Based on the properties of HA fillers, in 2011, a group of researchers reported the feasibility and safety of PGE using HA fillers . Additionally, the slow degradation of the HA filler through cross-linkage increases its longevity by a hundred times compared to that of natural polymer implants, without a decrease in biocompatibility . Penile girth, satisfaction level, Premature Ejaculation Profile (PEP), and self-estimated intravaginal ejaculation latency time (IELT) were assessed at baseline and at 24 weeks post-injection. During the study period, assessments before and after the procedure were performed by a single physician, independent of the filler injection at each institution (evaluator-blinded). The subjects' penile girth was measured at baseline (before the procedure) and at 4, 12, and 24 weeks after the procedure. Thus, PLA filler was selected as a control to evaluate the effect and safety of HA filler injection for PGE in this study. Consequently, the Korean Ministry of Food and Drug Safety has approved several HA fillers for PGE. Fat grafting involves harvesting fat from another area of the body and injecting it beneath the penile skin. Division of the ligament may necessitate additional procedures to stabilize the penis and prevent retraction. Lengthening procedures typically involve cutting the suspensory ligament, which connects the base of the penis to the pubic bone. Penile traction devices, or extenders, are the only non-surgical method with limited scientific backing, primarily for length increases. Our research suggests that 45% of men are dissatisfied with their penis size or suffer from penis size anxiety. At Menness Clinic, we provide advanced penile enlargement procedures performed by experienced urologists. The aim of this review is to describe reported techniques and to provide available scientific data on the success of penis length procedures for cosmetic purposes. The authors confirm that the data supporting the findings of this study are available within the article. The review showed the wide landscape of penile augmentation surgeries, highlighting both the surgical techniques and the psychological considerations pivotal to patient selection. Furthermore, it is necessary to determine whether HA fillers with different properties (HA concentration and cross-linking degree) show similar effects and safety to those of previously studied HA fillers. A major advantage of HA filler over temporary fillers such as fat and collagen is its low complication rate . Food and Drug Administration (FDA) in 2003, it has become the filler of choice in the dermal filler market and clinical practice . 1.2. Skin Reconstruction Plasty The penile length gain occurs in both flaccid and erect status and is mainly dependent on the flexibility of the NVB and urethra. Complications can be minor with hematoma and penile oedema which most commonly resolve with conservative treatment. These flaps can be harvested from several body areas including the scapula, radial forearm, buttock, and latissimus dorsi, but the most commonly used for good cosmetic results is the radial forearm flap. In general, two flaps are created from a body area and are used to form a neophallus around a neourethra that is formed (“tube within a tube” technique). It is time that these men are taken seriously and offered transparent information and access to state-of-the-art medical treatment. There were no reports of thrombosis, implant migration, sepsis, venous or arterial injury, urinary bother, penile curvature, or erectile/sexual dysfunction. Temporary adverse events included 6 cases (1.5%) of temporary loss of glans sensation (recovered 2-3 days post surgery). My aim is to arm students with these insights so they can critically discuss the tradeoffs and implications of legal policies that promote formal equality or substantive equity. Traditional cases that never received a class analysis—from Vosburg to Palsgraf—are recast in their casebook. Thus, when we think about inclusion in tech today, we have to contemplate addressing decades of disadvantage. Few people know that Lockheed was the largest employer in the Valley until the rise of the .com bubble. Consistent, long-term use of VEDs is sometimes medically prescribed for erectile dysfunction or rehabilitation after prostate surgery, but not for cosmetic enlargement. The penile tissue, primarily composed of erectile chambers and fibrous tissue, does not respond to topical creams or oral supplements by increasing in size. Furthermore, it was demonstrated that PGE using fillers improved clinical symptoms related to ejaculation. Has the success rate been medically reviewed in studies? We review any risks with you and take precautions to mitigate risks of complications and reduce recovery time. For this reason, we have assembled some of the best surgeons and urologists at Morganstern Medical. We have experience in discussing solutions for issues, including any sexual health concerns or erectile dysfunction. At baseline, 18 subjects (8 in the HA group and 10 in the control group) reported a self-estimated IELT of Both groups showed significantly improved PEP index scores at 24 weeks post-injection; no significant differences were observed between the groups (Table 3). At baseline, 20 subjects (10 each in the HA and control groups) reported a PEDT score ≥9. In conclusion, while penile augmentation surgeries offer potential solutions for individuals concerned about genital size, they involve considerable risks and complexities. These studies should also be conducted following standardized reporting criteria for surgical outcomes and complications, using uniform data collection and analysis, facilitating better comparisons. Penuma® has been recently cleared by the FDA for aesthetic enhancement of the flaccid penis . The penis shaft was degloved from its skin and the dermal graft was tailored according to the desired shape and size and applied to the degloved penis shaft from the coronal sulcus to the base. Penile girth augmentation was also performed using a porcine dermal inteXen graft in a case series of 39 men with penile dysmorphophobia. A neo glans can be formed usually some months after the formation of neophallus/neourethra, and the final third stage is usually the insertion of a penile prosthesis. There was no evidence of erosion or infection of the cartilage used and 100% had normal erectile function, while 26.3% developed penile curvature which was treated conservatively with penile stretch and vacuum devices . It can be combined with plasty of the penopubic angle using the