These procedures have shown promising outcomes, albeit with certain limitations, such as postoperative complications and varying levels of patient satisfaction . Proper diagnosis, involving comprehensive clinical evaluations, hormonal profiling, and psychiatric assessments, helps determine whether patients would benefit from medical therapy or invasive procedures . 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 operation is performed under general anaesthetic or local anaesthetics with twilight sleep (sedation).These procedures exhibit a spectrum of outcomes and complications, with some showing promising results in increasing penile girth.Variation occurs and even average-sized men would like to experience length extension or additional thickness.This usually results in much more of the penile being visible, therefore enhancing the overall length of the penis.First off, you need to go to someone who can perform the procedure properly — always by a board-certified dermatologist or cosmetic surgeon, never ever at a medi-spa.Depending on the type of treatment performed, abstinence from sexual intercourse for 3 to 4 weeks is recommended.How long the extension will be is not clearly evident until the time of surgery.However, the penis will swell in the first week, and erections during this time can be painful. 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. However, over time penile cosmetic surgery has not presented equal progress in all its fields, maybe because of an increasing attention to less invasive and cheaper methods, or because of a not always rigorous scientific method applied in studies. For these patients the first step could be the differential diagnosis, through screening scales (eg. COPS-P), between patients with PDD and patients with SPA, to exclude the latter from an invasive management . On the other hand, patients with lifelong premature ejaculation can mainly benefit from using injectable fillers. GPA can be performed using injectable fillers or surgical grafting. Yes, circumcision is required before undergoing any girth enhancement at Morganstern Health. At Morganstern Health, all surgeries are performed by experienced urologic surgeons in accredited surgical settings with a focus on safety, precision, and results. Patients with excess skin in the pubic region can experience what's known as hidden penis syndrome. The harvested fat is then placed under the penile skin to allow it to become much thicker. Before moving forward, you should consult with a member of our board-certified surgical staff, to verify that your health and age don’t restrict your ability to have this procedure performed. The effect of previously described techniques on penile length is, for most patients with micropenis, not enough to improve genital image and sexual quality of life. Eighty-seven percent of patients who underwent tunica albuginea plication combined with VP, reported an increase in perceived length after surgery . Lipoplasty is designed to improve the visibility of the shaft in obese patients and in patients with significant weight loss having excessive suprapubic fat and skin (“double belly” sign in orthostatic position) . 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. 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 . They have been synthesized in recent years and have been already approved in several countries . Microparticles of polymethyl-methacrylate are suspended in solutions of bovine collagen or cellulose, and once injected lead to a granulomatous-like reaction in the injection tissue, which, consequently, is enriched with new supporting vascular tissue. No major complication was recorded in the study, but arterial embolization is mentioned in the medical literature concerning HA used in other tissues. We have performed countless surgical repairs of patients who received a girth enhancement elsewhere that migrated to the foreskin. 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. These procedures aim to address concerns regarding penile size, impacting men’s sexual confidence and satisfaction. Austoni et al. reported an augmentation phalloplasty with bilateral saphena grafts in a case series of 39 patients with either hypoplasia of the penis or functional penile dysmorphophobia. 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. 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 . The final step is represented by the closure of any skin defect with scrotoplasty and, in case of large penile defects, with skin grafting vacuum assisted closure 25, 33. The doctors at Morganstern Health provide the widest variety of augmentation options under a single roof, so patients can obtain the best procedure, given their enlargement goals, age, and current health status. 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. For a patient having a girth enlargement surgery, having a circumcision before can improve the aesthetic appearance of girth increase. 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. 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. Access options The association between the V-Y skin advancement, the suspensory ligament release and the filling of the suprapubic space represents the best example of such synergy . 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. 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 FDA issued a premarket notification for its use in the cosmetic correction of soft tissue deformities. In the last years a new option for penile cosmetic surgery, a silicone penile implant called “Penuma®” has been approved and showed promising results. 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. Penile hematoma, exacerbated in hypertensive patients or by nocturnal erections, was rarer. The most frequent complication was preputial edema at 3–5 days after the procedure, avoidable with an infrapubic access to the shaft and a careful postoperative compression. Nowadays there are many techniques capable of earning girth, both in erect and flaccid penis, less invasive and of easier execution. These treatments work in conjunction to stimulate natural tissue growth without surgery and anesthesia. If you are seeking a safer, non-invasive way to increase penile size, the MAXL® option offers an effective solution. The MAXL penile lengthening procedure is a 90-day program designed to add one inch in length to the penis. Finally, patients with a Type-II diabetes diagnosis and an A1C above a score of “7” will not succeed with this procedure. Girth & Thickness Augmentation Similarly, Ahn et al., applied VP to improve perceived penile length as compensation for shortening after tunica albuginea plication. This technique is not easy to reproduce and exposes to the risk of circumferential choking of the penis and to high tension on the wound, causing poor blood supply and risk of breaking . Scrotal raphe is taken as an incision site, on which the Z plasty is applied at a 60° angle allowing a 75% gain in visibility of the shaft. Major complications may be secondary to compromised flap vascularization during resection, thus wound dehiscence, infection, and/or dorsal flap loss . The first incision is an upside down “V”, which is subsequently closed as “Y”, lengthening the dorsal skin, and bringing the lateral skin medially . 