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Fat Injection

NOTE: The Male Enhancement Centers and Dr. Elist do not perform Fat Injection 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 fat injection procedures and their associated complications.

”The American Urological Association (AUA) and the Urology Care Foundation consider subcutaneous fat injection for increasing penile girth to be a procedure which has not been shown to be safe or efficacious”


Fat Grafting

The concept of free fat transfer (FFT) has been around since the late 1800s when fat was first reported to be used to fill soft tissue defects. The scope of fat transfer techniques has been continuously broadened to include tissue defect repairs in the face, breasts, and other areas of the body. Despite advancements in harvesting and transfer, the effects of free fat transfer have been shown to be rather limited. FFT is mostly effective when used to fill small soft tissue defects in the face and in areas with scarring.

Fat grafting procedures are mostly performed by qualified plastic surgeons. The procedure entails the harvesting of fat tissue, mostly from the abdominal area, and the transfer of the harvested fat into other parts of the body. Nearly 30% of the harvested fat cells survive the procedure. The transfer of harvested fat tissue is then performed using cannulas and needles.

Despite initial beliefs, fat tissue has been discovered to consist of fat cells with a thin membrane and a network of fibrous tissue providing its structural network. Fat tissue is also highly vascularized and its survival after transfer requires integration into the surrounding tissue for later revascularization.

Fat transfer procedures are generally very minimally invasive, cost efficient, and do not require the insertion of foreign material. The success of a fat transfer procedure usually depends on the:

  • Location where the harvested fat is transferred
  • Amount of transferred fat
  • Patient’s healing properties
  • Surgeon’s expertise

The ideal location for fat transfer is in areas of the body which naturally contain a fair amount of fat, but may have diminished over the years- transfer of fat to areas with no natural fat content is not recommended for many reasons.

Here is what the American Society of Plastic Surgeons says about fat transfer procedures:

January 2009- Fat Transfer/Fat Graft and Fat Injection ASPS Guiding Principles

“…Using fat transfer and fat injections is both safe and effective as a cosmetic and reconstructive procedure… This technique works well for breast and gluteal augmentation, repair of contour deformities, facial augmentation, hand rejuvenation and lip augmentation.”

The American Society for Aesthetic Plastic Surgery says the following regarding Fat Injection:

“Fat injection or grafting has broad applications in cosmetic surgery. Fat injected into areas requiring volume-enhancement produces safe, long-lasting, and natural-appearing results as volume is replaced to tissues where fat is diminished.”

While the use of free fat transfer (FFT) has become mainstream in plastic and reconstructive surgery, its use has so far only been approved for the correction of defects mainly in the face, not for use in the penis.

American Urological Association (AUA) does not Approve Fat Injection for Penile Enlargement:

The use of fat for penis augmentation has not yet been approved by the American Urology Aassociation:

”The American Urological Association (AUA) and the Urology Care Foundation consider subcutaneous fat injection for increasing penile girth to be a procedure which has not been shown to be safe or efficacious.”

As a result, most urologists do not perform penile fat injection procedures.


How and How Much of the Transferred Fat Survives?

For the transferred fat tissue to survive, it requires a process called neovascularization where new blood vessels build and grow inside the fat tissue. Neovascularization is initiated by the surrounding fat and soft tissue. This process is accompanied by an inflammatory reaction which results in a replacement of the transferred fat cells with connective and fibrotic tissue.

This mechanism is one of the most important factors why fat transfer is not an appropriate technique for penile augmentation.

Fat tissue transfer has been recommended to areas where natural fat has previously existed so that newly transferred fat tissue can integrate into pre-existing fat and fill up the lost volume. When transferred under the penile skin, where natural fat has never existed, the newly transferred fat tissue survives by integrating itself inside the soft tissue of the underlying shaft and the overlying skin. By doing so, it does not only take away nutrition from the skin, but it also leads to fibrosis, scarring, and possible skin necrosis.

In fact, when too much fat has been transferred into one location, the removal of the excess graft is very difficult due to tissue infiltration into the fat graft.

Simply said, fat tissue transfer should only be attempted in areas with some pre-existing natural fat. If transferred to an inappropriate location, adhesions, scarring, and soft tissue damage may occur.

The amount of surviving fat tissue has also been widely studied in the field of plastic and reconstructive surgery:

Chajchir et:

  • 3 months after transfer: zones of cell necrosis, fat cells, and new vessel zones
  • 6-8 months after transfer: heavy inflammatory reaction and fibrosis
  • 12 months after transfer: large amount of connective tissue and fibrotic reaction. Some fat was still present.

Ersek:

  • Fat absorption range: 20-90%

Cortese et al:

  • Fat absorption range: 75-85%

When reading the above listed values, one needs to keep in mind that these are observations after using proper FFT techniques with transfer of fat to areas containing pre-existing fat. The loss of fat grafts injected inside the penis is usually much more dramatic compared to the above numbers.

Who Performs Fat Injection for Penile Augmentation Procedures?