inverted “V-Y” technique and lipoplasty, but does not increase the length of the erect penis. These methods should be recommended in the first instance to patients with true micropenis for whom the methods previously considered could be ineffective. PGE with HA and PLA fillers resulted in significant enhancement of girth without serious AEs with no significant differences. Vardi Y. Is penile enlargement an ethical procedure for patients with a normal-sized penis? In the second phase, men were exposed to the #penisenlargement hashtag for 6 months and completed an online questionnaire examining their motives to undergo augmentation. & 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). Associated Data Patients were observed for 30 minutes after the PGE procedure to monitor injection site complications such as hemorrhage, pain, induration, swelling, and redness. Depending on the penile size, 15–22 mL of HA or PLA filler was injected. It is a biphasic HA product with a particle size of approximately 700 μm. Second, it is possible to criticize the study design, which uses an active control rather than a placebo control. First, the study duration limits drawing a strong conclusion regarding the long-term efficacy of PGE using HA filler. It is well known that one of the two axons of the dorsal nerve is located along the dorsal midline and terminates in the glans, while the other group radiates from the main trunk over the lateral and ventral aspects of the penile shaft . In particular, a major concern is that PGE is mainly performed for cosmetic purposes, unlike penile lengthening . Pain at the injection site was reported in one subject in the control group, and it was transient and self-limited. Therefore, an appropriate psychological evaluation is crucial in patients intending to undergo penile enhancement surgery . In recent years, the popularity of penile augmentation surgery has increased significantly . The history of penile augmentation surgery dates to ancient civilizations, where the practice of enlarging the penis through various methods, such as stretching or tying weights to the penis, was reported. 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. Provides impressive increase in penis girth with FDA-approved filler injections. Lastly, the improvement of advanced imaging modalities or simulations can assist surgeons in preoperative planning and predicting surgical outcomes. Additionally, it does not exclusively focus on a specific group of interventions (surgical or non-invasive) or a particular condition or disease (e.g., PD), providing a comprehensive picture of the current landscape. Psychological assessments are pivotal, particularly in distinguishing between individuals with genuine concerns and those experiencing small penis anxiety. The rising demand for such surgeries reflects the societal emphasis on physical appearance and sexual performance. This is a subdermal implant inserted through a transverse incision above the symphysis pubis or scrotum and sutured below the glans and at the base of the penis 37,65. The data that support the findings of this study are available from the corresponding author upon reasonable request. And some universities allow study sponsors to control the outcomes of research—something that is explicitly prohibited at Cal. One of my goals has been to increase lateral faculty information sharing, and to that end I have helped moderate the Faculty Budget Forum. For instance, we have a fantastic eye clinic at Berkeley—why won’t we offer corrective vision surgery as a retention strategy, or as a privilege connected with earning tenure, or even as a recruitment tool for the best graduate students? In addition to these students, with Dean Shankar Sastry, I was Co-PI of a program (TRUST SITE REU) with a goal to increase diversity in graduate STEM programs. Lastly, it examines interventions aimed at enhancing both the length and circumference of the penis. The strength of this review lies in a comprehensive analysis of interventions performed for both aesthetic and therapeutic reasons in patients with concurrent penile disorders. Previous reviews have also acknowledged the lack of valid methods for evaluating outcomes, particularly in procedures for aesthetic purposes 10,67,68. The papers analyzed in this review demonstrated inconsistent approaches in evaluating changes in penile dimensions, highlighting the absence of a consensus in assessing and reporting efficacy outcomes. I understand and accept that this is a graduate-level class, with graduate-level materials and pacing. Graduate students, you can enroll if my course has a non-Law prefix, such as Info. I am no longer involved in PLSC, but am proud of what it has become, and am delighted that the model has been deployed elsewhere. Many of the most important articles in the privacy law field were workshopped at PLSC. Several studies have demonstrated the therapeutic efficacy of glans penis augmentation using HA filler for premature ejaculation (PE) 3,23; however, the effect on ejaculation of PGE using HA filler without injection into the glans is unknown. On gross examination, injected fillers were well distributed throughout the penile shaft, enhancing penile girth, which was maintained for up to 24 weeks (Fig. 2). Between-group comparisons, including differences in the change in mean penile girth, satisfaction level, PEP score, and self-estimated IELT, were analyzed by analysis of covariance using the injected volume of filler as a covariate. For lengthening surgery, the measurements of the flaccid, stretched, and erect penis post pharmacological stimulation are essential to obtain a quantitative idea of the possible gain for each patient. A variety of techniques have been developed for enhancing the length and girth of the penis, each with its own set of advantages and disadvantages. The growing demand for penile augmentation surgeries is driven by various factors such as increasing awareness about the availability of these procedures in combination with the availability of different techniques. Penile augmentation (PA), including penile girth enhancement (PGE), has been primarily performed in men with sexual dysfunction caused by anatomical abnormalities, such as in Peyronie's disease 1,2. There was no statistically significant difference between the groups in terms of increase in penile girth or change in satisfaction level. For a patient having a girth enlargement surgery, having a circumcision before can improve the aesthetic appearance of girth increase. Of the 3.4 million soft-tissue filler procedures that