing, stem cell therapy, nanotechnology, 3D printing, and mature biotissue engineering. Moreover, the application of fat, polylactic acid, HA, and dermal transplantation during the preparatory stages of penile enlargement surgery laid the foundation for emerging materials and technologies. These advancements, which are characterized by fewer complications, more effective results, shorter operation time, and higher patient satisfaction, are pivotal for the development of treatment options. Developments in skin flap procedures, the introduction of products such as Penuma, and breakthroughs in tissue engineering have redefined the landscape. You can be sure that noninvasive produces are expected to be completed within an hour. Our proprietary techniques minimize risk and maximize patient satisfaction. This procedure is less than one hour long and results are immediate. Dermal fillers are one of the best ways to increase penis circumference. The best patient management may result from a complete clinical pre-operatory evaluation, including a psychiatric and psychosexual assessment, especially for patients who fall within the normal range diameters. Among the first there are patients with a “true” micropenis and patients with a micropenis appearance, linked to other conditions like the buried or the trapped penis 26, 94. Patient selection is the key to achieve optimal results and to ensure that all patients are fully informed and physically and mentally qualified, the authors recently published their patient selection protocol for the Penuma® implant . We performed a retrospective analysis of all men undergoing penile silicone sleeve implants between 23 November 2020 and 30 November 2022 with four surgeons, each from a separate geographically diverse institution. Salkowski et al.5 found that 85% of patients would choose to have the surgery again. After being cleared by the FDA in 2004, penile silicone sleeve implantation began to gain traction in 2018; since then, approximately 5000 devices have been implanted across participating urology providers. Men believe that their actual penis size is significantly smaller than the ideal size (i.e., what they think their penis should be or what they expect it to be after penis enlargement surgery). In all the cohorts, patients with below-average penises were extremely rare, and most patients had normal penises.1,2 The second group of male patients seeks surgery because their penis is physiologically too small. The patients who underwent this treatment claimed various justifications for wanting to enlarge their penile circumference. In addition, it highlights the underlying motivations for penile enlargement and to provide an overview of the various medical, tractional, injectable, prosthetic, and reconstructive modalities commonly utilized in urology and plastic surgery (Table 1). Penis enlargement surgery, patient type, and normal penis size Device removal occurred in 12 (3%) cases due to 4 infections, 4 implant perforations, 2 suture detachments and resultant mispositioning of implant, 1 implant fracture, and 1 hematoma. Access is via penile inversion either through an infrapubic incision or by a “concealed” lateral scrotal incision near the penoscrotal junction.27 This implant is distinct from implants that treat erectile disfunction as it is anchored distally at the coronal sulcus between Buck’s and dartos fascia and provides no erectile function. The remedy for this is to correct this webbed skin by removing it. Preoperative measurements included flaccid penile length (from pubis to glans) and flaccid girth (at mid-shaft). Patients are instructed to avoid any behavioral or sexual practices that apply prolonged pressure to the penis, particularly constriction created by penile rings. The postoperative protocol involved educating the patient on wrapping their penis with a mesh tube wrap that protects the skin without creating pressure, avoiding regular activity for 1 week, masturbation and vigorous physical activity for 4–6 weeks, and intercourse for 6 weeks postoperatively. Those who have had previous penile enhancement surgery such as dermal grafting, fat injections, injection of any material for penile enhancement, or suspensory ligament release were also excluded. Uncircumcised patients were offered to undergo circumcision prior to surgery; circumcision was completed at least 3 months prior to the surgery. In some cases, surgical procedures are required for removal of silicone deposits and correction of deformities.12,13 Finally, there is no formal role or evidence for injection of platelet-rich plasma, stem cells, or other regenerative medical procedures for penile girth enhancement. In conclusion, the penile silicone sleeve can be used to significantly increase flaccid penile length and girth in patients who desire cosmetic augmentation or correction of retractile penis. This implant is intended for men with the perception of a small flaccid penis (both in terms of length and girth) and retractile penis who seek a cosmetic procedure for penile enhancement. Secondly, statistical data about the outcomes of all surgical procedures are not always available, and it is not unusual to note inconsistencies between the complications arising after surgery and patient’s satisfaction data reported by the authors. It has long been known how cosmetic surgery may represent an important support to psychotherapy in mitigating or even resolving the psychological distress of patients not satisfied with their appearance 97, 98, although this way to heal psychiatric disorders could create a surgery addiction . Among the patients with normal size penis there are some with “Penile dysmorphic disorder” (PDD) or “small penis syndrome”, someone with “small penis anxiety” (SPA) and others without any problem related to their appearance but wishing to improve it 2, 9, 