"Do you know if it will be a horizontal cut or a VY log cut? I been thinking about lig cut for quite some time now but I can’t make up my mind because I am kind of worried about the angle drop. I searched online to see if there will be any before and after pics but can’t find none. Also do you know how much are they charging? If it is appropriate to ask such question here in the forum. I would greatly appreciate your response. Thank you."
I’m going to provide a very lengthy response to your question in order to help you and others make the best possible decision for yourself in this regard.
Let’s start with the ligaments themselves. Every guy has a different number, size, tautness and exact location of their suspensory ligaments. They were designed into men during a time of evolution when sex between human beings was often a very violent process. Keep in mind: we might like using our sexual organs for fun, but their sole purpose physiologically is the procreation of our species. Many, many, many years ago we needed a lot of structural support at the base of the penis in order to consummate sex. If we had sex like that nowadays we would probably be charged with a crime.
What you “see” of your penis is where the organ becomes visible from underneath the pelvic bone. Your penis organ actually starts near the anus. The suspensory ligaments are connected to the base of the penis from the pelvic bone.
There are actually four aspects to optimal penile lengthening. One, is the cutting of the ligaments at the base of the penis. The second is the release of the deep ligament. The third is repositioning as much of the penis organ that’s situated on the inside to an outward location as is safely possible. And finally, there’s stretching.
It might be helpful to envision the suspensory ligaments at the base of the penis like the base roots you see around a tree in your front yard and the deep ligament as the tap root of that same tree.
I bring this up because we see lots of patients who had a previous ligament release performed and complained they actually “lost” length. How could that happen? It happens because of patients seeking a minimized scar in achieving penile length.
If we only cut the top suspensory ligaments (like the roots around the base of our imaginary tree) – the deep ligament (the tap root) will still hinder the penis from successful stretching. We found this most common for patients who had a ligament release performed through the scrotum to make it a “scar-less” procedure. Patients who had such procedures and are almost always unhappy with their length outcome are sometimes informed it’s likely “the ligament reattached”. However, we’ve discovered that wasn’t the case when we performed a subsequent lengthening surgery. The reason was rooted in the fact the deep ligament held fast and internal scar tissue underneath the skin from the procedure triggered new tautness and a reduction of penile length.
While a VY-plasty is suitable for some patients, we found that we get the most optimal lengthening results via a 2-3-inch singular incision running straight up from the base of the penis at the pelvic bone. This opening allows optimal access the suspensory ligaments, the deep ligament and repositioning of the penis, as able.
It’s important to understand that the penis doesn’t just “jump forward” following a release of the ligaments – they’re not that tight on 99% of patients. That’s why the penile repositioning is so important for most patients – along with the fact it inhibits the likelihood of ligament reattachment. It leaves a scar akin to a hernia operation which is what most single male patients use to describe where they got it in the future.
The degree of work with stretching on the part of the patient following surgery is often under-amplified by some doctors but a crucial aspect of increased penile length. It starts 2-3 weeks after your procedure with a traction device that causes mild tension on the organ while it’s still healing from surgery. At this juncture, we want to inhibit any post-surgical retraction of the penis and loss of any of the hard-earned gains you enjoyed post-surgical. Tissue will naturally retract following any procedure and you want to make sure your penis doesn’t get involved in that process through mild traction. A couple of months later after things are completely healed, you’ll want to evolve to using weights to stretch the penis organ. Results from stretching are no longer inhibited by the strong ligaments you had cut for length. This program will trigger the cells to slightly tear and grow back larger over time – in a process similar to building muscle mass to your biceps. Alas, it’s time consuming. You need to stretch for two hours daily for six months after the procedure to achieve best results.
The fear of a significant change in erect angle while standing up is most often promulgated by doctors who don’t perform penile lengthening procedures. The angle changes 5-20 degree’s depending upon your present angle when standing up straight. It drops more on a percentage basis if your engorgement points near straight upward and less if you’re presently situated me straight ahead. Most men are prone on a bed when erect and never notice that difference.
A bigger consideration for some if the subsequent “looseness” at the base of the shaft following a ligament release. While most sexual positions are still fine in this state, the force of a partner coming down at an angle as with “cowgirl and reverse cowgirl” are challenging without putting your fingers at the base of the penis to add support. Thus, if “rodeo” sex is your favorite pastime, you need to think long and hard before considering a penile lengthening procedure.
Thus, in summary:
You must have a ligament release in order to achieve real and lasting increase in penile length.
Only cutting the top ligaments to reduce scaring reduces the likelihood your lengthening will succeed. You need the deep ligament cut as well.
The post-surgical erect angle isn’t usually a big deal. The subsequent “looseness” at the base of the penis during rigorous sex is a more important consideration for some patients.
Stretching is required to achieve optimal results. If you’re not able or willing to invest the time in post-surgical stretching, it’s probably not worth your time and money to invest in a lengthening procedure.