were performed in the US in 2020, HA injection stands out as the most popular filler, accounting for an estimated 78% of all injectable dermal fillers.15 Not every man starts with the same penis size and same health conditions at birth. We have been enlarging penises for decades and are the longest running clinic in the USA. Morganstern Medical has extensive experience and references medically reviewed studies, research, testing, and data. Before deciding the procedure, we must carry out a correct psychological evaluation of our patients, discuss with them the technique of choice, and adjust their expectations.They were asked to sign the informed consent after a detailed explanation of possible adverse events (AEs) related to the filler and filler injection procedure.Additionally, among the subjects who completed the ejaculation assessment, less than half showed clinical PE.This process results in permanent enlargement.The aim of this review is to describe reported techniques and to provide available scientific data on the success of penis length procedures for cosmetic purposes.Zhang GX, Weng M, Wang MD, et al.Many of the most important articles in the privacy law field were workshopped at PLSC. Scrotal septum detachment in men undergoing plication for Peyronie’s disease resulted in a perceived increased penile length (87.5% vs. no detachment, 77.3%) . A high insertion of the penoscrotal junction on the penile shaft skin may be inborn or acquired from excessive removal of the foreskin during circumcision. Fifteen consecutive patients with a penis buried due to lichen sclerosis or phimosis underwent repair with VSSF. Westerman et al. described a ventral slit scrotal flap (VSSF) as a new surgical option for buried penis syndrome which avoids complex skin grafting. The penopubic skin can be advanced onto the penile shaft by an inverted V-Y advancement flap. Fibroblast cells harvested from biopsied scrotal dermal tissue are expanded in culture and suspended cells in culture medium are then seeded on pretreated tube-shaped PLGA scaffolds and incubated for 24 h. After being mobilized from the groin, the flap was tunneled under the pubic region to emerge at the base of the penis and then sutured to the subcoronal area and on either side of the spongiosum. Minor complications, including seroma, lumps, ecchymosis, and suture dehiscence, were resolved with conservative treatment within 3 weeks . Edema and congestion of the penis and scrotum were observed postoperatively, along with an area of sloughing on the dorsum of the penis, which re-epithelialized spontaneously . It was wrapped around the penis short of the corpus spongiosum and insinuated under the glans. Four of the studies referred to non-surgical procedures for penile length augmentation (PLA) and the remaining 10 analyzed the results of invasive (surgical) procedures. These procedures exhibit a spectrum of outcomes and complications, with some showing promising results in increasing penile girth. The reported mean increase in penile length was 4.9 cm in one study and 2.1 cm in another, while the increase in girth ranged between 39.9 and 56.7% 37,39,65. The dry polylactic-co-glycolic acid (PLGA) scaffold, a copolymer composed of lactic acid and glycolic acid, in association with autologous fibroblasts has been used to increase penile girth. HA, calcium hydroxylapatite, polymethylmethacrylate microspheres, and PLA fillers have been examined for use in PGEs 12,17,18. This is consistent with other recent studies on PGE using HA and PLA fillers 13,14,15. As a result, we achieved a high satisfaction rate for penile appearance during the post-injection follow-up period. 6.1. Soft Tissue Fillers Our patient liaisons educate patients on how it works, and the best choices for you. Our urologists offer the most expansive list of penoplasty or non-surgical options available. The team at Morganstern Medical is glad to work with you and share educational knowledge of the programs and what to expect. Dr. Leary has also been involved in clinical trials for erectile dysfunction. The Rise of Medical Tourism for Male Health Treatments in Bangkok We recommend carrying out a minimum of 3 sessions 2 weeks before your penis enlargement surgery. Penis rejuvenation with shockwave therapy can help you improve your natural erections but also assist with the healing process after a penis enlargement surgery, potentially leading to a better aesthetic outcome. There is evidence that extensive penis stretching can help increase the penis length by 0.5-2in (1-5cm). Furthermore, my foot doctor told me that surgery alleviates the pain but undermines the strength of your foot. During this consultation, our doctor will examine you and explain all possible treatments options in detail, discuss the size you wish to achieve and answer any questions you may have. Package 4 – Non-surgical Girth Enhancement – Hyaluronic Acid Injection Below you’ll find the extensive range of procedures for men we provide, which are not just exclusive to extending or enlarging the penis. And, with the majority of men clued in to the dangerous world of ‘penis pills’, it can often be difficult to trust in the procedures. The limitations of the current research underscore the need for more robust studies to guide clinical practice and enhance patient outcomes. Rigorous research, standardized protocols, and advancements in surgical techniques are imperative to ensure optimal outcomes and patient satisfaction. Furthermore, advancements in biomedical engineering might lead to the development of novel biomaterials or implants specifically tailored for penile augmentation, aiming for improved biocompatibility and durability. Penile girth enhancement has been a subject of increasing interest and significance in the field of urology and sexual medicine. Correction of curvature was observed in all patients, no erectile dysfunction was reported, and satisfaction of patients ranged between 90 and 100% 30,31,32,33,34,54,55. During a follow-up of 3.3 years, authors reported a 2–3 cm increase in 13 patients and a 3–4 cm increase in 6 patients in both the flaccid and erect status. To increase the actual penile length, Perovic et al. described the penile disassembly technique, during which the penis is separated into the neurovascular bundle (NVB) with glans, corpora cavernosa, and urethra . A ventral phalloplasty involves a vertical incision parallel to the phallus ~1 cm from the phallic edge connected to a convex curve taken from the scrotal edge of the outstretched penoscrotal web. At a mean follow-up of 12 months, 73.3% of men