11, 70. Elist et al reported outcomes of 400 patients who underwent Penuma implantation from 2009 to 2014. Djordjevic et al. proved the feasibility of repeated treatment in 21 patients, who were unsatisfied with results achieved and wanted an additional girthening. Eight (72.7%) articles concerning injection therapies showed a significant increase in penile girth (p p Our team is committed to ensuring that all patients are well-informed and comfortable before proceeding, emphasizing the importance of addressing any concerns during consultations. For instance, many wonder about the longevity of results, and it's important to note that the natural collagen produced through the procedure leads to permanent enhancements. The cost of the Max X procedure varies depending on individual needs and enhancements desired. During the recovery period, patients are advised to follow specific aftercare instructions to ensure optimal results. This procedure injects excess fat cells from any part of the body into the area to be filled, and the fat cells regrow and fuse with the tissue at the site. However, the effect was different for the circumference of the penile head (9.3 ± 0.86 vs. 8.8 ± 0.66 cm). No significant differences were observed in the circumference of the proximal penis. A proper counseling must always be done before planning any intervention, to resize any false hopes built by the patient or indirectly induced. On this matter it would be useful a structured follow-up based on objective measurements of outcomes and complications and based on the evaluation of patient satisfaction (eg. Sexual quality of life, Visual analogue scale, APSSI, Self-body esteem, etc.) through validated questionnaires. Today, due to the constant media emphasis on esthetics and to the widespread diffusion of pornography and the continuous growth of the average age of survival and quality of life, cosmetic surgery of the genitals is a very lively field with an increasing demand on the world market 13, 100. This method is not only safe and effective, but it also leads to more firmness and girth, setting it apart from other enhancement techniques. Unlike temporary fillers or fat transfer procedures, Max X uses a Collagen Layering Activating Filler that stimulates your body to produce natural, permanent collagen. Max X is a Penile Shaft & Glans Permanent Filler Enlargement treatment designed for men seeking a significant, long-lasting enhancement. The distal end of the penile implant can be aligned with the episcleral and glans sulcus connections before alignment.They set a new standard for male enlargement solutions.Call your provider if you have any symptoms that worry you, especially signs of infection, such asfever, reddened or swollen skin or problems urinating.Unfortunately, there are still few studies with long-term follow-up and with a complete evaluation of the sexual e psychological distress before and after treatment.Given the seemingly high rates of complications with ADM grafting, grafting does not appear to be viable despite the successful enhancement of penile girth.Implantation should be avoided in patients with any conditions that increase the risk of poor wound healing (such as uncontrolled diabetes or immunocompromised status), prior penile cosmetic surgery, lack of circumcision, or current tobacco use.2 There is no hydrophilic coating on the device.These compounds determine granulomatous inflammatory reaction around silicone cyst-like vesicles with obliteration or dysfunction of the microcirculation . For enlargement surgery the circumference measurements of flaccid and erect penis, at the distal third of the shaft, just below the glans, at the middle third and at the proximal third at the level of the peno-pubic junction are important to evaluate a possible gain on girth. Particularly, the PDD concerns the strong distress generated by a functional issue (patients dissatisfied with the erect size) or by the esthetic appearance (patients dissatisfied with the flaccid size) of the penis . Our non-invasive penis enlargement procedures are discreet, safe, and effective. Loria Medical USA has a reputation for providing non-invasive penis enlargement and cosmetic treatments. Loria Medical USA specializes in non-invasive penis enlargement methods that help men reach their desired size without surgery. The third group of male patients undergoes cosmetic penile contour surgery and repair for congenital and acquired causes of penile damage.22,26,32 These men seek various enlargement methods to increase the size and girth of their penises. In the male esthetic surgery field, some studies report an increase in sexual satisfaction by patients who underwent enlargement procedures, whose real gain in shaft size was not preserved over time . Non-invasive penis enlargement includes procedures that are aimed at increasing penile length and girth without surgery. In a recent pilot study of acellular collagen matrix grafts, Xu et al. observed 78 patients treated with prostaglandin E and ADM. At the 3-month follow-up, the mean increase in penile girth was 1.1 cm. In recent decades, autologous fat injections have been widely used for cosmetic, breast augmentation, and enhancement procedures. Among 23 patients with a mean age of 26.5 years, the mean flaccid penile length increased from 8.8 ± 1.2 cm to 10.1 ± 1.2 cm and 10.5 ± 1.2 cm, respectively, in the first and third months of follow-up. Recognizing the limitations of the current evidence and employing a multidisciplinary approach is crucial for better assessment of patient eligibility and meeting patient expectations. Regarding expectations and patient satisfaction, the former must be managed realistically. Collaboration is crucial to comprehensively understand a patient's condition and effectively manage their expectations. This approach should involve experts from