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 . 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%) . To cover the defect in the ventral shaft skin, local flaps are created by making a ventral midline scrotal incision with horizontal relaxing incisions. This day case procedure involves an initial ventral slit made in the phimotic ring and exposing the penis. Other described skin flaps used to lengthen the penis include the lower abdominal Z plasty and the W-flap reconstruction . The V-Y and Z plasty describes the shape of the incision and closure and can be performed on the penile shaft or foreskin, peno-scrotal, or penopubic junction. Patients who have a diseased shaft skin or retracted penis due to previous circumcisions may require further reconstruction in the form of a penile shaft skin (±foreskin) excision and a split-skin graft taken from the inner thigh 17,41. These patients should first undergo lipoplasty, and only in case of inadequate penis size should a further intervention be considered . The authors also reported patient satisfaction with a five-point Likert scale ad hoc questionnaire to measure postoperative penile sensitivity. Several technique modifications have been described and nowadays sliding elongation is mainly used for increasing corporal penile length in patients with Peyronie’s disease. 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. Another non-surgical penile enhancement option that has been shown to achieve a more robust, stronger penis, better erections, and longer staying power, without a full surgical procedure, is the injection of the patient's own blood.This testifies both the frequent presence of psychological distress and the real therapeutic possibilities of cosmetic genital surgery for these patients.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.The tip of the cannula is injected subcutaneously and well away from the erectile tissue of the penis "The injections are performed from the base toward the glans, otherwise known as the head of the penis and from the glans toward the base," says Dr. Shafer.The MegaMAXL is the premier penile lengthening enhancement.Erection ability is not influenced by the procedure.We recognize its bad healthcare and insist a patient get a circumcision before augmenting penile girth."You don't want to inject any filler of any kind into a blood vessel, and the penis contains very large ones," says Dr. Emer.If there is unilateral scrotal enlargement, an asymmetrical excision of the lower scrotal skin may be performed.However, there is an important discrepancy between patient satisfaction declared in the questionnaires and the results obtained. "When patients with foreskin undergo these injections, they are at additional risk of more penile swelling and post-procedure gel migration, creating a 'lumpy-dumpy' appearance to the penis," says Dr. Houman. Reasons for this unreasonable practice include, on one hand, the fact that it is easily available and easily performed by non-medical personnel or the patient himself, on the other hand, lack of standardized medical or surgical techniques for penile girth enhancement. So, if surgery is still the gold standard treatment for patients with micropenis, today we do not have precise recommendations for patients with a normal penis size and PDD. There is a slight difference between “buried” penis, defined as an hidden penis concealed by suprapubic fat, and the “trapped” penis, which presents a scarred or fibrous tissue, requiring surgical lysis and more invasive esthetic reconstruction procedures . Pubic Lift However, the penis will swell in the first week, and erections during this time can be painful. The wound will be reviewed in the clinic 5-7 days after surgery. It is essential to keep the area clean and shower twice daily from the 3rd day after the procedure.The sutures are dissolvable. Penoplasty is penis surgery performed to elongate and/or widen the penis. Furthermore, treatment-related complications are poorly reported. A thorough understanding of the glans anatomy and treatment strategies remain essential to safely and effectively address the patient’s needs. A search of the PubMed and Scopus databases, focusing on English-language papers published in the last 15 years, was performed in December 2023. Studies have shown within cells contained in the bloodstream to contain the energy and growth factors to stimulate tissue in the body. Loosening the ligament will allow some extension to the penis which in the long run will allow it to appear a bit bigger and longer. In those patients with no ABP and a moderate pubic fat pad, surgeons could choose the liposuction to improve the perceived penile length . 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. In all these patients it is very common an ABP, which could be defined as the entrapment of the penis by the surrounding tissue . In fact, these patients should first undergo lipoplasty, and only in case of inadequate penis size a further intervention should be considered . Glans-shaft penis asymmetries, small glans size, and loss of glans tumescence can be managed by both injectable fillers and surgery. The growing demand for glans penis augmentation (GPA) makes it a hot topic in the field of andrological surgery, albeit still widely debated. Cosmetic procedures such as male enhancement surgery are considered elective and are not covered by insurance. A circumcision can’t be performed the same time as a girth enhancement as the healing pressure on the tissue works in opposite directions. Morganstern’s MegaCONTOURTM combines a surgical pubic fat pad reduction with a MegaMAXL penile lengthening procedure. Rather than injecting the entire perimeter of the penis, the injections are performed 270 degrees around the circumference for a natural-looking shape, "similar to a cylinder, while staying clear of the urethra on the underside of the penis," says Dr. Shafer. Once the local anesthetic is injected, the penis goes numb for about an hour — more than enough time to perform the treatment, since Dr. Shafer says that it takes approximately 15 minutes to do. However, Dr. Emer suggests patients who have undergone a phalloplasty opt for reversible hyaluronic acid fillers rather than permanent options like Bellafill or silicone-based fillers. If you've had a phalloplasty (masculinizing gender-affirmation surgery), Dr. Rowe, Dr. Shafer, and Jason Emer, MD, a board-certified dermatologist based in West Hollywood, say you can explore this procedure. "Bellafill can't be melted or softened like the Voluma or the Volux, and that's why I always tell patients it's never a first-try filler," says Dr. Shafer. 