remain satisfied with their results and have required no further intervention. To cover the defect in the ventral shaft skin, local flaps are created by making a ventral midline scrotal incision with horizontal relaxing incisions. Therefore, in this randomized controlled trial, we aimed to evaluate the efficacy and safety of PGE using HA filler and its clinical impact on ejaculation.Clinical safety and effectiveness of penile reaugmentation.The reported mean increase in penile length was 4.9 cm in one study and 2.1 cm in another, while the increase in girth ranged between 39.9 and 56.7% 37,39,65.The penile tissue, primarily composed of erectile chambers and fibrous tissue, does not respond to topical creams or oral supplements by increasing in size.The control group was injected with polylactic acid (PLA) filler, previously approved by the KMFDS for PGE.We also adopted the practice of having papers presented by a “commenter”—a designated discussion leader who introduced the paper and then curated the conversation amongst the group.No major complications and specifically no losses of sensitivity of the penis or erection deficiencies occurred during the postoperative follow-up period and all the patients resumed their sexual activity in 4 months.It can be combined with plasty of the penopubic angle using the inverted “V-Y” technique and lipoplasty, but does not increase the length of the erect penis. Filler injection-related AEs in the HA and control groups were reported in two (6.3%) and three (9.4%) subjects, respectively. They were asked to sign the informed consent after a detailed explanation of possible adverse events (AEs) related to the filler and filler injection procedure. Subsequently, using a 22-gauge or 20-gauge cannula, HA or PLA filler was injected in the respective group of patients, between the Buck's fascia and the dartos fascia, by combining the back-and-forth and fanning techniques. Four entry sites were made on the penile base and distal penile shaft at the 2 o'clock and 10 o'clock positions, respectively. Penis size can cause significant anxiety for men and although a penis enlargement treatment can help alleviate this anxiety, many men will also benefit from a course of psychosexual counselling with one of our experts. Please note that pills, creams and other medicinal products advertised for penis enlargement do not work and in many cases can be dangerous and should always be avoided! Many men researching the procedures available at London Andrology are often skeptical of whether penis surgery is even possible, which is a perfectly understandable way to view procedures if you’re new to the staggering possibilities which are available. I teach at professional schools, which tend to encourage teaching and research related to practice challenges. The University of California recognizes that engagements in the private sector enrich academics’ research and teaching. As a dual appointee in two professional schools (Law & Information), I have worked with many colleagues in the humanities and sciences. I have raised money from NSF, from many companies, and I led a grant-making foundation. While they temporarily increase the appearance of size due to swelling, they do not lead to permanent changes in length or girth.Patients seek protocols that have been improved over time and have been medically reviewed.Eight (72.7%) articles concerning injection therapies showed a significant increase in penile girth (p pThe mean penile girth at baseline was 81.75±9.86 mm in the HA group and 80.37±6.79 mm in the control group (no significant difference).A small, blunt cannula is usually used when performing suction lipectomy at the base of the penis.Surgical intervention for penile size enhancement is discouraged by major urological associations due to high risks and low satisfaction rates.Not every man starts with the same penis size and same health conditions at birth. Sorry, a shareable link is not currently available for this article. A systematic search identifying the 100 most viewed YouTube videos on penile augmentation was conducted. Aesthetic penile augmentation is considered investigational and not shown to be safe or efficacious. Morganstern’s Instant Penis Enhancement is the simple, low health risk and affordable opportunity for men to achieve a larger penis. Vardi Y, Har-Shai Y, Gil T, et al. Zhang GX, Weng M, Wang MD, et al. Augmentative phalloplasty. Additional research studies can be read in Men’s Health Magazine. Variation occurs and even average-sized men would like to experience length extension or additional thickness. Looking for a non-invasive, non-surgical, or minimally invasive effective option? For instance, in my technology courses generally, I intend to connect students with the history of Silicon Valley, and the root causes that made the area and its most successful companies homogenous. Recent events have caused me to deepen diversity and inclusion efforts in teaching. In my career at Berkeley, I have taken specific, sustained action to promote women in higher education, to raise awareness of SES issues in technology, and to include underrepresented and minority students in my work. Years ago, I found a literature review (can’t find it anymore) that suggested that all interventions for plantar fasciitis were equally inefficacious, and it is a condition that takes about 18 months to heal. I have a hypothesis of what has gone wrong and what to do about it. Furthermore, patient satisfaction is uncertain, given the lack of validated questionnaires in this population seeking penile girth enhancement. Importantly, no devices or techniques for penile girth enhancement have undergone rigorous, prospective, long-term study to ensure their safety over an extended period. 