There are a number of surgical techniques for total penile enlargement. These will invariably increase the penis length, girth and the size of the penis glans. All the techniques can be performed individually or in combination depending on the patient’s wishes. Performing all operations together results to significant cost savings as well as reduced healing time and most of our patients choose this option.
The operating time is between 60-120 minutes and all the operating techniques are day care surgeries and usually can be performed under sedation, rather than general anaesthesia, which means that the same day of the operation, the patient will be able to function normally and return home. Some patients might choose to spend one night at the hospital but this is more about comfort rather than medical necessity.
At The London Medical & Aesthetic clinic we offer our patients the best services for andrology from one of the top surgeons in the country. Dr. Franklin Kuehhas is a top surgeon whose specialization is the treatment of penis curvature. He devised the STAGE technique together with Dr. Paulo Egydio after extensive medical practice and academic research and he is one of the few European doctors that was trained in the EGYDIO technique for correcting penile curvature due to Peyronie’s disease by Dr Egydio himself. He has conducted a significant number of surgeries for the correction of bent penis, with a very high patient-satisfying success rate. Beyond that, he has shown a continuous drive for innovation; improving significantly the standard surgical techniques for penis enlargement, devising with Dr Egydio a new technique for penile prosthesis with simultaneous penile lengthening and co-developing the sclerotherapy treatment for erectile dysfunction. He also has an intense interest in the application of outcomes based healthcare and statistical learning for delivering personalized treatments for erectile dysfunction and premature ejaculation. Dr. Franklin Kuehhas graduated from and worked as a urologist – andrologist at the Medical University of Vienna, the largest medical university in Europe.
The different techniques for penile enlargement:
In all men, part of penis is not visible and extends inside the body. The hidden part, as it is often referred, is attached to the pubic bone through the so called suspensory ligaments. These do not play any role in the functioning of the penis but help retain an upwards facing erection, as opposed to downwards which is the natural tendency of the penis.
Ligamentolysis can be viewed as the basis of a penis lengthening operation and involves cutting some of the penis ligaments. This allows part of the “hidden” penis to move downwards and outside the body. As a result the visible part of the penis increases. Whereas it sounds like a relatively simple technique there are a number of elements that require significant skill.
With an experienced surgeon the individual results with ligamentolysis will depend mainly on the ratio between the visible and hidden part of the penis. This can be established pre-operatively using imaging techniques as well as physical examination by the doctor. Given that the penis body size does not alter with ligamentolysis but rather the ratio between the hidden and visible parts, the effect of the operation is more profound during the flaccid state where an increase between 2 – 5cm (0.8in – 2in) is achievable. In the erect state, the gain in length will usually vary between 0.5 – 2cm (0.2in – 0.8in) and will be dependent on post-operative care. As explained in previous sections, for most men and their partners flaccid state length and girth size (or at least should be) are more important than the erection length. In this respect, we consider ligamentolysis, in combination with girth and glans enhancement, an excellent penis enlargement option as it is minimally invasive, very safe and for the majority of patients and their partners, the results will be very satisfying.
Penile lengthening through prosthesis insertion
For patients with severe erectile dysfunction, who are candidates or already had penile prosthesis surgery, then significant penile lengthening can be achieved in both the erect and flaccid states through a modified penile prosthesis implantation surgery. Furthermore, doctors have pioneered a technique which minimizes operating time and any possible complications. The average gain is 3 cm (1in) but we have seen patients gaining up to 5 cm (2in). In this case the outcome will generally depend on the elasticity of the neurovascular bundle of the penis but the results are usually excellent. For more information please visit the penile prosthesis section.
Lengthening through complete penile reconstruction
This is the most radical technique as it involves completely disassembling and reconstructing the penis. By disassembling the penis to its anatomical parts, a space is created between the penis glans cap and the penis shaft and cartilage harvested from the patient is inserted in this gap, leading to increased penis length. The average gain in penile length (both in flaccid and erect state) through this technique is similar to the prosthesis lengthening as it depends on the elasticity of the neurovascular bundle. Combining this technique with standard ligamentolysis can result to further gains and overall impressive outcome. However, due to the high degree of difficulty and significant rehabilitation time, our doctors will only perform this surgery to patients suffering from true microphallia i.e. with an erect penis length of less than 8-10cm (2-3in).
Peno-scrotal web correction and pubic area fat removal
All the aforementioned techniques can be complemented by simultaneous fat removal from the pubic area and adjustment of the peno-scrotal web (the skin connecting the penis to the scrotum). The effect of both will depend on the patient’s anatomy but they can add significant visual length to the penis. Although these extra steps are simple, both our patients and their partners report very high satisfaction rates with the results.
Penis girth enhancement through autologous fat injection
Autologous (i.e. harvested from the patient) fat injection for penis girth enhancement is the most widely used technique. It can be performed under local anaesthesia and is comprised of three simple steps:
Abdominal/Thigh Fat Suction (Harvesting Autologous Fat)
This is the first step where, from an appropriately identified area, fat cells are harvested from the patient through a tiny incision.