different fields such as psychology, urology, and sexual medicine. The incision of the ligament allows the release of the corpora cavernosa from the pubic branches, changing the peno-pubic angle from acute to obtuse, giving the perception of a longer penis . Finally, a vertical skin resection along the median rafe with a subsequent Z plasty has been proposed in order to better preserve the scrotal sensitivity since the genital branch of the genitofemoral nerve and the ilioinguinal nerves run from lateral to medial . The Dartos fascia is then plicated and the skin is sutured posteriorly at the base of the scrotum . More recently, Lorenzo et al proposed a novel technique involving the excision of two rectangular skin flaps posteriorly along the perineum border of the scrotum up to the most dependent point of the scrotum. The dartos is then reapproximated with resorbable sutures, and the skin is closed with subcuticular resorbable sutures . Over the last decades, different surgical strategies have been developed, aimed at either increasing flaccid penile length or improving penile girth. Management of penile size-related concerns represents a real challenge for the urologist, especially when dealing with patients suffering from penile dysmorphophobic disorder (PDD). The search strategy included a range of keywords; e.g. penis, penile, enlargement, augmentation, lengthening, girth. The primary outcomes were changes in penile dimensions, specifically in terms of length and girth, as well as the incidence of surgical complications and the impact on quality of life. This systematic review aims to summarize the available evidence on outcomes, complications, and quality of life after penile augmentation surgery, examining both minimally invasive and more radical techniques. Ingenuity and device innovation are vital to technological surgical advances that can produce a more sustainable improved quality of life for patients. Repeated penile girth enhancement using biodegradable scaffolds employing biopsy of previously formed tissue. Postoperative penile girth relaxation and erectile enhancement improved by 1.1 and 1.0 cm, respectively. In addition, the repeat surgical technique resulted in a considerable improvement in peripenile enhancement, with a mean follow-up period of 38 months. Perovic et al. also performed a second penile widening among 12 patients using a biodegradable scaffold containing enlarged autologous scrotal sarcolemma cells. When the skin was compliant, the scaffold was molded and grafted with Buck's fascia; when the skin was not compliant, the scaffold was grafted underneath the neurovascular bundle. Perovic et al. performed the surgery on 204 men with a mean age of 26.77 years. By creating new functional tissues from somatic cells, the circumference of the penis can be enlarged. No serious adverse events (fibrosis, flap infection, sclerosis, or excision) were reported during the 6-month follow-up period. The adjuvant incision enlarged the penile circumference by 50% (from 8.0 to 12.0 cm). Most (96.4%) patients who underwent cosmetic procedures for SPA reported worsened or unchanged SPA symptoms. In 2017, among 23 patients who underwent single-treatment PLA injections with a mean volume of 20 mL for penile girth enhancement, the mean circumference increased by 2.2 ± 0.2 cm at 3 months. Therefore, patients must be informed about the practice statements of various medical associations regarding enhancement procedures. Table 2 shows patients who present for medical treatment due to small penis size. For a better cosmetic result several surgeons complete the lipectomy with the liposuction, which may precede or follow the first step . A first approach could be a degloving incision to cut fibrous tissue on dartos or skin adhesions . Usually, the management could be led by the presence or not of a specific clinical picture, like the acquired buried penis (ABP), which presents itself as a “false” micropenis 23, 24. The mean stretched penile length was 11.5 (±1) cm at baseline and it increased to a mean of 12.4 (±1.39) cm and 13.2 (±1.47) cm respectively in the first and third month. Treatment with penile extender was continued for 3 months with progressive intensification from the first 2 weeks until the end of the third month. In 2018, Elist et al. reported both satisfaction and adverse events in 400 patients who participated in a postoperative questionnaire. Although HADM is becoming a common modality for penile enlargement, relatively few descriptions of its complications exist. However, one disadvantage of HADM is that penile girth increases significantly in the flaccid state, but less significantly during erection. Given less trauma, a simpler operation, a precise effect, and fewer complications, day surgery and outpatient surgery can be performed. These extensively utilized methods for penile enlargement demonstrate effectiveness and yield high patient satisfaction. A comprehensive research was carried out on MEDLINE/PubMed database to identify pertinent studies concerning penile enlargement issues.In some cases, surgical procedures are required for removal of silicone deposits and correction of deformities.12,13 Finally, there is no formal role or evidence for injection of platelet-rich plasma, stem cells, or other regenerative medical procedures for penile girth enhancement.Secondary placement of the penile silicone sleeve is possible only in rare scenarios; this is typically not recommended after removal for infection, as the subcutaneous penile compartment becomes very fibrotic.The average penile girth measured before and after treatment was 9.5 and 12.1 cm, respectively.Why Choose Permanent Penile Filler at Loria Medical USA Choosing an aesthetic medical treatment is never a casual decision, especially Kang et al. reported similar outcomes in 52 patients, with a mean circumference gain of 2.5 cm, 6 months after surgery. Soft tissue fillers are the second most widespread esthetic surgery technique in the United States of America for their reduced invasiveness, safety of use and low cost, counting almost 3 million procedures in 2018 . Several methods have been adopted to achieve penile girthening, starting from the injection of the most various substances 65,66,67, the positioning of grafts and scaffolds 68, 69, up to more invasive methods such as cosmetic phalloplasty . 