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. Girth enhancement techniques, including soft tissue fillers, grafting procedures, biodegradable scaffolds, and subcutaneous penile implants, have gained traction. This article provides a factual, evidence-based overview of average size and evaluates the scientific efficacy and risks of non-surgical and surgical enlargement methods. However, further studies are recommended regarding the efficacy and safety of PGE using fillers in patients with severe PE. In particular, the current study showed safety using HA filler with a higher HA concentration and cross-linking degree than the HA filler in previous studies. Recently, several studies have demonstrated the efficacy and safety of PGE using HA fillers 13,14,15.Furthermore, PGE using filler improved clinical symptoms related to ejaculation.During the study period, treatment-related AEs were assessed through vital signs, physical examination, and medical history obtained at each visit.During the injection, the needle was indwelled at the penile base at 1–2 and 10–11 o’clock positions with a volume range between 10 and 22 mL.Explants can be done via a circumcising incision and degloving, however we recommend a penile inversion approach to best access the distal implant tacking sutures.31 Although some authors report good results following explant and penile rehab,27,29 our group has described a case of significant curvature and penile retraction leading to loss of function (“penile cripple”) following the removal of an infected Penuma implant.Consistent, long-term use of VEDs is sometimes medically prescribed for erectile dysfunction or rehabilitation after prostate surgery, but not for cosmetic enlargement.Thank you for visiting nature.com. This releases the internal portion of the shaft, allowing it to hang lower and appear longer in the flaccid state. These products are often unregulated and may contain ingredients that pose a health risk without offering lasting benefits. Many products marketed for enlargement, such as pills, supplements, and creams, lack scientific evidence to support claims of permanent growth. The average erect girth, or circumference, measured at the widest point, is about 11.66 centimeters (4.59 inches). These patients should first undergo lipoplasty, and only in case of inadequate penis size should a further intervention be considered . Furthermore, procedures for extending penile length can be categorized into those enhancing the perceived length and those increasing corporal length, whether or not penile prosthesis implantation is involved. A systematic literature search of the PubMed, Web of Science, and Scopus databases was conducted in December 2023 to identify English-language papers on penile augmentation surgery published within the last 15 years. At the time of questionnaire completion, participants reported a substantial drop in their genital self-image (22.3 ± 3.6 to 17.8 ± 3.0, p pOur urologists offer the most expansive list of penoplasty or non-surgical options available.The penile parts are assembled, and the procedure can also be combined with ligamentolysis and plasty of the penopubic angle.A study of 303 penile implants showed that the release of the suspensory ligament during an infrapubic insertion of an inflatable penile prosthesis may maintain or even increase penile length .However, complications such as infection, hematoma, and dissatisfaction have been reported across different techniques, highlighting the need for cautious consideration.The average erect girth, or circumference, measured at the widest point, is about 11.66 centimeters (4.59 inches).Depending on the penile size, 15–22 mL of HA or PLA filler was injected.Four of the studies referred to non-surgical procedures for penile length augmentation (PLA) and the remaining 10 analyzed the results of invasive (surgical) procedures. Results from individual studies were synthesized and presented in tables, indicating mean/median preoperative and postoperative differences in penile length and girth. The primary outcomes were changes in penile dimensions, surgical complications, and quality of life. Review articles, editorials, commentaries, and research letters were included only if deemed to contain pertinent information on penile augmentation surgery. Penile augmentation surgeries are primarily performed in men with sexual dysfunction caused by anatomical abnormalities, such as Peyronie’s Disease, or in men with true congenital micropenis (stretched penile length of less than 2.5 SD below the mean for age or stage of sexual development) . Eighty-four articles were included for full-text screening following the abstract screening stage, and a total of 46 articles were included for analysis (Figure 1). Moreover, the condition can be classified as a body dysmorphic disorder if the patient experiences obsessive behaviors, significant psychological distress, and SPA present at least 1 h per day . A total of 1670 articles were retrieved from the search and 46 were included for analysis. Provided by the Springer Nature SharedIt content-sharing initiative These procedures vary in complexity and require specialized training and experience. Both invasive and non-invasive techniques achieve similar improvements in penis length. Abstracts, opinion papers and case series ≤10 patients were not considered. This collaboration should also be encouraged between different institutions to facilitate data-sharing and to enhance understanding of patient outcomes. This approach should be incorporated with psychological support, including counseling or therapy, to address body dysmorphic disorders or psychological distress related to genital size concerns. Filler injection-related AEs in the HA and control groups were reported in two (6.3%) and three (9.4%) subjects, respectively.Penile traction devices, or extenders, are the only non-surgical method with limited scientific backing, primarily for length increases.Morganstern Medical has extensive experience and references medically reviewed studies, research, testing, and data.The review showed the wide landscape of penile augmentation surgeries, highlighting both the surgical techniques and the psychological considerations pivotal to patient selection.As the present study was not specifically designed to evaluate PGE using injectable fillers for the treatment of PE, further studies are needed to demonstrate the therapeutic effect of PGE on PE.Although the reason for this has not been clearly demonstrated, it is considered to be the same mechanism as that of glans penis augmentation using HA filler for the treatment of PE .This approach should be incorporated with psychological support, including counseling or therapy, to address body dysmorphic disorders or psychological distress related to genital size concerns.Eighty-four articles were included for full-text screening following the abstract screening stage, and a total of 46 articles were included for analysis (Figure 1). In a single case report, a penile girth augmentation using flaps was performed, known as Shaeer’s augmentation phalloplasty. At 3 months, an increase in penile length was reported in 83.7% of patients who had a release of the penoscrotal web vs. 2.7% who did not have the release. For enlargement surgery, the circumference measurements of the 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 penopubic junction are important to evaluate a possible gain on girth. The following review aims to compare surgical outcomes, quality of life, and complications of non-invasive and invasive approaches to penile augmentation surgery. 