MALE INTIMATE SURGERY

A small sex can have significant psychological effects. The size of the penis varies from one individual to another, both in length and in diameter, both at rest and in erection. The cosmetic surgery of the penis, penoplasty or phalloplasty consists in an increase in the penis’ size, either in diameter or in length.

This cosmetic surgery aims male patient whose sex has a size at the limit of normality which has important physical and psychological repercussions.

The enlargement penoplasty (or phalloplasty) will allow to increase the diameter of the penis, both at rest and erection. The penoplasty of elongation makes it possible to increase the penile length especially at rest.

These two surgical procedures can be carried out separately or combined. Additional surgical acts can be made such as injections to increase the volume of the glans, plasty of the frenulum, plasty of the foreskin or circumcision.

• The enlargement of the penis (Figure 1):

Figure 1: The penile enlargement surgery

This enlargement is achieved through a lipostructuring (or lipofilling), or reinjection of autologous fat. The procedure allows to increase the diameter of the penis by injecting fat under the skin. This fat is taken from the belly or from the thigh. The increase in the volume of the penis will be visible at rest and in erection. This is a very reliable technique with a definite result, although sometimes a revision surgery is necessary, on the condition that the patient keeps the same weight.

• The penile lengthening surgery (FIG. 2):

It is achieved through the cutting of the suspensory ligament of the penis that connects the penis to the pubic bone, which will release the penis. The obtained elongation varies from 3 to 6 cm. This gain in length concerns only the sex at rest.

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The medical consultation takes place at Laclinic-Montreux, or at the Beauty Suite in Lausanne, (only 30 minutes from Geneva by train).

A careful study of the medical background and a complete physical examination, carried out by Doctor Jean-Charles BAYOL, will enable to choose the type of surgical procedure that is the most suitable for you.

To properly assess the indication for surgery, it is important to know your sex life, surprising questions may be asked during the interrogation. You may sometimes be referred to an urologist, a sexologist or an andrologist. A medical consultation with your life partner may sometimes be necessary.

If there are functional disorders such as a problem of erection, medical treatment may be prescribed to optimize the result of the surgical procedure.

As with any surgery it is highly recommended to refrain from smoking at least 15 days before surgery, as tobacco consumption reduces the engraftment of fat tissue and delays the wound healing process in the case of a penile lengthening.

For patients with a predisposition to genital herpes, preventive treatment will be prescribed to limit a postoperative eruption.

The shaving of the pubis will be mandatory in case of a penis lengthening, but won’t be necessary in case of enlargement.

A treatment to temporarily suppress erections will be started on the day of surgery, to allow a proper healing after surgery.

In the case of an enlargement, anesthesia is required, either under vigil sedation, or under local anesthesia. When an elongation is performed, general anesthesia is often necessary.

Whether it is an enlargement or a lengthening, hospitalization is most often done as an outpatient surgery at Laclinic in Montreux. In some cases of lengthening surgery, an overnight hospitalization may be necessary.

• The penile enlargement:

The first step is the removal of the fat using a small cannula, at the level of the belly or the thighs, according to the patient’s available fat reserves.

The fat is then cleaned and centrifuged using the Coleman technique.

Then it is reinjected through small incisions located at the base of the penis and under the glans. This injection is done under the skin, in small amounts, harmoniously disseminated so that the maximum of fat tissue survives.

Lipofilling is a definitive method, however the injected fat cells are sensitive to the patient weight variations, and it is advisable to keep a stable weight. The glans is not modified by the procedure.

At the end of the procedure, the surgeon applies a light bandage on the penis.

The procedure lasts from 1 hour to 1 hour and a half.

• The penis lengthening:

The course of the incision, the seat of the future scar, is located at the level of the pubis. Depending on the case, it may have the shape of an inverted Z or Y.

The dissection is done under the skin to the iliac bone, then the suspensory ligament is cut.

The scar will be closed with resorbable or nonabsorbable stitches that will be removed between 7 and 10 days after surgery.

A light dressing will be placed on the scar at the end of the procedure.

It is important to know that the gain in length (3 to 6 cm) depends on the anatomical conditions encountered during the procedure. Therefore, it is not possible to predict it before surgery.

The penis will be elongated in its flaccid state, in erection the gain will be moderate, or even null.

The surgical procedure also lasts from 1 hour to 1 hour and a half.

There is little pain after surgery. Analgesics will however be systematically prescribed as well as antibiotics.

Preventive medical treatment will make it possible to temporarily suppress the erections in order to ensure a good healing process.

• The follow-ups of a penis enlargement surgery:

The penis is very swollen on the days following the surgery because of the edema. Pulling back the penis foreskin is impossible at the beginning, it is necessary not to be insistent, to be patient, and to wait a few days until it becomes possible again. The progressive deflation of the penis should not worry you, it is simply due to the disappearance of the edema and not to the melting of the fat.

The areas where the fat has been removed can be marked with bruises that will disappear between 7 and 10 days after surgery. Showers are possible the day after the procedure without any dressings to be applied afterward.

Wearing a loose-fitting undergarment is necessary for 4 to 6 weeks to avoid inappropriate compression.