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 . 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. Elist et al reported outcomes of 400 patients who underwent Penuma implantation from 2009 to 2014. 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 . Bhavik et al., proposed to spare the suspensory ligament and resecting only the overlying fundiform ligament achieving similar results with lower risk of shaft shortening from ligament re-adhesion . 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 . Postoperative complications may occur as an infection, penile skin pressure necrosis, or seroma formation, usually treated conservatively 62,63,64. Acellular Dermal Matrix (ADM) has also been employed to improve penile girth, after being wrapped around the degloved penile shaft. Six months after surgery, the patient had an erect girth of 19.5 cm and a flaccid girth of 16.5 cm, compared with 11 cm and 7 cm, respectively, before surgery, thus maintaining the intraoperative girth gain. The superficial circumflex iliac artery island flap was used to increase penile girth for the first time. At 18 months, the mean penile girths had significantly increased in both groups and satisfaction levels were significantly higher than those at baseline in both cohorts. Previous reviews have also acknowledged the lack of valid methods for evaluating outcomes, particularly in procedures for aesthetic purposes 10,67,68. However, complications such as infection, hematoma, and dissatisfaction have been reported across different techniques, highlighting the need for cautious consideration. Penuma® has been recently cleared by the FDA for aesthetic enhancement of the flaccid penis . The reported removal rate during follow-up of up to 4 years is 3–10%, while rest complications are usually minor 37,65. A recently developed penile implant made of silicone is a Penuma® implant and can be inserted to increase penile length in flaccid status 37,65. 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. In addition, penile shortening was reported in 4.7% of patients who had a release of the penoscrotal web vs. 83.8% who did not have the release . Westerman et al. described a ventral slit scrotal flap (VSSF) as a new surgical option for buried penis syndrome which avoids complex skin grafting. These procedures can also be used to manage phimosis in patients who do not wish to undergo a full circumcision. 44 patients completed the treatment, with no evidence of decreasing in the periods off therapy. Gontero et al., in a prospective pilot study, evaluated the possibility of achieving a long-lasting increase in penile shaft length using the penile extender. The trial was unsuccessful, with only 11% of participants able to achieve at least 1 cm increase in stretched penile size on 8 month. 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 . 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 . From these results the Penuma® implants could achieve both girth and length enhancement with a high long-term satisfaction rate. 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 . 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. By using silicone and dermal fat grafts, Srinivas et al. demonstrated a 2.5 cm gain on penile shaft 6 months after ligament resection. We require every patient be circumcised before we perform any type of girth enhancement.Temporary cosmetic fillers and surgical procedures are expensive, risky, and often provide unsatisfactory results.The numbing agents wear off about an hour after the procedure, so mild swelling and bruising will probably happen by the time you step out of the office.The probability of infection is also increased, adds Dr. Goldberg, since the foreskin has bacteria and is harder to clean.P-Long is the first and only clinically proven protocol that naturally increases the length and girth of the penis without the need for surgery or temporary fillers.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.Alei et al. implanted xenograft porcine acellular dermal matrix on 69 patients with overlapping results in girth in both flaccid and erect penis at 1 year from surgery "The skin of the penis is extremely thin and the skin of the face, overall, is not. If you put fillers in lips, the skin holds structure better and looks natural. It's very hard to do that on the penis because the skin is so thin.” he says. "You can end up getting some asymmetry." "If filler were to get into there, you could cause necrosis tissue death or damage to the penis itself." To minimize pain, he suggests patients use an arnica-infused topical to reduce swelling and redness. He recommends avoiding blood thinners like Advil or aspirin for two weeks before the procedure since they can increase your chance of bruising. Once the injections are done, the penis is then cleansed and antibiotic ointment is applied, followed by a sterile wrap dressing, which is kept in place for 24 hours. Review articles, editorials, commentaries, and research letters were included only if deemed to contain pertinent information on penile augmentation surgery. 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. 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. In conclusion, while penile augmentation surgeries offer potential solutions for individuals concerned about genital size, the risks and complexities need to be accounted for. The increase in practices related to enhancing penile size can be attributed to the belief that an improved genital appearance contributes to a man’s virility, coupled with an altered self-perception of his body. The doctors at Morganstern Medical encourage you to talk with your primary care physician if you are concerned about your penis size or dysfunction.Removing this extra skin can add significant visual length.The other side effect of fat injection is a “lumpy appearance.” This can be settled by massage or simple drainage.These procedures have shown promising outcomes, albeit with certain limitations, such as postoperative complications and varying levels of patient satisfaction .In patients who underwent such technique, the average length gain was between 2.5 and 4 cm .Each technique is evaluated based on its clinical outcomes, durability of results, and complications.The dartos