80% of patients were satisfied postoperatively, 76% of patients managed to reach orgasm and reported an acceptable level of penile tactile and erogenous sensation. With the achievements in the microsurgery field, free flaps incorporating sensory nerves have being used for the surgical treatment of micropenis. A fair amount of literature on this procedure is available, witnessing complications and constant evolution over the years. The results of this series concur with others in that the forearm free flap phalloplasty technique provides the patient with a satisfying surgical result, according to the patient and surgeon . Four patients experienced an acute arterial thrombosis, leading to complete loss of the phallus in two. In patients who underwent such technique, the average length gain was between 2.5 and 4 cm . In addition, a Canadian study found that penis size tends to be larger in gay than in heterosexual men, with a preference for larger sizes noted within the gay community. In male-male sexual activity, which primarily involves oral (mouth-to-genital) and anal (anal-genital) sex, the size of the penis is closely linked to sexual satisfaction. In summary, the size of the male penis is uniquely beneficial for female reproductive health, orgasm, and sexual dysfunction. The following review aims to describe non-invasive and invasive approaches to cosmetic surgery of the penis with the purpose of laying the foundation for possible indications and recommendations for the future. Sometimes behind the request for penis enlargement, that is the increase of penile circumference, is hidden the desire to give more pleasure to the partner, although men generally view penis size as more important than women do . The main outcomes recorded were change in penile dimensions in term of length and girth and surgical complications. Some procedures do result in increases in penis length and/or girth. Loria Medical USA offers minimally invasive surgery that is safer and more comfortable.However, the procedure, although not excessively invasive, requires expert surgeons, as well as further booster treatments for those who wish to maintain over time the circumference gained, making it much more expensive than it could be.They might think that both length and girth aren’t adequate.In addition, we discuss preventative techniques to minimize postoperative complications and the management of these events.Hence the sense of inadequacy and discomfort that many patients feel, even though from a physical-anatomical point of view they fall within the parameters of normality .This strategy is his newest iteration of a lengthening techniques without grafting accompanied by penile prosthesis implantation.Usually, the patients are back to doing their normal routines within a few days. Therefore, penile prosthesis surgery does not decrease penile size and may indirectly help the penis grow larger. After prosthetic implantation, 72% of patients reported a decrease in length. One of the most common complaints of patients after penile prosthesis implantation is that their erection is perceived as smaller than their natural erectile memory. The erection of the penile prosthesis simulates the physiological erection of the penis, thus allowing patients with erectile dysfunction to achieve coitus and treat severe erectile dysfunction. Although no perfect penile injectable material exists, PMMA microspheres appear to be safe, stable, and effective, and patient satisfaction is high. Beginning in 2007, Casavantes et al. administered PMMA injections to enhance penile girth in 752 men and conducted follow-up reports over 7 years. At 24 weeks, the average increase in penile girth was 2.1 ± 1.0 cm in the HA group and 1.6 ± 0.9 cm in the PLA group. In conclusion, this newly developed PLA filler caused significant penile enlargement for up to 18 months and was well tolerated without serious adverse effects. Therefore, penile size has additional significance for both heterosexual and homosexual relationships. In addition, in the context of gay culture, penile size may influence sexual attractiveness, particularly among men who have sex with men. Additionally, the researchers propose that the importance of penis size is further magnified by its prominence in the prevailing male gay culture, highlighting its role in shaping sexual dynamics and identity within this community.” Max, herbatint 5n, garnier color sensation, essensity schwarzkopf, herbatint 6n, herbatint 4n, herbatint 7n, colorance, igora absolutes, feria b61, loria medical usa At Loria Medical USA, we are committed to delivering the highest quality care for our patients. The newly formed collagen provides a natural appearance, avoiding the unnatural look and feel that some other procedures may cause. With no need for stitches and a low risk of complications, Max X is a preferred choice for men seeking reliable, long-term enhancement. The use of local anesthesia ensures that the injections cause minimal discomfort, and most patients find the experience manageable and straightforward. This technique involves a peno-pubic incision up to Buck’s fascia, which is preserved, followed by complete degloving of the penis. An interesting note is how satisfaction with sexual performance increases despite circumference gain is lost in the following months. Moreover, excluding two cases