This procedure is designed to increase the length of the visible or apparent portion of the penile shaft. This is accomplished by releasing the ligament (called the suspensory ligament of penis) which suspends it from the under surface of the pubic bone. That frees up more of the penis for external stretching. Weights are worn during the postoperative period in order to maintain the newly acquired length and to extend the penis further. It is estimated that an increase in length of anywhere from half an inch to two-and-a-half inches should be expected following the use of the weights. The outcome is unpredictable as it depends on multiple factors which include initial penile length and elasticity as well as the patient's adherence to an external stretching regimen daily for several months to years. Sterilization (vasectomy) can also be performed at the same time as penile lengthening.
The cosmetic procedure was pioneered by Dr. Long, Professor of Plastic Surgery, from China. In 1984, a young man, who had his penis bitten off by a dog during infancy, asked Dr. Long if he could lengthen his penis so that he might marry. A reconstructive procedure using plastic surgical techniques was performed successfully. Dr. Long was then able to offer his knowledge and skill to cosmetic patients who, although normal, were unhappy with their size.
What is hidden penis (plastic) surgery?
When done properly, surgery is relatively noninvasive and effectively provides functional and aesthetic improvement whilst curing profound self-esteem issues that affect men. Hidden penis is when the penis is buried in the pubic fat. When standing or sitting, the penis is partially or completely hidden in the pubic fat and skin or scrotum, causing embarrassment and discomfort. This condition can be congenital or as a result of obesity, radical circumcision, chronic inflammation, aging, or various cosmetic procedures, (fat injection, tummy tuck or failed penile lengthening with a VY advancement flap).
The underlying abnormality for hidden penis is lack of a synchronous attachment of the skin and dartos fascia to Buck’s fascia and the corporeal bodies. As a result, the corpora and skin do not stay connected as a unit. The corporeal bodies telescope proximally inside the scrotum and pubis, causing the penis to hide in the pubic fat pad, while the penile skin stays out. The goal for hidden penis surgery is to make the penile skin and erectile bodies one unit. In most men and boys, this can be done by elevating the pubic skin, removing the pubic fat, and tacking the pubic skin to the underlying muscles, which secures the penile skin on the pubic side. If there is no excess pubic skin or significant fat, the skin at the penopubic junction is tacked directly to the erectile bodies. Despite the above and other techniques, the penis can still stay buried in the scrotum in some patients. In order to prevent this, the skin at the Penoscrotal junction is tacked to the erectile bodies to stabilize the skin to the underside of the penis.
These relatively noninvasive techniques will keep the penis exposed, thus markedly improving self-esteem and also preventing the inflammation often associated with a chronic buried penis.
Will penis function be affected?
No. Function (urination and copulation) should not be affected, but the angle of the erection may change slightly from more vertical to more horizontal.
Does phalloplasty surgery affect penis sensation?
Transitory changes in feeling due to swelling and bruising are normal after any surgery. Permanent loss of feeling is a rare complication.
Does insurance cover phalloplasty?
Who is a good candidate for phalloplasty?
Cosmetic surgery is elective and best performed on healthy realistic patients. Those who want to enhance their penis length are good candidates. Smokers are advised to stop for two weeks prior and at least two months post surgery. Complete cessation is recommended as new research indicates that smokers heal very slowly.
What are the risks?
Although the technique is not complex, the location and its significance to the patient makes the surgery risky. Patients have only one penis, and it is therefore important that they read the consent form very carefully and understand that there is no guarantee of any gain, and that if post-op traction weights are not used, all gains will be lost.
Can penile lengthening and girth enlargement procedures be performed at the same time?
No. Patients should wait for 6-12 months after lengthening before fat injection or dermal-fat grafting is performed. Injected fat cells are mobile and fragile. They would be adversely affected by the post-op penis lengthening protocol. I do not like the visual outcome of girth enhancement and so I prefer not to perform that procedure.
How is the penis lengthening surgery (phalloplasty operation) done?
