TOPIC: Dermal fat graft and ligamentolysis

I had dermal fat graft inserted and underwent Ligamentolysis 6 weeks ago in Bangkok, and unfortunately I did not know about this forum pre-surgery. I also had a scrotal lift done at the same time, in addition to a procedure called selective dorsal neurectomy, which is well-known in the field of penile surgery in South Korea to increase the time to ejaculation.

I had not even researched penile lengthening and Girth enlargement thoroughly before, because I thought it would just scare me, so I did not know about the various options. I wanted to believe that it was safe and low-risk, and hope for the best surgical outcome.

After reading like every post on this forum and PhalloBoards 2.0 related to dermal fat gtaft and Ligamentolysis, I became quite worried about complications. There were some members of this forum who had their dermal fat grafts die eventually.

I will first summarize my impressions from what I read on this forum, and from different clinics and the studies I read, and then my own experience so far (6 week post-op):

Some of those forum members combined dermal fat graft with Ligamentolysis. Ligamentolysis is commonly offered by clinics offering penile surgery in both the USA, Europe and Asia, but after reading a lot I think the procedure either did not do much or it had some undesirable side effect, hence the satisfaction rate is not high.

It seems however that the frequently-mentioned complication of losing penile support, upward pointing Erection angle and having post-surgical penis retraction is greatly exaggerated, but many people seem to report a slight change in Erection angle. I guess the surgical techniques might have been refined compared to when the first studies were made, but it still seems that satisfaction rate is not high.

As for dermal fat graft, many studies I found did not say it was generally bad, and the website of Dr. Gary Alter that I came across through this forum seems to sum up the general consensus pretty well: "The dermal fat graft procedure works very well most of the time and tends to stay permanently. However, some significant problems can occur, such as curvature and shortening"

The penile curvature and shortening seems to be consistent with what forum members here wrote when their dermal fat grafts started to die. They had their dermal fat graft removed eventually. Another possible complication I read about is that right after surgery the dermal fat graft might be rejected by the body, causing an infection and immediate need to remove it, but this seems very rare.

And a brief note on scrotal lift and selective dorsal neurectomy: scrotal lift seems quite safe, but it seems the recovery time can be greatly understated by surgeobs. As for selective dorsal neurectomy, it does seem rather scary when one reads about it, but supposedly the rate of complications is extremely low. The largest Korean study mentioned 0.4% reported erectile dysfunction. Many other studies come from China and report good results.

To summarize my impressions: in retrospect I might have considered fat transfer. Any kind of grafts whether Dermal Grafts or alloderm seem like they might need to be removed eventually. I know there is a general consensus on this forum that fillers are best, but I feel reluctant about that too, based on what I summarized from many different sources. Fat transfer might be absorbed very quickly, but it seems the safest option for short-term Girth enhancement.

As I mentioned, Ligamentolysis seems to have a low satisfaction. Selective dorsal neurectomy seems too invasive an option, with some risk that the nerves might be damaged. If someone wants to increase their time to ejaculation, there is dapoxetine available, which is considered to work very well as a pharmaceutical option.

And now for my personal experience 6 weeks post-op: after the initial swelling went down on the third week, I tried to use a penile extender to do stretching on the third week, but the penis was still too swollen. On the fifth week I tried again, and it was still too swollen. Some clinics wrote that after combining grafts with ligamenyolysis, it is a good time to start stretching on the sixth week.

Some people who underwent the procedure seem to have started stretching on the eight week. I plan to give stretching another try in the coming days, but I am not very optimistic that it will be possible at this time. Because I am not Circumcised, it is also an issue at the moment to pull down the Foreskin.

Contrary to what many people wrote after having underwent the same procedures, it seems my scars will heal completely, except on the buttocks where the dermal fat graft was taken. It is important to emphasize that the scar on the buttocks is likely to be very big, and it seems very unlikely to disappear.

At the moment I have some worries:

Penile retraction ( caused by inability to use penile extender and waiting a long time to do so)
Loss of penile support (Ligamentolysis)
Loss of upward pointing Erection angle (llgamentolysis)
Dermal fat graft dying
Inability to pull back Foreskin
Continued penile swelling and pain
Possible nerve damage ((selective dorsal neurectomy)

My hope by posting here is that some people who underwent combined Ligamentolysis and dermal fat graft might share their experiences, and hopefully it might calm my worries. If not, at least I can share my experiences in case someone has been considering the same surgeries.

It has been one week since my post, and unfortunately I cannot slide back the Foreskin yet. It has me a bit worried. The swelling of the penis seems mostly gone, especially when it comes to the initial post-surgical Girth gains. Fortunately, I would say that about 30% in Girth gain remains, and I guess 7 weeks post-surgery it might stay this way.

For some reason I just cannot slide down the Foreskin. It is not tight in the glans or a lack of skin. At this point I can only believe what the surgeon say that the wound under the Foreskin needs to heal.

I have been tempted to try the penile traction device again, but I might wait one more week. I still feel like the penis is sore. Strangely, my penis does not seem to be retracting at all. but I have not gained any length either.

I would reach out to your Doctor regarding the use of stretching devices.

*Unfortunately I'm not familiar with your physician's background or credentials, and wish to reiterate that surgical procedures (as opposed to non-surgical injections) really ought to be performed by Surgeons with vetted backgrounds - obviously you found this forum after the fact and that is not your fault, I'm just reminding others of this important consideration.*

Do you mind if I ask where you reside? You mentioned getting work done in Thailand and South Korea, do you live in the region? I ask because if you are in the U.S., there are a few Doctors you could see to reverse any of the potential complications you might be experiencing, through revision/reconstruction (maybe). I'm not saying you will ultimately end up with complications, but from your two posts it appears there are concerns.