We presently charge $9,800 for our optimal lengthening procedure that includes release of top and deep ligaments plus penile repositioning, anesthesia and supporting stretching devices.
Know that’s a lot of information but I hope it helps you make the best decision for your particular case.
PhalloBoards member "Chester" asks:
"Hi Doctor, before I ask my question, I'm happy to report that the procedure has been a huge success. Thank you for your great work! My question has to do with the impact a filler in your penis has on blood pressure. There is only so much size and mass in the penis, and if you're adding filler volume, one stands to reason that there will be added pressure on the veins in the penis. I'm curious about your thoughts regarding long-term impact this has on blood pressure. I ask because, as we age, blood pressure tends to go up, and I think this topic is important yet rarely addressed. Personally I'm in my forties and there's a history of hypertension in my family, along with being pre-hypertensive."
I’m happy to hear you’re pleased with your outcome Chester.
When girth is added to the penis via any sort of injectable or FFT, that enhancement occurs by adding the bulking agent into to the subcutaneous tissue “surrounding” the vascularized penile organ. The incredibly small capillaries located within the subcutaneous tissue are not affected by total body blood pressure – they are simply too minuscule and remote to be impacted. If you added additional girth augmentation later, our limitation is the degree of stretch within that subcutaneous tissue – not the penis organ. Human tissue is very stretchable with time. You just can’t force stretch it without risks.
Your erection process to attain a full engorgement is an automated sealing process within the organ. If you provided increased blood force it won’t change the amount of blood provided to the penis as it locks itself closed once a full dose of blood is in place for optimal penetration size. Alas, high blood pressure tends to cause an opposite effect on men and their erections as veins in the body can and will harden from high blood pressure, resulting in erectile dysfunction symptoms from insufficient arterial blood flow. Remember, your penis is located on the very edge of your body. That means it gets lower priority of blood flow when resources are limited – as with patients exhibiting cold hands and feet.
Finally, some blood pressure medicines are notorious for triggering significant ED issues as they medicate the same sort of situation I just described. The hypertension drug we recommend patients not use for their blood pressure condition relative to penile performance is Propranolol. We’ve discovered it not only causes ED but also triggers penile fibrosis: the building block of Peyronie’s disease.
Information Provided By Dr. Carney. To learn more or schedule an appointment: https://www.phalloboards.info/directory/75-dr--carney.html
Dr. Solomon, do you believe attitudes toward male elective medicine (namely penis enlargement) will ever become as socially accepted or mainstream as the common "nose" or "breast" job? If so, how long do you predict this shift in attitude will take? If not, what are some reasons potentially holding it back from normalization (e.g. stigmas)?
I think that attitudes are definitely changing. I recently was asked to publish a paper in the journal Plastic and Reconstructive Surgery on this topic. In addition, I presented at our annual meeting and, as a reviewer for the Journal, I am seeing articles presented for publication almost monthly on the topic of penis enlargement surgery. Awareness of the topic is increasing, so it is likely that it will become more acceptable with time.
Dr. Solomon, concerning costs (*3 Part Question):
how can I go about acquiring the costs for any given procedure?
My office gives a range of costs to patients who inquire on the phone. We do not provide costs by email. However, the only way to get an actual cost for surgery is after an evaluation by me. This is due to the fact that procedures are individualized for each patient. In many cases, patients ask about one procedure, but after an exam, they need something different, which may be less expensive than their original request. For example, men often inquire about getting both length and girth, but after an exam, they may only benefit from one of those procedures, so the cost is less.
are there any procedures my insurance will accept?
There are several parts to this answer. First, medical insurance covers procedures that are defined as "medically necessary." Procedures for penis enlargement are cosmetic in nature (like breast enlargement). Cosmetic surgery is not generally covered by insurance. Your individual policy may have some exception to that rule, but only you can determine that by asking your insurance company or reading your insurance policy. Surgery for revision after failed cosmetic surgery is also not generally covered by insurance. Most insurance plans will not cover cosmetic surgery or complications from cosmetic surgery. Again, the best way to determine your coverage is to review your policy or call your carrier. Even if you have coverage, you will need to find a surgeon who participates with your insurance carrier. Otherwise, the surgeon is considered "out of network", which means you will be responsible for the costs of surgery and you can ask your insurance to reimburse you according to your plan. Most times, they will reimburse only a portion of the costs in that situation.
is financing available? This was mentioned on your website, but I'd like to know more.
My practice works with several outside entities that provide financing for surgery. You need to apply to them directly to determine if you qualify. The two that we work with most often are CareCredit and United Medical Credit. They each have their own rules about financing and they make their decisions independent of my medical decisions.
Dr. Solomon, the Moderation Team would like to know if your Clinic has any exciting new plans, procedures, devices, locations, publications, and/or promotions for the new year (2021) & beyond?
I publish articles on penis surgery in the plastic surgery literature from time to time. These are designed for a medical audience and are not usually available to nonmedical people. You can access them by going to PubMed. I am always evaluating new methods for surgery, but will only discuss them once I have implemented them and have follow up data.
