The penis is made up of many structures: the urethra, the corpora cavernosa containing the erectile tissue, arteries, veins, nerves, lymphatic vessels. It is practically impossible to lengthen all these elements. There are mechanisms to traction the penis continuously for long periods of time, being able to achieve some degree of lengthening, depending mainly on the laxity of the anatomical structures, which happens at early ages. The surgery known as phalloplasty has a greater probability of success. It consists of sectioning the ligament that holds the part of the penis that is inside the body to the pubic bone (suspensory ligament of the penis). This is achieved by advancing the penis and the distance achieved depends on the extent of the ligament. This surgery can be performed through an incision at the root of the penis, however, considering aesthetic factors, we prefer to perform the surgery through an incision that is the same as the one used in phimosis surgery.
Regarding penile thickening, there are surgeons who use the patient’s own fat, however, this methodology may require repeated procedures, given the absorption of the fat and may result in irregularities that do not favor the aesthetics of the penis. We use a uniform material that allows dermal regeneration by integrating with the surrounding tissues.
Occasionally, other procedures may be indicated to improve penile aesthetics. Among them, it is worth mentioning scrotoplasty, which consists in reducing the scrotal skin when there is flaccidity and excess of it, and liposuction of pubic fat in those cases in which the penis is buried in it.
The surgery to be performed depends on the genital anatomical characteristics and the patient’s desire and expectations, based on objective and realistic information.
The phalloplasty of enlargement and / or thickening is a procedure that is performed under general anesthesia or spinal anesthesia and lasts 1 to 2 hours. It can be performed on an overnight or day hospital basis. It is generally well tolerated, requires 1 to 2 days of rest and sexual activity can be resumed in approximately 30 days. With a well-performed technique in a patient who follows the doctor’s instructions well and undergoes appropriate follow-up, complications are not usually significant. The most frequent are limited to a hematoma that is reabsorbed in a short time. Infections or intolerance to the graft are exceptional.
The main indications for phalloplasty are micropenis, i.e. penis measuring less than 7 cm, and dysmorphophobia, defined as non-conformity with the size of the penis, even though it is within the values considered normal. In today’s world where aesthetic factors are overly valued, there are men who, despite not receiving any complaints from their partners, become obsessed with penis size. Many report that their biggest concern is showing off their penis in places like the gym or the beach. They wish to improve the aesthetics of the penis in flaccidity, given that, even penises at the lower limit of normality, present a size in erection that does not constitute any problem for sexual activity. In most cases, it is very difficult to get this type of concern out of the patient’s head, and sometimes psychologists or psychiatrists are the ones who advise the patient to undergo surgery.
For the above reasons, the demand for cosmetic surgery of the genitalia has greatly increased in recent years.