Dermal Graft, Dermal Fat Grafting or DFG
NOTE: The Male Enhancement Centers and Dr. Elist do not perform Dermal Fat Graft (DFG) Penile Enlargement Procedures. The following material is solely for information purposes. Complications reported in this section are based on phalloplasty revision surgeries performed at our facility due to previous dermal Fat Graft (DFG) procedures and associated complications.
Dermal Graft, Dermal Fat Grafting or DFG
Dermal Graft or Dermal Fat Grafting (DFGs) are utilized by plastic and reconstructive surgeons to patch superficial and deep skin defects where compromised wound healing does not allow natural closure of the affected region. As opposed to to skin flaps with their own blood supply, Dermal Graft or Dermal Fat Grafting (DFGs) do not have a blood supply after being harvested. As a result, they are solely dependent on the blood supply of the area where they are transferred. This neovascularization (development of new blood channels) requires an integration of the graft into the surrounding tissue.
Dermal Graft or Dermal Fat Graft Penis Enlargement procedures are similar to procedures involving fat injections. They represent a sort of novelty technique widely used by many physicians to achieve penile girth / circumference enhancement. It has been claimed that the Dermal Graft technique, while more labor and recovery intensive, has superior results when compared to fat injection penis enlargement procedures.
Dermal Graft or Dermal Fat Grafting (DFG) Penis Enlargement procedures are best compared to a combination of fat injection and AlloDerm (cadaver skin) placement into the penis. There is a claim, however, that Dermal Fat Graft procedures are superior to AlloDerm or fat injections because of increased initial thickness and durability.
Where Do Dermal Graft AKA Dermal Fat Grafts Come From?
Dermal Graft or Dermal Fat Grafting (DFG) Penis Enlargement procedures are performed using the patient’s own skin and fat tissue. Surgeons claim this as an advantage as no foreign material is used for the procedure.
Dermal Grafts are usually harvested from the crease of the buttocks, just where the upper thigh meets the gluteal region.
Usually two strips, one from each side of the buttock crease and with a dimension of 5 cm x 12 cm are removed with the underlying fat tissue. The most superficial layer of the skin (epidermis) is then removed and the remaining skin (dermis) and underlying fat tissue is used to be placed inside the penis.
The transfer of the dermal fat grafts (DFGs) are performed either in a longitudinal or circular fashion (based on surgeon’s preference and expertise) where the dermal fat grafts are positioned around the penile erectile bodies enhancing the girth.
Note: Foreign material such as the silicone (ELIST) implant is biologically inert and does not require integration into and scarring of the surrounding tissue. Foreign material also does not require harvesting of the patient’s own skin, which can cause additional scarring and later wound healing issues.
What Is A Dermal Graft And How Does It Survive?
Per definition, a dermal graft is one part of the body (specifically skin with or without underlying fat and/or muscle) which is cut off from its blood supply (free graft) in order to be transferred to another region of the body. The survival of the dermal graft is then dependent on the physiological circumstances at the recipient site where a neovascularization is necessary in order to maintain the dermal graft’s blood supply.
Dermal grafts are usually used to close non-healing wound defects on the body. Once the dermal graft is placed in the defective area, it is sutured (sometimes stapled) to the surrounding healthy skin where it starts to integrate itself into the new location by building new vessels for blood supply.
The same principle is also used in penile dermal grafting where a free graft is harvested from the buttock area and placed into the penis, underneath the shaft skin and over the erectile body. Sutured in place (or fixed using other techniques) the dermal graft eventually starts to integrate and grow inside the underlying shaft tissue as well as partially (or completely) into the overlying skin.
Ideally, the dermal graft should act as an inert material, which would not adhere to the underlying or overlying structures allowing a free movement on the skin on the shaft of the penis. Furthermore, any type of graft should ideally be reaching further into the pubic area, where a major part of the penis is sitting and moving out upon erection, in order to prevent a gapping between the grafted area and the base of the penis upon erection. This characteristic can only be achieved by an inert material, which does not adhere to the skin or shaft tissue.
What Do Surgeons Say About Dermal Fat Graft (DFG) Penile Enlargement Procedures?
A large number of plastic surgeons utilize Dermal Graft or Dermal Fat Grafting (DFGs) for penis widening procedures. While the success rate of Dermal Grafts is described as superior when compared to AlloDerm and fat injections, the complication rates are also widely understated. It is true, however, that initial gains with Dermal Fat Grafts seem to be greater when compared to AlloDerm, and more homogenous when comparing to fat injection.
Some surgeons report the absorption rate of fat to be 70-85%, and that of skin to be only 20%. If you do the math and compare the amount of tissue lost with Dermal Fat Grafts (DFGs) versus silicone implants, you’ll see that beyond comparison, a permanent non-degrading implant has much more durability and consistency than a DFG.