As with any surgical procedure, a patient’s first step when considering surgical penile augmentation should be extensive research about available options, expected outcomes, and desired results. Medical specialties have been established in order to provide the patient with knowledge about the area of concern and secure the best possible outcomes. When it comes to the male genital area, a urologist is certainly the most appropriate resource for information regarding safe penile surgery. The American Urology Association has not approved fat transfer procedures for penile augmentation:

”The American Urological Association (AUA) and the Urology Care Foundation consider subcutaneous fat injection for increasing penile girth to be a procedure which has not been shown to be safe or efficacious”

In the US, most urologist do not perform fat injections for penile augmentation. Fat injections into the penis are mostly performed by plastic and aesthetic surgeons. The American Society for Aesthetic Plastic Surgery says penile fat injection is experimental, with “insufficient data to establish its safety and effectiveness”.


What Other Doctors Say About Fat Injection for Penile Enlargement

“Fat grafting is the most common, and the most notorious, of the penile augmentation procedures. It can result in disasters such as loss of the penis if fat is injected into blood vessels or if infection occurs. When the augmentation does work, the result is temporary. Complications such as nodules in the penis, skin deformity, and scarring and loss of normal contour are common. The injected fat is extremely fragile and needs to remain fairly motionless in order for blood vessels to grow into the tissue. If they don’t grow in three days, the fat will die and be absorbed by the body. If the fat is disturbed during the first three weeks, it will lose its new blood supply and be resorbed. The penis cannot stay motionless when urinating and when erections develop. Virtually, by definition, fat grafting into the penis is doomed to fail.”

“Most of the research has suggested that the fat injections will dissolve within six to eight months. Occasionally small areas of ‘fat encapsulation’ or hard fat nodules will occur which can give a lumpy texture to the penile shaft. There seems to be fairly good initial results, but the long-term results seem to be more inconsistent and unpredictable.”

“Patients who desire to have augmentation must clearly understand that initially there will be a fullness and swelling of the areas of the transplanted tissue, and that multiple or additional procedures may be required to maintain the desired girth enhancement and to smooth out any irregularities.”

“Complications relating to autologous fat injections include disappearance of fat, penile lumps and nodules, and shaft deformities.”

“Many a penis has been injected with anything you can imagine including paraffin wax, silicone and others. Fat has repeatedly been tried. The problem with fat is that it does not always survive leaving irregular lumps and scars. When it does work, the penis takes on the texture of fat. How erotic is a wider, somewhat irregular penis with the consistency of a marshmallow?”

What are the Complications of Penile Fat Injections?

Complications with fat injections into the penis can be include the following:

  • Mild to severe absorption with severe deformity
  • Skin adhesions
  • Skin scarring
  • Necrosis associated with severe deformity, and severe infections

In areas where fat injections have been proven to be safe and effective (e.g., the face), complications may include:

  • Placement of too much fat: failed revascularization and graft loss
  • Graft migration: deformities and graft loss
  • Graft absorption: loss of volume with deformity
  • Clumping of graft: nodules, lumps and deformities
  • Damage to the underlying structures: skin and soft tissue scarring and necrosis
  • Prolonged edema: swelling and watery consistency of injected area
  • Bleeding
  • Infections
  • Donor site scarring: contour irregularities on harvested site

Case Studies

Our office is frequently visited by men who have had previously undergone penile augmentation procedures done using free fat graft transfer. As a result, we often observe most of the above mentioned complications. The following are examples of complications we have seen and treated at our facilities.

Case#: 1

27 years old African-American male with a history of fat injection into the penis performed 6 months ago. Current complaints included diminished injected fat with areas of skin thickening, resulting in an unacceptable appearance of the penis. The patient was very unhappy with the results and requested a removal of the residual fat and placement with the ELIST implant. While the damages upon physical examination seem to be rather limited to aesthetic deformity and some skin adhesions, the actual state of being of his penile skin and erectile bodies was discovered to be much more dramatic during surgery.

The residual fat graft was partially loose, and partly adherent to the skin, especially to the areas which had been noticed to be thickened before surgery. These areas of the skin presented with severe soft tissue adhesions due to fat tissue replacement by necrotic tissue. A partial removal of the necrotic skin was necessary in order to remove the fat graft. Two areas of the skin suffered severe damages which resulted in later skin necrosis and perforation requiring two additional revisional surgeries.

Due to severe skin damages by prior fat injection, it is not possible, nor will it ever be possible, to place the ELIST implant in this patient.

Fat Injection for Penis Enhancement
Fat Injection for Penis Enhancement

Case#: 2

Fat Injection for Penis Enhancement
Fat Injection for Penis Enhancement
Fat Injection for Penis Enhancement

Case#: 3

Fat Injection for Penis Enhancement
Fat Injection for Penis Enhancement
Fat Injection for Penis Enhancement

Case#: 4

Fat Injection for Penis Enhancement
Fat Injection for Penis Enhancement
Fat Injection for Penis Enhancement
Fat Injection for Penis Enhancement

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