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 12,15. The stretched penile length (SPL) represents the most overlapping measurement of the erect penis, corresponding to the distance between the pubic symphysis and the apex of the glans . Small penis anxiety (SPA) is a condition some men with normal-sized penises may experience, where they feel substantially distressed about the length of their penis . Papers discussing surgery in animal models and case reports were excluded from the present study unless further evaluated in a follow-up case series. PGE for cosmetic purposes requires clarification on various aspects, such as standardized methods and performing the procedure in patients with psychiatric distress . Furthermore, PGE using filler improved clinical symptoms related to ejaculation. Patients recruited between December 2017 and March 2018 were randomly assigned to the HA filler or control group (polylactic acid PLA filler). The following review aims to compare surgical outcomes, quality of life, and complications of non-invasive and invasive approaches to penile augmentation surgery.Meanwhile, the demand for surgical treatment to enlarge genital circumference has steadily increased, and various procedures are available, including PGE using dermal acellular graft , autologous fat injection , and other scaffolds .In a Z plasty, triangles made at 60-degree angles when transposed can lead to a 1.75× increase in length .We literally decide not to do “the right thing” or the strategic thing because of transaction costs we have imposed upon ourselves.More invasive surgical techniques up to total phalloplasty can be used to increase the effective length and width of the penis.Only 1 enrolled patient had a medication history of phosphodiesterase-5 inhibitor for erectile dysfunction and there was no patient who had a medication history for other sexual dysfunctions.Conversely, more invasive methods including penile disassembly and total phalloplasty offer substantive length gains . We hosted scores of undergraduates at Cal, and in some cases, I published papers with these students, including Mika Ayenson (Johns Hopkins University Applied Physics Laboratory), Shannon Canty, Quentin Mayo, and Lauren Thomas. It is a delight to have a multi-year collaboration with JSP and JSD students. If you are a faculty member, I am happy to add you to FBF. It is among the largest lateral (department to department) lists we have—the other being Teach-Net. Data Sharing Statement If you are considering penis enlargement, it is important to research the safety and effectiveness of all options out there. Individuals with PDD experience intense distress over a perceived flaw in their penile size or appearance, even when it is medically normal. For many men seeking enlargement, the preoccupation with size relates to a distorted perception of their own body, not objective measurement. Although an ideal penile filler has not yet been established, PGE with HA and PLA filler resulted in significant PGE for 24 weeks post-injection and appears to be safe and stable. We believe that our study will provide useful information for clinicians to choose HA fillers among various available products. Despite these limitations, the present study showed the efficacy and safety of PGE using HA fillers with properties different from those of previous studies. Penile size is a considerable concern for men of all ages. Open Access articles citing this article. Thank you for visiting nature.com. You have no rights under Article 22 of the GDPR to object to this system, because sending email to this address is explicit consent to automated processing, including profiling. Pursuant to Article 52 of the EU AI Act, please be aware that this message comes from a low-risk \”AI\” system and not a human. Vacuum erection devices (VEDs), or penis pumps, create a vacuum around the penis, drawing blood into the shaft to induce an erection. A true medical condition known as micro-penis is defined by an erect length of less than 7.5 centimeters (under 3 inches). Flaccid length is a poor predictor of erect size, as many smaller flaccid penises expand significantly upon erection. While concerns about size are widespread, most men seeking intervention fall within the normal range of penile dimensions. The HA filler used in this study had a higher degree of cross-linking and HA concentration than the HA fillers used in previous studies, thus increasing the viscosity and cohesivity of the filler, which in turn increases the longevity and tissue volume of the injection site . We aimed to evaluate the efficacy and safety of penile girth enhancement (PGE) using hyaluronic acid (HA) filler with different physical properties from previous studies. Eight (72.7%) articles concerning injection therapies showed a significant increase in penile girth (p p From girth surgery to penis fillers and consultations from our team, you’re in safe hands at International Andrology. The mean penile girth at 4, 12, and 24 weeks increased significantly in both groups compared to that at baseline (pFig. 3). As the PGE procedure was expected to increase the entire penile circumference, the mean penile girth was defined as the mean of the proximal, mid, and distal circumference measurements of the penis. Although previous approval studies have evaluated subjective satisfaction regarding sexual performance, detailed information regarding ejaculation after PGE using injectable fillers is still unknown. Meanwhile, the demand for surgical treatment to enlarge genital circumference has steadily increased, and various procedures are available, including PGE using dermal acellular graft , autologous fat injection , and other scaffolds . My aim is to arm students with these insights so they can critically discuss the tradeoffs and implications of legal policies that promote formal equality or substantive equity.It is a delight to have a multi-year collaboration with JSP and JSD students.This was considered to be due to the difference in the properties of the HA filler used in this study and in previous studies.This is consistent with other recent studies on PGE using HA and PLA fillers 13,14,15.Indeed, in the initial feasibility study of PGE using HA filler, most patients experienced decreased tactile sensation of the shaft .Penile augmentation (PA), including penile girth enhancement (PGE), has been