is then reapproximated with resorbable sutures, and the skin is closed with subcuticular resorbable sutures .Men wear traction and suction therapy devices for a little more than an hour a day to gently stretch the penile tissue in both length and girth. Since the skin around your groin has more bacteria than the skin on your face, it's more susceptible to gnarly infections in the injection site. As if necrosis isn't frightening enough, Dr. Goldberg says that hygiene of the genital area alone was enough to make him stop performing the procedure for good. "You don't want to inject any filler of any kind into a blood vessel, and the penis contains very large ones," says Dr. Emer. First off, you need to go to someone who can perform the procedure properly — always by a board-certified dermatologist or cosmetic surgeon, never ever at a medi-spa. The MegaMAXL guarantees a minimum of a one inch increase to the flaccid penile length for qualified patients. Cigarette smokers and chronic drinkers of alcoholic beverages are also not well suited for a tissue transplant for permanent girth increase. You can also enlarge your Glans (the “head” of the penis) at the same time as a non-surgical girth enhancement. 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 . 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 soft tissue fillers for cosmetic purposes has steadily increased thanks to the mini-invasiveness and cost-effectiveness compared to more invasive procedures and their versatility of use for various areas of the body . 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. Kang et al. reported similar outcomes in 52 patients, with a mean circumference gain of 2.5 cm, 6 months after surgery. 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.No adverse reactions or need for a second surgery were reported, except for one case of nodular fat occurrence .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 .Plastic surgery, like any surgical procedure, carries inherent risks and potential complications.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.Most men over 65 years old are not good tissue transplant candidates as the fatty cells deteriorate with age, making successful transplantation unlikely.The scaffolds are three-dimensional porous supports made of biocompatible and bioresorbable material able to promote cell adhesion and proliferation up to the formation of a new tissue and micro-network of blood circulation. Your treatment plan includes two visits to our Morganstern Health clinic. The procedure has consistently shown effective results and positive outcomes. Some potential tissue harvest sites result in uneven and less natural final results. Flaccid, stretched and/or erect penile length as well as patients’ satisfaction rates were reported when available in the included studies. The main outcomes recorded were changes in penile dimensions in term of length and girth and surgical complications. The main outcomes recorded were change in penile dimensions in term of length and girth and surgical complications. Men wear traction and suction therapy devices for a little more than an hour a day to gently stretch the penile tissue in both length and girth. Temporary cosmetic fillers and surgical procedures are expensive, risky, and often provide unsatisfactory results. Provides impressive increase in penis girth with FDA-approved filler injections. At Morganstern Medical, our surgeons provide an array of ground-breaking, proven techniques to medically increase penis size. During the consultation, Dr Barnouti will discuss any urological and sexual problems, which may require further investigation. The length of the penis can vary from a few centimetres up to 15 centimetres whilst at rest. This is a relatively new field in aesthetic surgery, however along the years this type of operation has become more popular. All authors contributed to the acquisition, analysis, interpretation of data, and drafting of the manuscript. Our Mini-Fat Pad removal is available for an additional charge during lengthening procedures. The MegaMAXL is the premier penile lengthening enhancement. Most men over 65 years old are not good tissue transplant candidates as the fatty cells deteriorate with age, making successful transplantation unlikely. He knows as much or more about cosmetic enhancement of the penis than almost any doctor in the world. It is the shrinking,thinning, or tissue loss of the penis. An ideal flowchart for the diagnostic evaluation and management of patients requiring cosmetic genital surgery is presented in Fig. For lengthening surgery, the measurements of flaccid, stretched, and erect penis post pharmacological stimulation, are essential to have a quantitative idea of the possible gain for each patient. 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 . The key is to tailor interventions on the real needs of patients, carefully evaluating the history, the psychological background, and possible surgical advantages. 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. 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. 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. 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 . Men seeking to improve their sexual confidence or address concerns related to penile size often explore various techniques aimed at increasing penile girth. Material and methods Not every man starts with the same penis size and same health conditions at birth. The majority of products and devices and pills that claim to increase size simply don’t work and can be unsafe. Our patient liaisons educate patients on how it works, and the best choices for you. These are patients who have often tried pills and devices with no positive outcomes. Some potential tissue harvest sites result in uneven and less natural final results.Cutting-edge regenerative medicine leveraging autologous stem cells and exosome therapy to restore function, enhance healing, and promote tissue regeneration across aesthetic and therapeutic applications.On the other hand, patients with lifelong premature ejaculation can mainly benefit from using injectable fillers.During the consultation, Dr Barnouti will discuss any urological and sexual problems, which may require further investigation.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.Dr Barnouti will select the surgery that suits the individual patient. 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. 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 . Finally, penile girth enhancement may be performed using soft tissue fillers, grafting procedures, biodegradable scaffolds, and Penuma®. Penile enlargement surgery also referred to as phalloplasty, is a surgical procedure to enlarge or increase the size, length, and/or width of the penis permanently. 