of inflammation and three of pain in the site injection, no major complications were recorded. They have been synthesized in recent years and have been already approved in several countries . Furthermore, patient satisfaction is uncertain, given the lack of validated questionnaires in this population seeking penile girth enhancement. The soft tissue filling materials that have received US Food and Drug Administration (FDA) approval for cosmetic purposes since 2004 include polylactic acid, polymethylmethacrylate microspheres, hyaluronic acid (HA), and autologous fat obtained through excision or liposuction.14 The use of these fillers for penile girth enhancement is considered off-label. Nevertheless, patients should be appropriately counseled on the risk of implant erosion, which appears to be higher than previously reported. The longest reported follow-up for penile silicone sleeve surgery in the literature is a single surgeon case series with a mean length of follow-up of 4 years, whereas ours is a median of 1 year. Our patient population had minimal comorbidities (5% hyperlipidemia, 2% smokers, 2% cardiovascular disease, and 1% diabetes).In addition, a Canadian study found that penis size tends to be larger in gay than in heterosexual men, with a preference for larger sizes noted within the gay community.Prior to this study, seromas were reported at higher rates than we observed (4.8–27% versus 2.0%).3,5 The reduction in seroma formation may be related to progression in operative techniques such as judicious use of electrocautery and minimization of the dissection area.Major complications may be secondary to compromised flap vascularization during resection, thus wound dehiscence, infection, and/or dorsal flap loss .The majority of patients experience immediate improvement.Men believe that their actual penis size is significantly smaller than the ideal size (i.e., what they think their penis should be or what they expect it to be after penis enlargement surgery). Many pumps, pills, weights, exercises and surgeries claim to increase the length and width of your penis. Due to the popularity of this procedure, it has been featured on some of the largest news networks in the world. This procedure truly is the safest and most permanent solution you can find. The full effects of treatment are often visible only after the swelling has gone down. For wound treatment, our team is happy to provide you with additional treatment and medicine to help the recovery process. The time of recovery would depend on the technique and procedure that is being done. The TSS scores of patients who underwent pearls implantation increased by 11.96%, and the partners' scores increased by 9.17%. A new penile rehabilitation program has been developed with the aim for the penis appearance to be restored to its pre-operative state if the Penuma® is removed. As the device is now surgically implanted by surgeons other than its inventor, new developments have appeared authenticating the original published paper in 2018. The objective of this article is to provide updated information regarding the Penuma® aesthetic penile implant. If replacement were attempted, there would be an inability to safely recreate or enter the correct subcutaneous penile compartment due to fibrosis. Two sites reported the number of infrapubic versus scrotal approach (center 1 used the infrapubic approach for 13 cases and center 2 used the infrapubic approach for 42 cases); the other two sites used both techniques but did not differentiate in their reporting. Our patient population had minimal comorbidities (5% hyperlipidemia, 2% smokers, 2% cardiovascular disease, and 1% diabetes). Our minimally invasive penis girth enlargement procedure is designed for your comfort and safety. We follow a process that is designed to provide you with the best possible results and ensure your comfort in our penis girth enlargement procedures. The cosmetic outcomes of the silicone sleeve implant are immediate thus length of follow-up is less relevant; however, some complications such as erosion and infection could potentially occur beyond the follow-up period reported in this study. Subcoronal flaring of the silicone implant was the most frequently encountered complication occurring in over 10% of patients; nevertheless, only about half of these cases required surgical revision (Figure 2). Side-by-side esthetic results of a patient’s erect penis before (silicone model) and after penile silicone sleeve implantation. The lack of comparative study with other procedures for penile enlargement and the necessity of skilled surgeons to achieve optimal results reported in the literature limit the widespread of this procedure. These reasons have generated, over the years, a vast medical literature on the surgical procedures available for the removal of silicone and the correction of resulting deformities 65,66,67. Total phalloplasty is a two-step procedure including the creation of a neophallus with an urethra that helps in urinating standing up and an acceptable esthetic size and sensation followed by penile prosthesis implantation to provide enough rigidity for sexual intercourse. Invasive treatments However, serious complications were not noted in the dermal fat grafting cohort (Fig. 5). The aforementioned studies using autologous fat augmentation and dermal fat grafting demonstrated considerable changes in the average penile circumference. In 2012, Shaeer selected 10 men who underwent a dermal fat grafting procedure. Essentially, the fat cells grow in a different place, and because the fat cells are transplanted autologously, rejection does not occur, which fundamentally guarantees the safety of the procedure. Although HA injections are becoming a popular modality for penile enlargement, relatively few reports of their side effects are available. This concludes that