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Phalloplasty FAQ

With various penile enhancement procedures performed worldwide, researching the right procedure can be challenging for men who seek penile enhancement with safe and permanent 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.


Notes:

  • ALL provided information is solely based on Dr. Elist’s 40 plus years experience in urology, urological surgery, and male enhancement surgery. The information here is not intended to promote Dr. Elist’s procedures or to criticize other procedures that Dr. Elist does not perform.
  • All questions on Phalloplasty FAQs are posted exactly as received. Any spelling or grammatical errors are based on patients’ wording. In order to maintain authenticity, no correction attempt have been made to the questions’ content.

FAQ Phalloplasty

    Are silicone implants safe? Are Alprostadil injections effective after a Soft Silicone Implant?

    Silicone leakage from breast implants has been a big controversy since the first silicone implants for breast enlargement were introduced to the world of plastic surgery. Meanwhile, research and new material development have made breast implants consisting of a silicone pocket and soft silicone gel filling relatively safe. Nevertheless, the chance of rupture and material leakage is always possible when the implants are exposed to large amount of forces. However, while this might be true for breast implants, it is not for our implant! Our soft silicone penis enlargement implant consists of a soft but solid silicone material which when even cut in half, does not leak. If you would like, you can compare the material or the implant consistency to that of a gummy bear. Simply said, our silicone implant is a soft but solid structure without any fluid or gel component and without the risk of leakage. Regarding your second question, the implant covers about 2/3 of the penis surface, which is about 270 degrees. By doing so, the lower part of the penis carrying the urethra is not being covered. We do indeed have some patients who are using injections for erectile issues and have the implant insert. After implant insertion we teach our patients how and where to inject in order to avoid puncturing the implant.

    What is the average penis size?

    In recent years the expression “average” has gained more popularity than ever. A study published in the September 1996 Journal of Urology concluded that average flaccid penile length was 8.8 cm (3 1/2 inches), and average erect length was 12.8 cm (5 inches); more men are now concerned about their penis size to be “average” or below than before.

    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.

    Does the Elist Implant change my sensation? Can it be felt by others?

    Given the location of the placement of the subcutaneous soft silicone implant under the penile shaft skin, sensation is typically not affected, and nerves are not damaged.

    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.

    Is it possible to have Elist Implant after a failed Dermal Graft or Fat Injection?

    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.

    Can you point me to studies conducted by third parties on the efficacy value of your unique Elist implant procedure?

    As noted on our websites, the Elist implant penile enhancement surgery is a patented procedure currently performed at our facility only. If you visit our research section you will find the announcement of our most recently prepared paper about the use of the Elist implant, including an IRB-approved, 400 patient, 5 year retrospective review that was published in the peer-reviewed Journal of Sexual Medicine.

    Do you cut the suspension ligament when you insert the implant?

    The suspensory ligament is not cut during the Elist implant surgery.

    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.

    How do you compare the Elist Penile Enlargement Surgery recovery time vs AlloDerm Penile Enlargement Surgery recovery time?

    The Elist implant surgery is performed on an outpatient basis, takes about 45 to 60 minutes, and patients are then picked up and brought back to their accommodation of stay. The subsequent 3 (three) days, you will be coming to the office for your usual follow-up visits, and you will be able to go back home in the afternoon of the third day after surgery (that is, if you are not local).

    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.

    How does the implant feel when the penis is erect and supposed to be hard?

    The Elist implant consists of medical grade soft silicone; it is a solid structure which is soft to the touch (comparable to a gummy-bear; though not as soft). However, it does not have the same consistency as a women’s breast implant, which consists of a shell and a saline / silicone GEL filling. When the penis is erect, the strength and stiffness of the erection will likely be bigger in dimension, and the erection feels natural.

    What are the advantages of the Elist Implant vs. Suspensory Ligament Release?

    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 (Elist implant) on the other hand provides increases in penis length AND width at the same time (an average of 1.5 to 2.5 inches). The results of the procedure are permanent.

    I had PMMA injected and now have open wounds on my penis. Is there any chance my skin will heal over these wounds?

    Unfortunately, most men are not aware in how far a wrong decision regarding the choice of procedure might affect the outcome and severely damage the penis.

    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.

    To have enlargement done, do I have to be circumcised?

    Circumcision is a must if you are considering the penile enhancement surgery with the subcutaneous soft silicone implant.

    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.

    Can I have Penile Prosthesis and the Elist Implant at the same time?

    Yes, you can come to us for the penis lengthening and widening procedure using the patented subcutaneous soft silicone implant. Our patients have not only regained any lost size as a result of the prosthesis, but were able to achieve additional length and girth after the implantation of the Elist implant. Please note that these two procedures (penile prosthesis for erectile dysfunction and Elist implant for penile enhancement) cannot be performed during the same setting. The penile prosthesis for erectile dysfunction need to be placed in first, and after a recovery period of 6 (six) weeks, the Elist implant can be placed in for increased length and girth.

    What gains can I get with the Elist Implant?

    On average, based on our past experience, our patients have seen an increase of 1.5 to 2.5 inches in girth and the appearance of length. Nevertheless, as with all available options for penis enlargement, we cannot guarantee end results. With the Elist implant it is possible to achieve two types of gains:

    • Immediate gain in flaccid length and girth, as well as erect girth, and
    • Potential gains in erect length, if any, over the next 6-12 months or longer.
    • While the implant adds instant thickness and length to the flaccid penis, the increased length of the erection, if any, likely occurs over time when the skin stretches, allowing the penis to move further out of the body.

    What do you say about Elist implant comments and reviews?

    We are proud that the vast majority of our patients are highly satisfied with the outcomes of their procedure. Unfortunately, there can sometimes be a very small, but vocal, minority online often propagated by other practices who offer other enhancement procedures. It is important that all patients follow all post-operative instructions closely. Our office is always here to help answer questions and for any follow-up visits.

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