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. Xu et al. reported solutions to avoid these complications in a group of 78 patients who underwent penile girth enhancement with acellular dermal matrix . Sixteen patients with PDD completed the 6-month therapy (daily use for at least 4 h), with a gain of 0.38 (0.02–0.73) cm on the stretched penis at sixth month and an insignificant gain on girth of 0.09 (0.24–0.05) cm. The median stretched penile length increased from 7.6 (6.9–9.4) cm to 7.9 (7–9.7) cm but only 30% of patients were satisfied with the therapy and it was recorded a case of penile hematoma and a case of glans numbness . 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. 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 . 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 . 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. Complications can be minor with hematoma and penile oedema which most commonly resolve with conservative treatment. The penile parts are assembled, and the procedure can also be combined with ligamentolysis and plasty of the penopubic angle. 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. Penile girth augmentation was also performed using a porcine dermal inteXen graft in a case series of 39 men with penile dysmorphophobia. In a single case report, a penile girth augmentation using flaps was performed, known as Shaeer’s augmentation phalloplasty. The gel was evenly distributed with multiple passes, also to achieve the desired girth increase according to patients’ needs and goals. A significant mean increase of girth of 2.4 cm for the mid-shaft of the flaccid penis was recorded, even though 52% of men experienced many irregularities and 0.4% of them required a PMMA nodule removal . Techniques include soft tissue fillers, grafting procedures, biodegradable scaffolds, and penile implants. 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. 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 . With LIPOSKILL PLUS it is possible to give volume and shape to your penis, obtaining natural results both to the sight and to the touch. No insertion of permanent prostheses or surgery under general anesthetic conditions, with the consequent medical and intraoperative risks. It can also be used to correct asymmetries or damage caused by trauma or previous plastic surgery. Penile augmentation surgery, also known as penile enhancement or penis enlargement surgery, is a surgical procedure that aims to increase the length and/or girth of the penis. 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 . The treatment for penis enlargement and reshaping uses the stem cells from the fat tissues of the patient who will undergo the surgery, thus reducing the risk of contracting infections or suffering other complications. The majority of studies conducted in the past decade examining penile enhancement procedures in both healthy men and those with concurrent penile disorders have reported successful increases in penile dimensions or corrections of deformities, with only a few significant complications . Firstly, it is a natural and long-lasting solution that doesn’t involve surgery or temporary fillers. There are no scalpels, no stitches nor anesthesia – and you’re ready to get back to sexual activity almost immediately. Morganstern’s Instant Penis Enhancement is the simple, low health risk and affordable opportunity for men to achieve a larger penis. Patented procedure with financing available. A fair amount of literature on this procedure is available, witnessing complications and constant evolution over the years. 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 . 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 a panniculectomy, the suprapubic fat is excised down to the level of the abdominal fascia, and the dead space and skin are closed in layers. The characteristics of studies on the techniques for increased penile length are summarized in Table 1. Data on flaccid, stretched, and/or erect penile length, as well as patient satisfaction and quality of life, were extracted when available. 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 . 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 procedure allows for a safe, fast and sample free of side effects to be extracted during an outpatient treatment. LIPOSKILL PLUS, the treatment based on stem cells derived from adipose tissue (ADSCs) by the Bioscience Institute, allows to overcome this characteristic and improve the quality of life by increasing the penis volume with totally natural results. Dr Barnouti will select the surgery that suits the individual patient. 6.3. Biodegradable Scaffolds Keeping in mind that surgical male enhancement is real surgery, most patients report only mild to moderate discomfort for a few days after penis surgery. The MegaCONTOUR provides a pathway for men with larger mid sections, pubic fat pads and/or patients with a mild or moderate buried or hidden penis diagnosis to achieve maximum penile lengthening in one remarkable procedure. Morganstern’s PERMMAXL is our most popular surgical penile enhancement because it provides about an inch of permanent all natural increase in both the length and width of the penis in a singular procedure. The proprietary fat tissue transplant methodology is designed to create a permanent all natural one-inch increase in penile girth and is considered the gold standard within the world of penile augmentation. Morganstern’s proprietary non-surgical penile enlargement procedure usually achieves about 1/2 inch increase in girth in a singular procedure. Necrosis may be secondary to delayed healing by traction mechanisms on the wound itself, and any circumferential skin loss could be resolved by using a scrotal flap reconstruction. However, there is an important discrepancy between patient satisfaction declared in the questionnaires and the results obtained. 