Information Provided by Dr. Solomon. If you have questions or would like to schedule an appointment:https://www.phalloboards.info/directory/77-mark-p-solomon-md.html
Do you believe there is any validity to the claim that penis enlargement devices (example: pumps, hangers, etc.) and penis enlargement exercises (example: jelqing, stretching, etc.) can increase the size of the penis?
There is no objective evidence that these methods do very much good. I am aware that they are very popular and that men would like to avoid surgery, but these devices do not have a great track record for most men. One exception is the use of a stretching device for penile curvatures. This does sometimes work and is worth a try, especially for mild curvatures that are not associated with a thick Peyronnie's plaque.
Do you believe there is any validity to the claim that supplements (example: male enhancement pills, topical creams, etc.) can work in increasing the size of the penis? If they are indeed scams, how have they been able to remain prevalent?
Supplements provide no long term benefit. Yohimbine, which is one type of supplement, can provide some short term benefit, but does not create a permanent change. Of greater importance regarding supplements is that they are not regulated by any agency in the US. Therefore, the makers of supplements can make any claims they want with little or no downside. An interesting study performed at the Children's Hospital of Philadelphia examined the content of supplements and found that many of them had little or none of the product claimed to be present. This included some vitamin supplements. I actively encourage my patients to stop taking supplements before surgery since they can create problems such as bleeding after surgery.
(8c) Do you see any benefit in employing the use of growth factors (like Platelet Rich Plasma treatment) to achieve size? Also, do you believe there is any merit to the idea of PRP-therapies improving the result of a penis enlargement procedure?
This is a hotly debated topic. Like the other topics in this thread, there is little evidence to support the use of PRP. I am aware of anecdotal evidence for PRP, especially with hair restoration. As for its use in penis enlargement, there is, at present, no evidence that supports its use.
Information Provided by Dr. Solomon. To learn more or request a consultation:https://www.phalloboards.info/directory/77-mark-p-solomon-md.html
Dr. Solomon, Forum Member "Chrisresearch" asks: "Hi Dr. Solomon, I have been reading your posts and researching revision. Regarding PMMA removal, can it be done if there is not much PMMA?"
PMMA causes an inflammatory reaction as it integrates with your tissues. Often, the amount of PMMA is relatively small compared with the reaction that it creates. If these areas can be readily identified on physical examination, then its removal is fairly straightforward, regardless of the amount of PMMA injected.
Dr. Solomon, The Moderation Team would also like to add the last question: How do you gauge whether removal or revision of a penis filler is "safe" or "advisable." How does this assessment apply to all the cosmetic filler varieties (from PMMA to hyaluronic acid (HA) to silicone oil)?
All surgical procedures have risks. The question of safety relates to several issues. First, does the benefit of the procedure outweigh the risk? If, by removing the foreign material, a more normal contour can be restored with minimal risk to the patient, then the benefit outweighs the risk. This issue is of more concern in patients with pain in their penis or migration or erosion of the material through the skin. Second, it is important that patients understand the risks of the procedure. Injection of materials in the penis varies widely. I have seen patients with injections that are placed deep in the penis as well as superficial. Removal of these injections includes not only the material, but the body’s reaction to the material. For things like hyaluronic acid, this reaction is often minimal. For silicone, the reaction can be large, as it can for PMMA. This is due to the properties of these various materials. So the surgeon must account for the location of the injection, the reaction it has caused and the initial material injected. With all injections, there is an issue of loss of blood flow to the skin superficial to the injection. The skin of the penis is thin and its blood supply is often adversely affected by these various injections (and other procedures). Therefore, removal of material is not only about the material and the reaction, but attempting to preserve blood flow to the overlying skin to avoid loss of skin that could require additional surgery to repair the loss.
Dr. Solomon, you have two locations, one on the East Coast (Philadelphia, PA) and the other on the West Coast (Los Angeles, CA). Do you have a set schedule between the Clinics or is one a primary location with the other being on an as-needed-by-appointment basis?
Typically, I spend 25% of my time in Los Angeles and 75% in Philadelphia. With the onset of the Covid-19 pandemic, I have limited my travel to Los Angeles. This is because the disease is fairly well controlled in Philadelphia. Were I to go to Los Angeles at the present time, I would need to be quarantined for 14 days upon my return, which is disruptive to my schedule in Philadelphia. Therefore, until that restriction is lifted, I will need to limit my time to Philadelphia only. I do have a waiting list for surgery for patients in Los Angeles, so when I return, I will be operating and seeing patients in consultation. Until that time, I have been using telemedicine to provide secure, encrypted video meetings with patients who cannot travel to Philadelphia. These appointments are arranged by calling my office.
Information Provided By Dr. Solomon. To learn more or request an appointment:https://www.phalloboards.info/directory/77-mark-p-solomon-md.html