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TOPIC: Dr. Solomon's Monthly Educational Q&A

Dr. Solomon's Monthly Educational Q&A 1 month 4 days ago #1308697479

The Moderators here at PhalloBoards will submit questions to Dr. Solomon to get his expertise & insight on phalloplasty and related subjects. Questions will be gathered from across the forum. Future submissions will be posted to this topic. This is a "read-only" posting which means it is not open for discussion. If you wish to contribute a question for Dr. Solomon in a future Q&A submission, please email it to This email address is being protected from spambots. You need JavaScript enabled to view it..
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(1a) Dear Dr. Solomon, I have been asked on occasion about surgical or non-surgical options for men with micro-penis. Do you (or have you) ever performed surgery on patients with a micro-penis? What's your opinion on the condition, and what are some advice you can give to men with micro-penis?

I have performed surgery on men with true micropenis. The nature of the procedure is quite customized since there are often several components to the problem. The goal for these men is improvement. It is often impossible to get a true micropenis to be more than a modest penis, but for these men, that is often enough.


(1b) Dear Dr. Solomon, Forum Moderator Hoddle10 asks: "What do you consider the ideal patient? What makes someone a good candidate for penis enlargement surgery? Are there instances you'd consider turning away a patient?"

Let me answer the last question first. I turn away almost one third of the men who seek my opinion. Most often, these are men who are either very unrealistic in their goals, or they have a very normal to large penis and I do not think the benefit of surgery outweighs the risks involved. The ideal candidate is a healthy male who wants to make his penis larger in one or more dimensions and has no issues with erectile dysfunction. The reality is that I see men of all types with variation in their health, so I do make exceptions for different medical conditions. I do not do girth procedures on smokers. I have found that smokers in particular have a high complication rate from girth procedures, so I will no longer treat them. The corollary of that is that men who have complications of fillers and are smokers are also at high risk of complications. I ask them to stop smoking for 3 weeks prior to surgery and 3 months after surgery. I have had men who start smoking after surgery and inevitably they need more surgery to get them healed.



Mark P. Solomon, MD FACS

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Last edit: by PhalloBoardsSystemAccount.

Dr. Solomon's Monthly Educational Q&A 3 weeks 6 days ago #1308697525

(2a) Dr. Solomon, what are the advantages of using Surgimend over other dermal matrices (like Alloderm & Belladerm)? Are there varying options for thickness? Could I add more sheets of Surgimend in the future for more girth?

This is an excellent question. Alloderm and Belladerm (among others) come from human sources. In particular, Alloderm is a donation from someone who has died while Belladerm often comes from remnants of abdominoplasty (tummy tuck) tissue that is removed at surgery. Human dermis is then prepared from these materials. Human dermis varies in thickness depending upon what part of the body it is from and the age of the donor. Human dermis gets thinner with age. As a rule, the thickest human dermis is not more than 2 mm and on average about 1.5 mm. Surgimend comes from fetal calf tissue. This has several advantages. It has never been exposed to bacteria, so it is sterile. Calf dermis is thicker than human dermis. This tissue is cut by machine. So its thickness is uniform and because calf dermis is thicker than human dermis, it is available in thicknesses from 1 to 4 mm.

My average Surgimend graft is 3 mm thick. This seems to be the "sweet spot" between giving a good result while allowing it to revascularize in a reasonable amount of time. I have used 4 mm grafts in some patients, as well as 2 mm grafts in some.

You can have a second wrap, but recovery is long and in several cases, the penis has been almost too thick for comfortable intercourse. I warn patients about these issues before performing additional girth enhancement.



(2b)Dr. Solomon, do you offer any solutions for glans enlargement? If yes, could you describe how you go about safely augmenting the glans? If you don't offer any procedures for the glans, is it due to the anatomical risks associated with the glans, or simply a matter of preference?

I have tried many methods for glans enlargement. None of them provides a permanent solution, so I do not offer this to my patients. I am aware that some physicians use injections, mostly hyaluronic acid. This generally goes away, but has, on occasion has left some nodules that I have had to remove surgically. I have also tried fat grafting the glans and using dermal graft material. None of these methods provided a natural, long lasting glans enlargement, so I do not perform this procedure any longer.



Mark P. Solomon, MD FACS

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Last edit: by PhalloBoardsSystemAccount.

Dr. Solomon's Monthly Educational Q&A 4 days 21 hours ago #1308697704

(3a) Dr. Solomon, do you perform lengthening surgery (ligamentolysis)? If so, what can patients expect to gain on average? Are gains limited to flaccid length or will I see improvements in both flaccid and erect lengths? Also, will there be a change in the angle of my erection post-op?

Penis length surgery, sometimes called ligamentolysis is one of the most common procedures that I perform. It has a high degree of patient satisfaction and the questions here are good ones. I tell patients that the average increase in flaccid length is 1 inch (2.5 cm). The most I have ever seen is 2 inches (5cm). This is related to the amount of penis that is beneath the ligament. The increase in length that occurs is always in the flaccid state. Some men tell me that they are longer when erect, but there is no way to know in advance if there will be a gain in erect length. Moreover, I do not measure patients in the erect length, so I have no data to answer this question in any greater detail. To my knowledge, there is no large study that discusses this. There are some reports of about an average of one-half inch (1 cm) increase when erect after surgery. Many men think the angle of their erection will change after surgery, but I have not seen this in my patients. I do several things in the surgery itself to restore the angle. I also have my patients wear a weighted condom for 6 hours each day for 6 months after surgery to help prevent scar tissue from pulling the penis back.


3b) Dr. Solomon, do you provide surgery to those who suffer from excessive scrotal webbing, sometimes called "turkey neck?" If so, can you detail some important things to expect like recovery time, whether it's an outpatient procedure, common techniques that are used, etc?

Scrotal webbing is an issue for many men. It can interfere with intercourse and be a source of irritation during exercise. There are several methods of correcting the web. The oldest method is known as z-plasty. Other methods include a U shaped skin excision and a V shaped skin excision. The decision about which pattern to use is based upon the extent of the problem, which varies with each patient. The surgery itself is not associated with much postoperative discomfort, but there is a large a mount of swelling. This takes the better part of a month to resolve and in that time men are restricted in terms of physical activity and sexual activity. Surgery is performed as an outpatient. Some patients require a drain to be used while others do not. This is a decision that I make at the time of surgery. The scars from these procedures are well hidden due to the nature of the skin of the scrotum. I use dissolving sutures that do not need to be removed.



Mark P. Solomon, MD FACS

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