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. Bilateral longitudinal corporal incisions are made into the lateral aspect of the tunica albuginea from glans to pubis, where saphenous vein grafts are then placed for augmentation. Morganstern Health has treated penileatrophy for decades and uses the latest techniques in diagnosing and treatingthe root cause of the atrophy.A new technique for widening the penis girth is performed by removing a small portion of skin and fat from beneath the buttocks, making the donor scar virtually undetectable.The most widely used technique is the one where the suspensory ligament of the penis is incised to release the penis from the pubis.Our Mini-Fat Pad removal is available for an additional charge during lengthening procedures.Two lines parallel to the spongy body of the urethra are drawn as limiters of the area to be preserved.Flaccid, stretched and/or erect penile length as well as patients’ satisfaction rates were reported when available in the included studies."Given that social media exposes the public to images that support the idea of a large penis, many men — be they cis or trans — feel that they should have larger penises to prove their virility or manliness."Provides impressive increase in penis girth with FDA-approved filler injections. In its most basic explanation, penis fillers are injections into the penis shaft that can instantly increase its girth. The review of the literature on penile esthetic surgery, shed lights on the unmet needs for patients who request it. Regarding penile enlargement, there are no guidelines, nor a standardization of the procedures so far recounted in the literature. 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. 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 . These methods should be recommended in the first instance to patients with true micropenis for whom the methods previously considered could be ineffective. Zhang et al. performed a suprapubic liposuction, penile suspensory ligament release, and insertion of a folded acellular dermal matrix between the corpora cavernosa and pubis symphysis in 15 men with a buried penis. 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! We believe in transparency, and to that end, we want to share the transformations our patients have experienced. Our research suggests that 45% of men are dissatisfied with their penis size or suffer from penis size anxiety. LIPOSKILL PLUS treatmentThe expanded cells are injected into the tissue being treated.The injected cells release specific growth factors and promote tissue regeneration. Furthermore, the treatment with stem cells obtained from their own adipose tissue is also suitable for those who wish to correct other small imperfections that may be present. "The filler doesn't enlarge when the penis is erect, so however big you are in girth in the flaccid state, you'll be that much bigger in the erect state," he says. But Dr. Shafer recommends starting with hyaluronic acid fillers because their formula is dissolvable if patients aren't happy with a newly plumper look. With that being said, if the prospect of a girthier (and, potentially, longer) dick via a quick and, surprisingly, painless in-office treatment piques your interest, we tapped a few experts on the subject so you will know exactly what to expect. Other mental health factors that could sway someone into exploring the procedure are gender dysphoria, body dysmorphia, or a simple desire to enhance their sexual appearance, according to Dr. Manly. Our specialist penile enhancement surgeons who perform the surgery are very experienced and have performed the procedure multiple times with successful results. Though Dr. Shafer notes that a few of his patients have seen a slight increase in length of up to an inch after a few years of routine injections, Dr. Rowe says a significant difference in length is highly unlikely unless you decide to undergo a surgical procedure. 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. They also reported improved sexual function without any adverse side effects or downtime. Over six months, participants in the study experienced an average increase of almost a full inch in length and an average of half an inch in girth. I developed the P-Long Protocol in response to the low level of satisfaction with current penis enlargement options. "I think Bellafill's a great filler for acne scars, but I would never ever use it on a penis," he says. This is not to say that penis filler is without risks (more on those below) — especially when a semipermanent filler is involved. Dr. Rowe also notes that his clients' circumference is usually increased to about 1.75 centimeters, which is just shy of an inch. Patients should wait 4-6 weeks before sexual activity is resumed. It is extremely important to keep the area clean and to shower twice a day from the third day after the procedure. You will have a simple dressing in the pubic area. Both types are repaired surgically and require twilight anesthesia of an epidural with IV sedation. Morganstern Urology offers a number of pathways to resolve scrotal-related penile issues. Additionally, we always maintain a focused effort upon the final aesthetic presentation of the penile organ. After 90 days, you’ll return to Morganstern Health for a comprehensive post-treatment evaluation to assess your progress and outcomes. 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 . If there is unilateral scrotal enlargement, an asymmetrical excision of the lower scrotal skin may be performed. In this case, the penile skin is peeled away from Buck’s fascia until it reaches the penile–scrotal junction, where the Dartos and the scrotal septum are identified, the former being circumferentially peeled away from Buck’s fascia, the latter ventrally from the base of the penis. Most of our patients leave our surgery center within a few hours after the procedure is completed. This liposculpture procedure, known as Free Fat Transfer, or FFT, will involve the removal of fatty tissues that are used to fatten or widen a thin penis to the desired thickness. For patients without enough fatty tissue on their stomach or love handles for liposuction, this technique works quite well, especially since the downtime is minimal and there is hardly any discomfort. Once you're in position and fully draped, the skin of your penis is cleansed with a sterilizing agent, similar to the skin prep before surgery. In fact, a 2014 study published in the British Journal of Urology International reports that the average erect penis size is 5.16 inches in length and 4.59 inches in width. Long before Ariana Grande injected "big dick energy" into the mainstream vernacular, the most desirable members — the pinnacle of penises, if you will — have usually been described as long, girthy, and maybe even a bit veiny. A psycho-physical evaluation along with accurate patients’ selection and counseling are mandatory steps to achieve optimal outcomes. We wanted to create a safe, effective, and affordable solution that allows men to achieve their desired penis size without the drawbacks of surgery and fillers. P-Long is the first and only clinically proven protocol that naturally increases the length and girth of the penis without the need for surgery or temporary fillers. Penile enlargement surgery involves cutting ligaments or using implants to add length and girth to the penis. As a board-certified urologist, I’ve seen a growing demand for penis enlargement procedures. Our penoplasty options offer the maximum potential increase in both length and girth size of penis. 