primarily performed in men with sexual dysfunction caused by anatomical abnormalities, such as in Peyronie's disease 1,2. From reimbursements to CPHS to IACUC to even the merit review process, we have no evaluative method that acts as a ceiling on paperwork and faculty time and we don’t probe the upside/downside risks from process requirements. We need to formally declare a time-value to faculty member time, and eliminate rules, trainings, and paperwork that 1) excessively impose upon faculty time or 2) are not risk-justified. Just as employees adopt “shadow-IT” to circumvent bad technology decisions, some faculty employ shadow-operations to get their work done. We literally decide not to do “the right thing” or the strategic thing because of transaction costs we have imposed upon ourselves. Surgical Procedures and Associated Risks Berkeley has big problems with governance. What if quantum computing is a bust? Hoofnagle’s new book with Golden G. Richard III is Cybersecurity in Context (Wiley 2024). A low rate (11.2–14.4%) of mild, temporary adverse events and poor-to-moderate patient satisfaction were found. The vast majority of articles (26, 89.7%) were not randomized controlled trials, with overall low quality and limited level of evidence. Why Paraffinoma Requires Immediate Medical Attention: Explained by Experts In conclusion, while penile augmentation surgeries offer potential solutions for individuals concerned about genital size, the risks and complexities need to be accounted for. At Morganstern Medical, our surgeons provide an array of ground-breaking, proven techniques to medically increase penis size. The majority of products and devices and pills that claim to increase size simply don’t work and can be unsafe. Yes, some of the enhancement options result in permanent increases. This procedure, known as ligamentolysis, does not increase the actual length of the erect penis, as the erectile tissue remains the same size. Additionally, our study is the first to report the impact on ejaculation of PGE using HA filler and is expected to serve as a catalyst for future research on PGE for the treatment of PE. Therefore, the current study used active treatment in the control group, as in previous studies. Although a placebo-controlled study allows better evaluation of the clinical effectiveness of a new treatment, there is a higher risk that nontreatment would be deemed ethically unacceptable by an ethics commission. Original articles in English-language, published until March 2021, were selected. You can purchase our recommended device (we have carried out the research on your behalf – learn more here) from our clinic and get trained on how to use it effectively from one of our patient’s co-ordinators. Patients should note that results vary significantly and more than 4-6h of daily stretching is required for a minimum of 6 months. In some men, the scrotal skin might go as far as the middle of the shaft. Scrotoplasty involves removing any excess scrotal skin which is attached at the bottom of the penis. His research has been published in journals including Brief Male Sexual Function Inventory. Dr. O’Leary is a Professor of Surgery in the Urology Department of Harvard Medical School (Cambridge) and Brigham and Women’s Hospital (Boston). This process results in permanent enlargement. Patients seek protocols that have been improved over time and have been medically reviewed. The majority of men who call Morganstern Medical are seeking a 1-2 inch or 2.54 cm to 5.08 cm increase in width or length or both. Briefly, under local anesthesia with the application of EMLA cream (EMLA 5% cream; AstraZeneca Korea, Co., Ltd., Korea) or penile dorsal nerve block, patients were placed in the supine position, and a medical curtain was placed at the umbilical level for a patient-blinded procedure. Although the composition of the PLA filler is different from that of the HA filler, the application methods and expected effects are identical. This was designed as a prospective, patient/evaluator-blinded, randomized, active-controlled, multicenter trial to evaluate the efficacy, safety, and clinical impact of ejaculation following PGE using injectable filler 24 weeks after the injection. Satisfaction level regarding penile appearance and sexual life significantly increased in both groups. The mean increase in girth was 22.74±12.60 mm and 20.23±8.73 mm in the HA and control groups, respectively. Clinical safety and effectiveness of penile reaugmentation. At the time of questionnaire completion, participants reported a substantial drop in their genital self-image (22.3 ± 3.6 to 17.8 ± 3.0, p p Also, the last 1000 posts related to the same hashtag were evaluated to determine follower reach and engagement impacts. If you are looking to increase the size of your penis, we advise that you book a consultation with one of our highly experienced doctors. The costs for penis enlargement treatments vary between £2900 and £8300 depending on whether a patient chooses the surgical or non-surgical option, the operating technique employed and the results that you want to achieve. As London’s leading experts in safe and effective penis enlargement procedures, our team are fully qualified and ready to answer any questions you may have. However, complications such as infection, hematoma, and dissatisfaction have been reported across different techniques, highlighting the need for cautious consideration. While these procedures cater to patients with true micropenis, they pose higher risks and complexities, often necessitating multiple stages for reconstruction and potential complications involving urethral anastomosis and flap survival 20,21,22,23,24,25,26,27,28,29,53. Girth augmentation of the penis using the Superficial Circumflex Iliac Artery and Vein (SCIAV) flap was reported in 52 patients. Augmentation of 40% and 22% of the girth of the penis was reported in flaccidity and erection, respectively, along with improved sexual self-esteem and patient satisfaction. The superficial circumflex iliac artery island flap was used to increase penile girth for the first time. Restylane Sub-Q (Q-med, Uppsala, Sweden) is a hyaluronic acid (HA) gel used in 41 cases to enhance penile girth. The PLA filler (PowerFill; REGEN Biotech, Inc., Seoul, Korea) is a currently commercially available powder consisting of 10 g of 50-μm PLA microparticles suspended in 3 mL of methylcellulose and carboxy-methylcellulose that is reconstituted with 8 mL of saline immediately before injection. Recently, several studies have demonstrated the efficacy and safety of PGE using HA fillers 13,14,15. In the first phase, the credibility of the 100 most recent publicly accessible postings with the #penisenlargement hashtag was evaluated. Herein, we review the data on penile size and conditions that will result in penile shortening. 