HA is a safe and effective method for penile body enlargement. Satisfaction with penile appearance and sexual life was significantly higher in the HA groups. It improves skin nutrient metabolism, is an excellent transdermal absorption enhancer,45,46 is a long-acting absorbable dermal filler with a good safety profile, and is present in multiple forms in the body, making immunization and implant rejection less likely. The pleasure from anal sex involves the stimulation of nerve endings and the stimulation of prostate gland, and is related to penis size. Penis girth enhancers are used to increase circumference. Men who are not happy with their penis thickness can experience insecurity. Contact us today to schedule a private consultation with our expert medical team. The aim of this study was to shed light on cosmetic surgery of male genitalia through minimally invasive and more radical techniques, with the purpose of laying the foundation for possible indications and recommendations for the future. The approach should be to modulate the interventions on the real needs of patients, carefully evaluating the history, the psychological picture, and possible surgical advantages. Experience the future of male enlargement with Loria Medical USA’s non-invasive penis enlargement. Loria Medical USA provides a range of non-surgical penile enlargement options. Non-invasive penis enlargement is one of these options. Penile size – both length and girth – is a common point of fixation and possible anxiety in adult men.1 This has led to a multi-million-dollar male enhancement industry; however, there are no proven non-surgical methods to augment penile size.This implant is distinct from implants that treat erectile disfunction as it is anchored distally at the coronal sulcus between Buck’s and dartos fascia and provides no erectile function.In all these patients it is very common an ABP, which could be defined as the entrapment of the penis by the surrounding tissue .Management of penile size-related concerns represents a real challenge for the urologist, especially when dealing with patients suffering from penile dysmorphophobic disorder (PDD).Experience the future of male enlargement with Loria Medical USA’s non-invasive penis enlargement.The approach should be to modulate the interventions on the real needs of patients, carefully evaluating the history, the psychological picture, and possible surgical advantages.Our team will create a treatment plan based on your individual needs.Another approach is based on filling the infra-pubic space resulting after ligament release between the pubic symphysis and the base of the penis . Unfortunately, 52% of patients directly witnessed shaft deformities secondary to the formation of nodularities, single or multiple, and indentations due to areas of void. This represent a possible complication, although it has not been reported in any case of penile injections . The distal third thickness of the penis was 7.06 (SD 0.37) cm before treatment and 9.34 (SD 0.86) cm after treatment . Panfilov et al. injected up to 70 ml of body autologous fat through a preputial incision in 60 patients, 31 of which underwent to another injection at sixth month, with an average circumference gain of 2.65 (1.4–4) cm after 1 year . Unlike traditional surgical methods that may involve extensive downtime, Max X minimizes recovery time, allowing men to feel comfortable and confident sooner. All providers at Loria Medical clinics have been trained and certified by Dr. Loria to follow his personal medical protocols, ensuring top-quality care. Max X is the future of male enhancement, providing permanent and natural results with minimal downtime. The Max X procedure is designed to be as comfortable and convenient as possible. Once injected, the filler begins to activate collagen production in the penile tissues. Therefore, this review evaluated the mental health status of men who complained of a small penis and examined the state of nonsurgical and surgical treatments for male patients seeking penile enlargement, along with a risk assessment for each. Despite the retrospective cohort series reported above, life-changing irreversible complications and poor patient satisfaction with aesthetic penile girth enhancement implant surgeries are garnering mainstream media attention30 and a class action lawsuit was filed in 2021. Potential catastrophic complications of exogenous materials such as liquid silicone, paraffin, Vaseline, oils (motor, baby, cod liver), and other materials injected into the penis for girth enhancement have been reported and their use is not medically advised.5–11 Silicone for injectable use has been fraught with complications. Our study demonstrates that at the 1-year median length of follow-up in appropriately selected patients, penile silicone sleeve implantation results in significantly increased flaccid penile length (50.0%) and girth (36.9%). Non Invasive Penis Enlargement The stretched penile length represents the most overlapping measurement of the erect penis, corresponding to the distance between the pubic symphysis and the apex of the glans . The negative perception of the size of one’s own penis could underlie a somatoform disorder called Penile Dysmorphic Disorder (PDD) which is classified according to DMS-5, within Body Dysmorphic Disorders (BDD) . Up to 66% and 12% of men in the general population perceive their penis size as average and smaller than average respectively and the desire to have a bigger penis was present in 46% of men who rated their penis as average and 91% of men who rated their penis as smaller than average . This is the largest study to characterize the safety of the penile silicone sleeve implant across multiple surgeons.Therefore, penile size has additional significance for both heterosexual and homosexual relationships.The most common