With various penile enhancement procedures performed worldwide, researching the right procedure can be challenging for men who seek penile enhancement with demonstrated results. The Phalloplasty FAQs section of our website provides an extensive collection of questions we receive and which are answered by Dr. Elist and his staff based on their vast experience with penile enhancement procedures. We receive numerous calls and e-mails on a daily basis from men who are looking to find answers to their questions about penile enhancement procedures.
Patients seeking solutions for a small penis size frequently have a distorted view of what they actually have. In these instances, psychological counseling may prove helpful.
To your 2nd question, our patients generally describe the feel and looks of the penis after surgery as “natural” or “normal”, but “bigger” or “huge”, etc. If asked, the majority of patients refer to their penis after surgery as being big and naturally looking and report never being addressed about having had any procedure done to the penis. This is especially the case with men who attend gyms or public showers.
Dermal graft and fat injection procedures are non-permanent and give unreliable results. Dermal grafts and fat injections do disappear or become dislocated after a certain amount of time, disfiguring the whole penile appearance. In some cases we even observe severe calcification of the injected fat which our patients describe as “having a piece of rock/bone under the penile skin”. These procedures are also associated with a high risk of infection, necrosis, scarring, and skin damage. Almost on a regular basis, we see patients with the aforementioned complications which require immediate removal of the dermal grafts/fat and skin grafting to salvage the remaining penile skin.
In general, we do not accept patients for our implant surgery with prior penile procedures (except for circumcision). In particular, dermal grafts and fat injections cause tremendous internal damage to the skin in-so-far as the skin is not suitable for the implant surgery. Simply said, those procedures damage the skin from inside, and the skin is not able to accommodate and hold on to the implant.
While we can perform a removal of dermal grafts or fat, subsequent implant surgery cannot be guaranteed at this time. The internal skin condition must be assessed during removal surgery and IF shown to be healthy enough, implant surgery MAY BE considered after several months of skin recovery. If the skin condition is determined to be not suitable for implant surgery, the implant surgery will not be scheduled.
Cutting the suspensory ligament will leave it with two severed ends which will have the tendency to build scar tissue and possibly be a cause of retraction. Also, cutting the suspensory ligament is likely to change the angle of the erection (as it will detach the penis from the pubic bone) and the additional weight of the implant will further drop the penis towards the bottom.
During the Elist implant surgery, the suspensory ligament is not cut, but it is rather stretched while putting in the implant using the suspensory ligament as a proximal resistor. While immediately extending the flaccid penis length, the implant continues to stretch the suspensory ligament and the penile skin with its length (ca. 2 inches of additional implant length remains inside the pubic area for later gains), as well as its weight, and allows for further extension of the penis for additional and progressive length gain.
If your job does not require any excessive amount of heavy lifting or strenuous physical activities, you can go back to work the next day when at home; many patients choose to take of a whole week just for themselves to recover better from the surgery. The recovery period is usually 4-6 weeks; light upper body exercises are allowed 2 weeks after surgery, light lower body exercises after 4 weeks, and sexual activity can be resumed 4-6 weeks after surgery and upon our approval.
As you have noted and personally have experienced, the suspensory ligament release procedure has some limitations to it. Despite the use of the extender, the gains are not always present, and some patients may even experience some retraction and penile shortening due to suspensory ligament healing and scar tissue formation.
The penile enhancement procedure using the patented subcutaneous soft silicone implant (Penuma implant) on the other hand can increase flaccid penis length AND width at the same time (an average of 1 to 2 inches).
One of the reasons why we do not perform PMMA, besides not being approved for use in the penis, is the severe internal and skin damages PMMA does to the penile skin.
We have had many patients who were treated for fat removal, AlloDerm removal, and PMMA removal, which had left them with more or less severe conditions.
Usually, and based on our experience, the only way to close the skin wounds is a complete removal of any remaining PMMA, and trial of primary closure IF sufficient skin remains available. Since a partial removal of the necrotic edges of damaged skin is needed for wound closure, the remaining skin might not be sufficient for a primary wound closure and require skin graft transplantation.
Regardless of your decision, it is highly recommended that you proceed with appropriate medical and surgical care in order to prevent further damages to the penis.
If you are considering the penile enhancement surgery, we can perform the circumcision. The implant surgery can then be performed after 6 weeks of recovery if the skin has healed properly.