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. Men’s sexual function and satisfaction are affected by their discomfort with genital size, which motivates them to seek out invasive and non-invasive penis augmentation options . In recent years, the popularity of penile augmentation surgery has increased significantly . 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. 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. We review any risks with you and take precautions to mitigate risks of complications and reduce recovery time. We have experience in discussing solutions for issues, including any sexual health concerns or erectile 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. Currently, available studies show promising results but are limited by small sample’s size and non-randomized design. A first approach could be a degloving incision to cut fibrous tissue on dartos or skin adhesions . No girth is gained in the proximal penis, while the glans circumference changed between the first and the second follow up, probably due to the device anchorage point. 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. According to Carla Manly, PhD, a clinical psychologist based in Sonoma County, California, the desire for a larger penis is more of a current phenomenon. But, not every person with a penis has one with a length and circumference that could rival an extra-large bratwurst. Conceptualization, CB, GC, LC; methodology, CB, AC, UGF, GMB; Literature revision, AAC, AR, UG; writing—original draft preparation, AAC, UGF. Additionally, evidence is still limited to few case reports, and we are far from being able to draw conclusions. Techniques such as lipoplasty, skin reconstruction plasty, and suspensory ligament release primarily aim to improve perceived length 17,41. 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. Penile augmentation surgeries have garnered attention throughout history, stemming from ancient practices to modern medical advancements. 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. Morganstern Maximum Permanent Penis Size Increase We understand this is a personal journey and we are here to answer patient questions about our model. 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? 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 . 80% of patients were satisfied postoperatively, 76% of patients managed to reach orgasm and reported an acceptable level of penile tactile and erogenous sensation. A primary anastomotic urethroplasty was performed in 90 patients (83.4%) and a staged procedure in the remainder. The operation is performed under general anaesthetic or local anaesthetics with twilight sleep (sedation). How long the extension will be is not clearly evident until the time of surgery. As a rule of thumb, approximately 30%-50% of the injected fat stays in permanently. This can often be corrected in combination with an extension procedure or as a separate one. "I don't do silicone and I wouldn't do it in that type of patient because they have a reconstruction there and I wouldn't want to risk a migration or some long-term issue, especially when they've spent a lot of money and it's psychologically for them, very important," he says. The girth effects can last anywhere from two to five years, depending on the filler you choose. "Legally, someone can inject Bellafill into a penis for off-label use, but do I think it's smart? No." In a Z plasty, triangles made at 60-degree angles when transposed can lead to a 1.75× increase in length . However, suction lipectomy alone is generally ineffective for the correction of a buried penis but can be successful in conjunction with panniculectomy. A small, blunt cannula is usually used when performing suction lipectomy at the base of the penis. The laboratory produces about 20 test tubes of cells, some of which will be used for the required treatment (or for several different treatments). Extraction and ExpansionThe Bioscience Institute laboratories perform the extraction of stem cells from the fat removed. The treatment is minimally invasive and allows an almost immediate return to daily activities. The tissues will have the same softness as natural ones, making them far more attractive than tissue shaped with artificial prostheses. Collection and Sampling20 cc of fat is collected during a simple (quick and painless) outpatient treatment. The enlargement of the penis volume with LIPOSKILL PLUS is based on the implantation of mesenchymal stem cells obtained from your own adipose tissue. Depending on the type of treatment performed, abstinence from sexual intercourse for 3 to 4 weeks is recommended. Treatment with LIPOSKILL PLUS is recommended for all men who wish to achieve an increase in the volume of their penis but do not intend to undergo invasive surgery under general anesthesia. 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. The reason behind the spread of penis enlargement practices over time is rooted in the virility that the appearance of the genitals can give a man, as well as an altered perception of his own body. As a urologist, I believe the P-Long Protocol offers a better and safer solution for men seeking penis enlargement. This represent a possible complication, although it has not been reported in any case of penile injections . Sometimes patient satisfaction was affected by decreased sensitivity and stiffness of the shaft during erection, secondary to coverage of the corpora cavernosa by HA. No noteworthy complication was reported in these two studies, and it is surprising how the circumference gained was preserved after several months, despite the exposure of adipocytes to resorption in a highly vascularized tissue. 