The simple fact is that, except for biologically inert materials, all grafts consisting of natural tissue used for penile augmentation, or closure of any kind of tissue defect, will undergo physiological changes, especially if inserted into areas of the body where fat grafting is not recommended.
What Does The Scientific Literature Says About Dermal Grafts (DFGs):
A dermal fat graft is a dermis-free graft that consists of all layers of skin and the underlying subcutaneous tissue after removal of the epidermis . The first known human adipose tissue transplantation was attempted in 1893 by Neuber . Since then, accumulated data have shown that the acceptance of and survival of the grafted adipocytes depends on a quick, atraumatic, sterile transfer of the graft and its early revascularization. Final results depend mainly on the amount of fat which is reabsorbed and replaced by fibrous tissue and on the remaining bulk of dermal tissue. Sawhney et al  documented the changes in size and consistency of a dermal fat graft for penile girth enhancement. At 1 wk after transplantation, the consistency of the dermal graft was still soft, with 70– 90% of the fat preserved, but at 8 wk most of the fat had been replaced by fibrotic tissue . Dermal fat grafts are harvested from the abdomen or the gluteal folds, and the strips or sheets of the dermal graft are then placed circumferentially between the dartos and Buck’s fascia. This technique has significant disadvantages such as prolonged operative time (7 h) and a high incidence of postoperative complications: persistent postoperative penile edema and induration, venous congestion,
and possible skin injury . Donor-site scarring and deformity of the buttock crease or the suprapubic region are often cosmetically unpleasant, and curvature and shortening of the penis, as well as penile asymmetry due to fibrosis may occur . Although the risk of partial graft loss or fibrosis is significant , girth enhancement is achieved at higher rates when compared with those following fat injections ; the final outcome (after 12 mo) is generally a 2.5–5.1-cm increase in girth. Nevertheless, after reviewing all published reports on this technique, we found that it gave inconsistent results and that the complication rates were high, and for these reasons
we conclude that dermal fat grafting is not an acceptable procedure for penile girth enhancement.
 Alter GJ, Jordan GH. Penile elongation and girth enhancement. AUA Update Series 2007;26:229–37.
 Sawhney CP, Banerjee TN, Chakravarti RN. Behaviour of dermal fat transplants. Br J Plast Surg 1969;22:169–76.
 Billings Jr E, May Jr JW. Historical review and present status of free fat graft autotransplantation in plastic and reconstructive surgery. Plast Reconstr Surg 1989;83: 368–76.
 Spyropoulos E, Christoforidis C, Borousas D, Mavrikos S, Bourounis M, Athanasiadis S. Augmentation phalloplasty surgery for penile dysmorphophobia in young adults: considerations regarding patient selection, outcome evaluation and techniques applied. Eur Urol 2005;48: 121–8.
What Side Effects Are Associated With Dermal Fat Graft (DFG) Penile Augmentation Procedures?
As with all types of penile enlargement surgical procedures, Dermal Graft or Dermal Fat Grafting (DFGs) Penile Augmentation procedures can also be associated with general complications such as swelling, bleeding, pain, hematoma, and infection.
Risks and complications specifically reported with Dermal Fat Graft (DFG) Penile Augmentation procedures include, but are not limited to, the following:
- Absorption of implanted Dermal Fat Graft (DFG) with consequent loss of initially achieved dimensions
- Shrinkage of dermal fat graft (DFG) with subsequent aesthetic deformity
- Shrinkage of dermal fat graft (DFG) with subsequent penile shortening
- Fat tissue fibrosis (reported 8 weeks after surgery)
- Detachment of the graft (failure to take)
- Necrosis (death) of the dermal fat graft (DFG) with associated severe internal adhesions causing severe penile deformity
- Post-operative complications due to prolonged surgery time of 3-7 hours)
- Persistent penile edema with skin induration
- Penile skin scarring and loss
- Penile asymmetry due to fat tissue fibrosis
- Wound healing problems of donor site (buttocks)
- Infection of donor site (buttocks)
- Prolonged pain and disability due to skin defect at the donor site
- Cosmetically unpleasant scarring at donor site
The extent of damages caused by Dermal Fat Graft (DFG) Penile enhancement procedures is best illustrated by the following case, which was presented to our facility for revisional surgery:
Case#1: Failed Dermal Fat Graft (DFG) Procedure with Subsequent Severe Infection, Removal, and Penis Reconstruction Surgery
Patient: 31 year old Caucasian male with two previous Dermal Fat Graft procedures done 1 year before visiting our office. Current complaints include diminishing of the graft with severe penile deformity, severe graft infection with fistula formation, wound infection, penile cellulitis and skin necrosis. A penile skin reconstruction was performed after removal of the severely infected dermal fat graft and wound clean up.
Case#2: Failed Dermal Fat Graft (DFG) Procedure with Subsequent Severe Infection, Removal, and Penis Reconstruction Surgery
Patient: 28 year old Caucasian male, with previous Dermal Graft insertion, now with severe graft infection, penile deformity and skin perforation.
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