postoperative complications were seroma (4.8%), scar formation (4.5%), and infection (3.3%), whereas no patients reported any change in sexual function, erection, or ejaculation.No patients had active infections, erectile dysfunction, current or recurrent cancer, or disorders that could lead to poor wound healing.Some patients may have shrunken testicles and the Penis size simply does not ‘match’ or is not proportionate to the scrotal area size.We offer advanced procedures that can be tailored to different goals and needs.The results obtained with hyaluronic acid and PMMA in terms of circumference gained are very interesting, avoiding most of the historic complications of this surgery.Penile lengthening procedures are more established, and satisfactory results can be achieved by experienced, large referrals’ volume, surgeons. Papers discussing surgery in animal models and case reports were excluded from the present study unless further evaluated in a follow-up case series. Noninvasive solutions include external devices such as vacuum pumps and traction devices. Minimally invasive solutions include injections of fillers (hyaluronic acid, polylactic acid, and polymethyl methacrylate). A low rate (11.2–14.4%) of mild, temporary adverse events and poor-to-moderate patient satisfaction were found. By discussing options with our team, individuals can find a solution that fits their budget, ensuring they receive the benefits of the Max X procedure without compromising on quality or care. There was also a gain on the penile flaccid length, from the pre-operative 9.1 ± 0.7 cm to the post-operative 11.3 ± 0.4 cm. The results reported was a gain on midshaft circumference of 56.7%, from a mean preoperative girth of 8.5 ± 1.2 cm to a mean post-operative of 13.4 ± 1.9 cm, at a mean follow up of 4 years. They degloved the penis after subcoronal incision, and implanted scaffolds on the buck’s fascia near the urethra, without covering it. Any treatment method for SPA must encompass significant psychological components, because the treatment of SPA is not merely physiological, but a complex interplay of psychological and physical factors. These technologies aim to achieve enhancements in precision and durability. Innovations such as Penuma and assistive technology for the penile tunica albuginea, along with their potential for tissue engineering, are steering the field toward more promising directions. Consequently, evidence-based clinical guidelines regarding dermal fillers for penile girth enhancement are non-existent. None of the patients reported any pain after the anesthetic effect had worn off. The average penile girth measured before and after treatment was 9.5 and 12.1 cm, respectively. In 2003, Yacobi et al. employed a series of subcutaneous injections of liquid silicone as the primary enhancement procedure in 324 men under local anesthesia. However, significant dissatisfaction was not found during patient follow-ups, and the erectile aspect of sexual function was not affected due to the independence of the PMMA implant from the corpora cavernosum and corpus spongiosum. The average girth gained was of 3.15 cm and 2.47 cm in the flaccid and erect penis respectively, without serious complications and high satisfaction from patients . Given longer surgical times (from 3 to 5 h) even in expert hands, the high risk of moderate complications and patient dissatisfaction and the overall cost of the procedure, graft implantation for male esthetic surgery is not the wisest strategy to undertake. The main goal of penile girthening surgery is to determine a long-lasting gain in the girth of both flaccid and erect penis improving the sexual quality of life. Clinical evaluation and the preliminary psychiatric evaluation can help in discerning those patients who would benefit from medical therapy or minimally invasive treatments from those who would benefit from surgery 7, 10. More and more men are seeking cosmetic procedures to help address a wide range of male-specific issues, including gynecomastia surgery, male enhancement and interventions for sexual performance. A healthy strategy for safe penis enlargement takes into account both physical and mental aspects, making sure that men are at ease, knowledgeable, and confident during the whole procedure. At Loria Medical USA, patient safety, education, and individualized care are our top priorities, ensuring a focus on safe penis enlargement. Although surgical procedures involve a considerable risk of scars, infection, and altered feeling, they may also modestly affect appearance. Moreover, excluding two cases of inflammation and three of pain in the site injection, no major complications were recorded.These reasons have generated, over the years, a vast medical literature on the surgical procedures available for the removal of silicone and the correction of resulting deformities 65,66,67.A summary of studies reporting outcomes of soft tissue filling, grafting and biodegradable scaffolds implantation for penile girthening, in presented in Table 2.Radial artery forearm free flap (RAFFF) phalloplasty was first described in 1984 and is still accepted as the standard technique for penile reconstruction worldwide .Many men believe that increasing the size of their penises will make them a better lover or make them more attractive.It would be interesting to know if this non-invasive management can meet the needs of patients with a normal-sized penis, mitigating psychiatric disorders in those who suffer from it.First, experiences of skilled surgeons operating on a large cohort of patients are reported, which makes it difficult for us to understand whether the various techniques can be reproduced by less experienced hands. At 6 months postoperatively, penile circumference enlarged by 2.29 ± 0.82 cm, with only 1 patient developing nodularity. The International Index of