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. With a focus on confidentiality and expert care, you’re in trusted hands. Before deciding the procedure, we must carry out a correct psychological evaluation of our patients, discuss with them the technique of choice, and adjust their expectations. However, it seems reasonable that, if possible, non-invasive techniques should be proposed as a first-line treatment. No adverse reactions or need for a second surgery were reported, except for one case of nodular fat occurrence . Several modifications of this technique have been described regarding either the site/shape and size of tunica albuginea incisions or the closure of defects with Buck’s fascia instead of graft material 34,54,55 (techniques described in detail in Table 1). The technique is utilized in most studies for patients with severe erectile dysfunction, Peyronie’s disease, and short length either due to curvature or after treating prostate cancer (radical prostatectomy or combination of hormonal therapy and radiotherapy) 30,31,32,33. The defects that were created by the incisions in tunica albuginea are covered with grafts, such as porcine pericardium or Tachosil, and in most cases a penile prosthesis is inserted . A newer technique, initially described by Rolle et al. in 2012, is the sliding elongation, during which several incisions of tunica albuginea are performed and, after a sliding between the parts created in the corpora cavernosa from the tunica incisions, the penile length is increased . Two subjects in each group reported inflammation at the site of injection that was mild and improved with conservative treatment. The satisfaction levels regarding penile appearance and sexual life during the study period are summarized in Table 2. The mean penile girth at baseline was 81.75±9.86 mm in the HA group and 80.37±6.79 mm in the control group (no significant difference). The overall complication rate was 71.8%, including 47 patients with erectile discomfort, 12 with delayed healing, 10 with unobvious augmentation effect, 8 with wound hematoma, 7 with prepuce edema, 4 with wound infection, and 3 patients with skin necrosis of the dorsal side. An increase in flaccid girth from 9.3 cm to 14.5 cm was observed with additional improvement in flaccid non-stretched visible length. During the injection, the needle was indwelled at the penile base at 1–2 and 10–11 o’clock positions with a volume range between 10 and 22 mL. It was injected into the subcutaneous tissue of the penile shaft in a linear threading technique using a small needle. For men with PDD, surgical procedures are likely to result in dissatisfaction, as physical change rarely resolves the underlying psychological distress. Hyaluronic acid fillers offer temporary girth gains but can result in migration, palpable nodules, or disfigurement, requiring further corrective procedures. While they temporarily increase the appearance of size due to swelling, they do not lead to permanent changes in length or girth. APaired t-test; bAnalysis of covariance test (injected volume of filler as a covariate). Only 1 enrolled patient had a medication history of phosphodiesterase-5 inhibitor for erectile dysfunction and there was no patient who had a medication history for other sexual dysfunctions. Baseline demographic and clinical characteristics were not significantly different between the groups (Table 1). Ten patients dropped out (four withdrew informed consent and six were lost to follow-up), leaving 64 subjects (32 each in the HA and control groups) who completed the trial (Fig. 1). Of the 78 subjects who were screened, 4 who met the exclusion criteria were excluded; thus, 74 subjects were enrolled in the study and randomly assigned to the HA or control group. Significant increases in penile girth both in flaccid and erect states at 18 months were recorded, along with improved patient self-esteem and satisfaction in the absence of major complications . Casavantes et al. described Polymethylmethacrylate (PMMA) microsphere injections to enhance penile girth in 729 cases of men with penile girth dissatisfaction. Reported functional results are encouraging with an increase in length of 3.1–4 cm, increased girth of 1.6 cm, sensation in almost all patients with reported temporary penile numbness in 3–5%, and permanent loss of glans sensation in one patient in one study. Despite some concerns about PGE using injectable filler in terms of patient satisfaction, a high satisfaction level with penile appearance and sexual life through a careful approach to men looking for penile enhancement was achieved in the current study. The PEP questionnaire has yet to be validated as a sensitive tool for evaluating PE. Nevertheless, there were no differences in the incidence of inflammatory AEs of concern compared to previous studies, and granuloma formation was not observed. By making minimal alterations to the material, manufacturers have created HA products that are well tolerated by the immune system and exhibit favorable properties of longevity and nonreactivity . Another limitation of conventional PA is that the procedure is invasive . Therefore, esthetic PGE should not be performed in patients with psychiatric disorders, and a multidisciplinary approach, including psychological counseling, is necessary. Dr. Mike O’Leary, MD, MPH says most men believe that bigger is better and would prefer a larger size for performance and confidence. Penoplasty is penis surgery performed to elongate and/or widen the penis. These are patients who have often tried pills and devices with no positive outcomes. The doctors at Morganstern Medical encourage you to talk with your primary care physician if you are concerned about your penis size or dysfunction. Consulting with a trusted advisor at Morganstern Medical is often a best first step in learning about what works and what doesn’t work when it comes to length and width augmentation. The penile parts are assembled, and the procedure can also be combined with ligamentolysis and plasty of the penopubic angle. The most widely used technique is the one where the suspensory ligament of the penis is incised to release the penis from the pubis. The authors found that the outcome was superior when the procedure was combined with the insertion of a silicone buffer (testicular prosthesis).