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 . This helps prevent complications like filler migration, swelling, and an unnatural appearance. At Morganstern Health, we use advanced anesthesia during the procedure and provide detailed aftercare instructions and medication to manage any post-operative soreness. At Morganstern Health in the Atlanta area, we offer fully transparent pricing and personalized treatment plans. Transplanting the dermis or fat to the penis shaft can thicken the penis. The length and size of the penis are evaluated, also its mobility and suitability for an enlargement. Neither the patient’s age nor the size of the flaccid penis accurately predicted erectile length. In conclusion, while penile augmentation surgeries offer potential solutions for individuals concerned about genital size, they involve considerable risks and complexities. Sex and working out can also increase the chances of filler migration and bruising, so Dr. Rowe suggests staying away from both for two weeks. The numbing agents wear off about an hour after the procedure, so mild swelling and bruising will probably happen by the time you step out of the office. However, Dr. Goldberg notes that the pain after the procedure shouldn't be overlooked. A penis of unsatisfactory size can cause complexes and problems in the intimate sphere. The preferred technique is dermal fat grafting. Fat transfers by injection often have excellent initial results, but at the end of 6 weeks, 30% of the fat injected is reabsorbed into the body. The dermal fat graft is harvested from the buttock, thigh, abdomen or pubic area. They degloved the penis after subcoronal incision, and implanted scaffolds on the buck’s fascia near the urethra, without covering it. Perovic et al. used poly-lactic-co-glycolic acid (PLGA) scaffolds as a support for the proliferation of autologous fibroblasts, harvested from scrotal dermal tissue. Finally, the scaffolds are placed in the tissue where they degrade, leaving space for the extracellular matrix produced by the cells, thus restoring and implementing the tissue . The scaffolds are three-dimensional porous supports made of biocompatible and bioresorbable material able to promote cell adhesion and proliferation up to the formation of a new tissue and micro-network of blood circulation. Although there are already several proofs about the use of biodegradable scaffolds for reconstructive surgery of urethra and corpora cavernosa 87, 88, in male esthetic surgery’s the evidence is still limited. If, instead, you've chosen a lengthening technique to satisfy your desires, your surgery will likely involve releasing the ligaments that hold the penis. Depending on the type of procedure you and your doctor determine is right for you, you'll undergo one of a few different procedures to achieve the results you desire. This usually results in much more of the penile being visible, therefore enhancing the overall length of the penis. Oils, lotions, massage therapy, vacuum devices, stimulation, and other non-invasive techniques have been assumed to work for penile enhancement, but often only reduce in a waste of time and money. If you'd also like to undergo male enhancement surgery, for reasons of your own, you must remember that the process is an invasive one. Given the paucity of data, no evidence is available to confirm the real benefit of vacuum therapy for esthetic penile improvement (Table 1). It increases arterial flow, resulting in increased oxygenation of the corpora cavernosa and modulation of growth factors and apoptosis . The Vacuum device is a mechanical device that exploits a negative pressure created by a suction pump to draw blood from the circulation into the corpora cavernosa. Someone seeks male esthetic genital surgery for work, someone for pleasure and someone for real discomfort. Two authors (A.A.C and U.G.F.) performed the initial screening of titles and abstracts independently to determine which papers could potentially meet the inclusion criteria. It's extremely important to choose a filler with a lower risk of filler migration, as this issue can lead to a lumpy look or, in severe cases, a donut-like shape at the base of the penis. In case you're not familiar, hyaluronic acid is a molecule found in your skin and is known for its water-retaining properties. As of now, the Food and Drug Administration has not approved any type of injectable for use on the penis. "Given that social media exposes the public to images that support the idea of a large penis, many men — be they cis or trans — feel that they should have larger penises to prove their virility or manliness." "Ancient Greeks believed that those with smaller penises were more likely to possess positive traits such as intellectualism, restraint, and heightened wisdom," she says. Another option for penile enlargement, cosmetic fillers, involves injecting materials such as hyaluronic acid, silicone, or polyacrylamide gel into the penis to increase girth. It is possible to permanently increase penile size using medical procedures. If you can plan to add girth to your penis, we leave a little bit of extra skin near the distal portion of the shaft to create an even larger subsequent sickening procedure. The Morganstern Foundoplasty is a minor surgical procedures that frees the penis from the retracted state from excess tissue at the base of the penis. Originating from a need to restore lost penis size for Peyronie’s disease patients, the Morganstern Permanent Girth enhancement technique and technology was improved and perfected over a forty-year span of urologic innovation. In this scenario, cosmetic surgery of the penis must be versatile complying with the various problems increasingly affecting this area of surgery. In fact, the sexual pleasure of the woman can be physiologically generated by a sufficient distension of the mucosa of the vaginal canal, especially in the distal-third of the anterior vaginal wall were a significantly increased density of nerves and microvessels have been noted . The reason behind the spread of penis enlargement practices over time is indeed rooted in the virility that the appearance of the genitals can give a man, as well as an altered perception of his own body. 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 . 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. These procedures can also be used to lengthen the penis during penile curvature surgery for Peyronie’s disease and inflatable penile prosthesis insertion . There are a variety of skin-related reconstruction procedures that help to increase penile length, such as V-Y and Z plasty, ventral phalloplasty, and scrotoplasty 9,42. 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. Permanent male enlargement surgery typically takes 1 to 2 hours, depending on the procedure. You can set a size goal, but results depend on your anatomy, skin elasticity, and the procedure type. Most procedures are done in-office or outpatient, with minimal downtime and detailed aftercare to ensure optimal results. Penile rejuvenation is a non-surgical treatment that restores sensitivity, blood flow, and sexual performance. Usually, evaluation could be led by the presence or absence of a specific clinical picture, such as for acquired buried penis (ABP), which presents itself as a “false” micropenis. 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 . Papers discussing surgery in animal models and case reports were excluded from the present study unless further evaluated in a follow-up case series. 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. 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. 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.