Erectile Function scores indicated that device satisfaction was generally favorable, with only 4 patients discontinuing use due to mild and reversible adverse outcomes. At the 6-month follow-up, significant increases in flaccid, extended, and erect penis lengths were observed, with mean increases of 1.7, 1.3, and 1.2 cm, respectively. Due to the risk for complications such as scarring, infection, pain, loss of penile sensation and erectile dysfunction, many surgeons don’t recommend surgery for a penis that is adequate in size. Loria Medical also includes procedures to help patients with erectile dysfunction and other male related complaints through customized medical plans. Based on the noted results and complications, the scrotal dartos flap approach seems to be a viable treatment for penile girth enlargement. In a 2022 study by Siegal et al., 49 patients who received Penuma implants found that the mean preoperative and postoperative flaccid girths were 9.3 ± 1.2 and 13.1 ± 1.1 cm. The most common postoperative complications were seroma (4.8%), scar formation (4.5%), and infection (3.3%), whereas no patients reported any change in sexual function, erection, or ejaculation. Meanwhile, a 2014 Mexican study regarding sexual dysfunction in young women highlighted that partner penile thickness/size was significant for female sexual dysfunction. The physiological and psychological evaluations must be considered with patients' attitudes toward surgery to analyze the feasibility and effects of surgery and determine whether these can be achieved (Fig. 2). Therefore, when receiving patients with penile thickening, a thorough physiological and psychological evaluation must be performed. Veale et al. conducted a systematic review pooling data from 20 studies measuring penile length and girth during flaccidity and erection, and subsequently derived nomograms for men of all ages and races (Fig. 1). Even males with average-sized penises wished to have larger penises, with studies revealing that males are often dissatisfied with their penile look, which is correlated with the frequency they overestimate their penis size. By using silicone and dermal fat grafts, Srinivas et al. demonstrated a 2.5 cm gain on penile shaft 6 months after ligament resection. If there is unilateral scrotal enlargement, an asymmetrical excision of the lower scrotal skin may be performed. These patients may refer dissatisfaction of the appearance of their genitalia but usually present with discomfort while walking, using loose clothes, doing sports and during intercourse. The scrotum is stretched away from the penis, two incisions are done, one parallel to the penis’ edge and the other convex to the scrotum’s edge, with the excision of excess scrotal skin. Local rhomboidal skin flaps can be used with good esthetic results , or lateral scrotal flaps, whose rotation of the base allows bilateral coverage of the corresponding dorsal penile tract . Due to the small number of surgeons certified in penile silicone sleeve implantation, beginning in 2018, there are a limited number of studies on adverse events.3–6 Our objective is to provide a review of multi-institutional data on safety and efficacy outcomes in patients undergoing penile silicone sleeve implant surgery among multiple high-volume implant surgeons. To provide multi-institutional data on safety outcomes in patients undergoing silicone sleeve penile implant surgery across high-volume implant surgeons. Update on the Penuma® an FDA-cleared penile implant for aesthetic enhancement of the flaccid penis. It would be interesting to know if this non-invasive management can meet the needs of patients with a normal-sized penis, mitigating psychiatric disorders in those who suffer from it. In the last years a new option for penile cosmetic surgery, a silicone penile implant called “Penuma®” has been approved and showed promising results. In penile augmentation, surgery involving tissue engineering with biodegradable scaffolds is a novel technique. A 2021 study by Lei et al. used a novel autologous scrotal flap (scrotal flap method) reversal to increase penile girth by rotating the scrotal flap to a loose plane between the superficial penile fascia and Buck's fascia. In total, 40 participants were satisfied with the results, but complications like edema, skin ulceration, wound dehiscence (12%), and infection (2%) were noted. The result was an average gain of 2.4 (SD 0.8) cm at 3 months, with no reported complications and a high patients satisfaction rates . Eighty-seven percent of patients who underwent tunica albuginea plication combined with VP, reported an increase in perceived length after surgery . In fact, these patients should first undergo lipoplasty, and only in case of inadequate penis size a further intervention should be considered . In addition, some patients may want to ‘feel’ more mass in that location, and the filler material, with the subsequent collagen production, will provide this increased mass and feel. When cosmetic complications occur, corrections may be completed with low risk or under local anesthesia. Lastly, retrospective studies can be inherently affected by selection and recall bias; this was minimized by including all patients from multiple practices and recording measurements at the time of operation. The micropenis is defined as less than 2.5 standard deviations from the average stretched length for age, mainly due to congenital endocrine dysfunction. Several studies have identified an increase in similar augmentation operations performed by medical experts, even though acceptability ratings for such surgeries are rarely recorded in the literature. Numerous studies have shown that men who believe their penis is small are not only unhappy with their physical appearance but also have a lower sense of self, which manifests itself in their relationships.