After the fat has been harvested, it is specially processed so as to remove any non-fat tissue. This ensures that post-surgery survival of fat inside the penis is maximized and the girth gain is retained.
Fat Injection in the penis
The fat is injected through a small incision on the penis. This is the step that extensive doctor expertise and experience will make the difference. How the fat is injected will determine the aesthetic outcome of the result. The aim is to have a natural looking penis (relative to the glans), with evenly distributed girth. Unfortunately, most doctors still perform the technique that was first introduced 20 years ago and for this reason they often report uneven results and hence reject autologous fat injection. We have introduced two very simple steps that resolve this problem:
- The fat is injected through a very thin injector. In this way, we filter out the larger fat cells that are responsible for the so called granulomas (fat lumps), which are aesthetically unpleasant
- We induce an artificial erection and then inject the fat. This ensures that the fat is distributed evenly in both the erect and flaccid state of the penis
Our collective experience with autologous fat transfer is unparalleled ensuring an aesthetically superior result. On average, an increase of around 30% in penis girth can be achieved. Nonetheless, in some patients the initial impressive results may subside as time passes by. Whether this happens and by how much is unfortunately unpredictable but can be minimized with good postoperative care. For this reason, we offer to all our patients an assurance for one year following the fat injection (the patient only covers the clinic costs and we do not charge a surgeon’s fee, which represents 80% of the treatment cost), where free “touch-ups” are performed if a significant reduction in the girth gain is observed.
The advantages of autologous fat transfer are summarized as follows:
It is the technique more widely performed and experienced doctors can achieve aesthetically superior results, with an average penis girth increase of 30%
It is minimally invasive, can be performed under local anaesthesia and there are no significant complications
The patient’s own cells are used and as such there is no risk of material rejection
Rehabilitation is usually very short and normal sexual activities can continue after around 4-6 weeks.
Beyond autologous fat injection, there are other materials that can be injected to the penis to increase penis girth such as hyaluronic acid and other ionised derma fillers. These products are in general safe to use but are relatively expensive (thus increasing the total costs) and are gradually absorbed by the body (approximately 5% per month of the volume of the material is absorbed). Touch-ups can also be offered but there is a further cost for the material.
Penis girth enhancement through surgery
In addition to injection of fat or other material, there are a number of more advanced surgical techniques that can result to significant penis girth increase. Our doctors can perform any of those and the choice of technique will depend on each individual patient’s circumstances and preferences.
The first category of such techniques involves taking biocompatible tissue(such as fat taken from another part of the patient’s body or specially treated donor tissue from animals) or other material and placing it below the penis skin. The choice of material will depend on patient specific circumstances such as availability of thick enough fat tissue or how much girth enhancement is required. The results with these techniques are in general very good but they do carry a certain degree of risk in terms of tissue survival (the tissue would need to get very well vascularised) or material rejection. Moreover, they are in general not repeatable, in the sense that once the operation is performed then in case of unsatisfactory results the same technique cannot be used again to provide extra girth.
Another effective and versatile technique is penis girth augmentation through tissue engineering with biodegradable scaffolds. This technique is only applied in very few centers worldwide and it was co-developed by our consultant, Professor Miroslav Djordjevic. It is safer than the other surgical techniques and almost always gives better results. Instead of implanting “formed” tissue under the penis skin, this technique uses a tube shaped (similar to the penis shape) biodegradable spongy material (PLGA) which is then soaked for 24 hours in a liquid containing the patients own cells. The tubes are then placed under the penis skin. However, these tubes are not what give the gain in girth. They only serve as a basis (scaffold) to keep the patient’s own cells in place, which as time passes form permanent penis tissue. The tubes themselves are completely absorbed (the material is exactly the same as that used for absorbable stitches) and after the operation the look and feel of the penis in both erect and flaccid state is perfectly natural. The additional advantage of the scaffold technique is that it can be repeated two more times if necessary to give truly impressive results. Finally, rehabilitation time is usually shorter than the other techniques and normal sexual activities can continue after 8 weeks.
The desire for a larger penis has been reported throughout history and there is recent scientific evidence that suggests that human evolution has favoured men with larger penises. However, penis enlargement has been a controversial topic in the medical community. On the one side, it is often considered as a lifestyle treatment, sometimes sought by men who do not need it. On the other hand, demand for this type of operation is increasing, operating techniques are constantly improving and new materials are being developed.
According to a recent study a staggering 45% of men reported that they were dissatisfied with their penis size, wishing that they had a larger penis. To put this in perspective, the percentage of men who are not happy with their height and weight is less than 40%. This study also found that men who are dissatisfied with their penis size also tend to be less confident and are less satisfied with their body and face. The findings of this study may suggest that penis size affects men’s more general views of themselves; men with larger penises feel more confident about themselves whereas men with smaller penises feel insecure. This is largely confirmed by our doctor’s experiences over the years. Men who undergo penis enlargement surgery, report increased confidence both during sexual intercourse and in their social life. Conversely, men who experience a loss of penile length and girth (usually due to radical prostatectomy or Peyronie’s disease) usually report severe distress and even depression.