There is no need to schedule a professional leave of more than 2-3 days.

Sexual activity can be resumed after 2 to 3 weeks. Wearing a lubricated condom will be recommended to avoid irritation. Sports activities can also be resumed after 1 to 2 months.

• The follow-ups of a penis lengthening surgery:

Swelling and bruises are frequent after a penile lengthening.

A thorough scar treatment must be daily followed for a fortnight after surgery. The showers are possible the day after the surgery, be careful not to wet the scar too much.

In order to limit any traction on the scar, it is necessary to wear supporting briefs for a fortnight.

Apart from sedentary work, it is necessary to schedule a professional leave of about one week.

As with enlargement penoplasty, sexual activity can be resumed after 2 to 3 weeks. Sports activities can be resumed after 1 to 2 months.

• Outcome of the penis enlargement:

It takes about 3 months to be able to judge the final result. This is the time it takes for the entire edema to resorb and for the tissues to regain their flexibility. Note that there may be a variable difference of up to 30% between the amount of fat injected and the amount of fat that has actually set.

The scars gradually fade.

One can hope for a diameter increase between 2 and 3 cm at rest. Sex in erection is also widened, but in smaller proportions.

There is no risk of altering the erection, as this surgical procedure does not affect the corpora cavernosa.

Normal sensitivity generally reappears within 2 to 3 months after surgery.

If the result of the surgical procedure is definitive, a stable weight must be kept. Nevertheless, since the grafted fat is sensitive to the weight variations, the patient must not lose too much weight because a loss of weight makes the result disappear, a weight gain improves it.

The main advantage of this method is that the penis keeps a natural appearance. The procedure remains unsuspected, without the need to reveal it to a sexual partner.

• Outcome of the penis elongation:

The result can be evaluated after about 1 month. The elongation is 3 to 6 cm at rest, in erection the gain is minimal or null.

The scar will be pink or even hypertrophic at first, then it will gradually fade. It must be remembered that a scar evolves between one and two years, at the end of which it will have become white and discreet.

The pubic hair can sometimes descend to the root. This can be corrected by a permanent medical depilation (lien vers “épilation définitive”).

The erection keeps the same vigor, but in some cases there is a slight decrease of a few degrees regarding the verticality of the erection which does not affect the sexual intercourses.

The scar, correctly hidden in the pubic hair will not make the surgical procedure obvious and will remain unsuspected, allowing you if you wish not to reveal it to a future partner.

In conclusion, the aim of these two surgical techniques is to bring an improvement and not to reach a spectacular volume and length.

Most often a properly prepared and performed penis enlargement or elongation gives a good result according to what the patient expect. But, as every surgical procedure of cosmetic surgery, imperfections can be seen without constituting real complications. These imperfections may be due to a misunderstanding of what can reasonably be expected.

• The imperfections of penis enlargement:

Localized imperfections such as asymmetry, irregularities or subcutaneous nodules are not severe. They can be treated by injections of local corticosteroids from the sixth month after surgery.

As with any fat tissue graft, additional surgery can be performed after the sixth month to complete the result, or in the case of a more important enlargement.

• The imperfections of penis lengthening:

They may occur due to unexpected tissue reactions or unusual cicatricial process.

The scar is sometimes visible and distended. It is most often hidden in pubic hair. If a scar fades over time, it never completely disappears. It should be remembered that if the surgeon does the sutures, the scaring process depends on the patient’s body.

Thus these scars are subject to the vagaries of any healing with the risk of a hypertrophic evolution which may require a specific treatment.

Most of the time, the follow-ups of the surgical procedure are simple.

However, complications may arise, some of them general, as for any surgical operation, other localized in specific regions. These complications, even if they are rare, must be explained.

The complications of the penis enlargement:

• Hematoma: exceptional.

• Infection: it must be prevented by a rigorous hygiene before and after the surgical procedure.

• Difficulty to pull the foreskin: in case of persistent edema and if the foreskin is narrow. A local surgery can be performed after 3 months.

• Hypercorrection: due to an excessive fat reinjection, giving an unsightly appearance to the penis. Some additional injections of corticosteroids will help to reach the desired result.

The complications of the penis lengthening:

• Hematoma and infection: may occur as in the case of an enlargement. The infection will be prevented by a rigorous hygiene before and after surgery and by a medical prescription of antibiotics.

• Cicatricial: it may be due to untimely postoperative erections or diabetes. It will delay the healing process but will simply be treated by nursing care for a few weeks;

• Cutaneous necrosis: rarely observed.

• Hypertrophic or even keloid scar: the scar can be hypertrophic in the first postoperative year. It will be masked by the growth of the pubic hair.

It should be noted that as with the increase in the penis diameter, one should not fear erectile dysfunction or altered sensitivity, it usually reappears within 2 to 3 months after surgery.

Cosmetic penile surgery, penoplasty, or phalloplasty is a cosmetic surgical procedure that gives great satisfaction to the patient.

Dr. Jean-Charles BAYOL performs male intimate surgery at Laclinic in Montreux where the whole medical team will listen to you and take care of you to make this procedure a real success.