The surgery is performed at the hospital. Different incisional approaches are used to release the suspensory ligament. Those incisions are made at the root of the penis (junction of the penis and pubic area). The penis is then released from its attachments (suspensory ligament of penis) to the pubic symphysis (pubic bone). Post-op traction is used to reduce the chance of retraction and provide more natural shaft skin.
How long does the phalloplasty operation take?
The procedure takes less than a couple of hours, and the patient remains at the hospital for observation for at least 1-2 hours prior to discharge. Patients must have someone to drive them home and stay with them the first post-op night.
When can I return to work?
Light duty may be resumed in a week but it is best to take at least two weeks off work, especially if it is strenuous.
When can sexual activity be resumed?
It is recommended that the patient refrain from sexual activities for at least 2 weeks. Cold compresses can be used to reduce nocturnal stimulation for the first 10-14 days post-op.
What is to be expected during the healing phase?
The penis and scrotum are usually swollen and bruised for two to three weeks. Pain is not severe. Soreness in the groin and pubic regions, which lasts for about ten days, is controlled with light oral pain medications. The scar in the pubic hair area may take many months to fade and soften, but it is hidden and usually is not a concern.
How much can the penis be lengthened?
The amount varies with each individual. At present, there is no test or examination to determine the amount pre-operatively. From 1/2 to 2 inches is a reasonable estimate. Therefore, those men who have a larger-than-average length should consider the risks carefully before having this surgery. Also, the use of weights (traction) attached to the penis after surgery not only maintains the new length, but also may add further length and should be done for 6-9 months daily and thereafter on weekly basis to prevent scar tissue retraction.
What are the risks & side effects of the penile lengthening operation?
In practice, the following side effects happen quite rarely, and your physician will exam you thoroughly to minimize the penile lengthening risks and avoid side effects:
- Excessive swelling and discoloration
- Bleeding and hematoma, seroma
- Infection and/or abscess
- Dehiscence (wound breakdown, opening up of incision)
- Bad scars (red, wide, raised, thick, painful, visible and contracted scar)
- Pain (early, late, neuroma)
- Abnormal nerve sensation: numbness, decreased sensation, itching, paresthesias (an abnormal sensation such as pins and needles or a burning sensation).
What kind of follow up is needed after surgery?
Patients can be seen the next day to go over their weight routine if needed. Many times, all the instructions about the weight are reviewed with the patients prior to surgery. Their dressings are changed and instructions are given with respect to bathing and other activities. It is recommended that patients wear loose clothing on the day of surgery and for the early healing period. The next visit is two to three weeks after surgery. Sutures are absorbable. Weights or other forms of traction are started as soon as possible. Some patients maintain traction for up to 12 months after surgery. This reduces the chance of retraction, stretches the shaft skin, and in some cases results in further lengthening by stretching tissues which could not be cut at surgery.
How can patients who are from out of town be treated?
You should forward a complete physical examination questionnaire, which is available on my website prior to your arrival. Our staff and Dr. Movagharnia will try their best to assist out of town patients, but we cannot guarantee a surgical booking until Dr. Movagharnia has examined the individual. It may be possible to coordinate everything with only one extended trip to Atlanta. We also recommend that patients stay in Atlanta for at least couple of days after surgery. All patients must have a companion (friend, spouse or nurse) with them to drive them back to their hotel after surgery. Post-operative convalescence can be arranged at an extra cost.
What is the cost of penis enlargement?
During your private meeting with Dr. Movagharnia, you will receive detailed information about penile lengthening and the costs of this procedure. We appreciate the sensitivity of the procedure, and we will respect your privacy. When you select Dr. Movagharnia, you will be treated with warmth and the utmost respect. He will make sure that you are well informed about penile lengthening so you can make the best decision for you. Dr. Movagharnia is proud to be the only plastic surgeon that can offer penile lengthening to patients in metropolitan Atlanta and patients from all over the USA. Please schedule a consultation with us today and discover why we have a reputation for providing meticulous, compassionate care.
For more information about penile lengthening call our office at 770-951-7595.