Stay in touch with your Doctor and if necessary get a second opinion - I'm sure you can get through this

I live in China, and then Thailand or South Korea are the natural choices where everyone in Asia go to do aesthetic procedures. There is a saying that if you are doing aesthetic surgery on the face, then South Korea is the place to go, but if you are doing something on your body then Thailand is the place to go. Both are quite well-known globally, both for medical tourism and aesthetic surgery. South Korea has more "marketing appeal", because of the k-pop craze and k-dramas, but I believe more ordinary people of all ages take the opportunity to do some aesthetic surgery when visiting Thailand on vacation. After all, Thailand is a much more popular tourism destination than South Korea.

I know Thailand used to have a dodgy reputation long ago when it came to Phalloplasty, but these days Thailand has a very well-developed medical tourism sector that rivals that of Singapore. Many rich Gulf states send their citizens to Thailand for medical care. If doing Phalloplasty, Thailand also has the advantage that Thailand is leading in number of gender reassignment surgeries, so there are many surgeons who are very experienced when it comes to male genitalia.

Ultimately I choose Thailand because there were many more options there, and unlike in South Korea, it was possible to have the surgery performed in an international hospital. If you want to stay at the hospital after the surgery for say a week, it is very cheap with nursing, compared to what one would pay in developed countries. I stayed at the hospital for 5 nights, and the surgeon came to visit me daily. Afterwards I saw the surgeon at his clinic two times a week for a month. I should add that I did some other aesthetic surgery too, namely liposuction, and that is why I felt much more comfortable with the idea of having it done in a hospital rather than a clinic.

I am not sure what experience the surgeon has when it comes to Phalloplasty, but I know he is regarded as a very experienced surgeon when it comes to gender reassignment surgery. I also heard that surgeons in Thailand have much experience with reconstructive surgery, because supposedly the number of penile decapitations is the highest in the world, due to girlfriends and wives discovering their husband cheating on them and meting out cruel punishment.

As for complications, I am not sure if I have any, other than the inability to pull back the Foreskin. This is however something that the surgeon mentioned even before the surgery, and he said that I must wait. On my last check-up he forcibly pulled back the Foreskin halfway to show me that it could be pulled back already. I tried to find out what other surgeons wrote, and I even emailed some to ask, but I cannot get a clear answer. It seems however that to be uncircumcised and have both Ligamentolysis and dermal fat grafts should not be a problem, but supposedly it will prolong the healing process, and uncircumcised or not it will also take longer before one can use a penile traction device.

Other than those two issues of not being able to pull back the Foreskin, and difficulty to use a penile traction device, the rest is just worries of possible complications I heard about but it is not something that I experienced myself. I still wonder how the angle of Erection will be affected and the possible loss of penile support? But based on what I read on this forum, it seems a highly exaggerated complication from long ago, and many surgeons seem to state it too. My surgeon said that I might experience the Erection pointing downward by a fifteen degree angle, and he said that riding a woman on top might be something to be avoided.

Screen2584 wrote: I live in China, and then Thailand or South Korea are the natural choices where everyone in Asia go to do aesthetic procedures. There is a saying that if you are doing aesthetic surgery on the face, then South Korea is the place to go, but if you are doing something on your body then Thailand is the place to go. Both are quite well-known globally, both for medical tourism and aesthetic surgery. South Korea has more "marketing appeal", because of the k-pop craze and k-dramas, but I believe more ordinary people of all ages take the opportunity to do some aesthetic surgery when visiting Thailand on vacation. After all, Thailand is a much more popular tourism destination than South Korea.

I know Thailand used to have a dodgy reputation long ago when it came to Phalloplasty, but these days Thailand has a very well-developed medical tourism sector that rivals that of Singapore. Many rich Gulf states send their citizens to Thailand for medical care. If doing Phalloplasty, Thailand also has the advantage that Thailand is leading in number of gender reassignment surgeries, so there are many surgeons who are very experienced when it comes to male genitalia.

Ultimately I choose Thailand because there were many more options there, and unlike in South Korea, it was possible to have the surgery performed in an international hospital. If you want to stay at the hospital after the surgery for say a week, it is very cheap with nursing, compared to what one would pay in developed countries. I stayed at the hospital for 5 nights, and the surgeon came to visit me daily. Afterwards I saw the surgeon at his clinic two times a week for a month. I should add that I did some other aesthetic surgery too, namely liposuction, and that is why I felt much more comfortable with the idea of having it done in a hospital rather than a clinic.

I am not sure what experience the surgeon has when it comes to Phalloplasty, but I know he is regarded as a very experienced surgeon when it comes to gender reassignment surgery. I also heard that surgeons in Thailand have much experience with reconstructive surgery, because supposedly the number of penile decapitations is the highest in the world, due to girlfriends and wives discovering their husband cheating on them and meting out cruel punishment.

As for complications, I am not sure if I have any, other than the inability to pull back the Foreskin. This is however something that the surgeon mentioned even before the surgery, and he said that I must wait. On my last check-up he forcibly pulled back the Foreskin halfway to show me that it could be pulled back already. I tried to find out what other surgeons wrote, and I even emailed some to ask, but I cannot get a clear answer. It seems however that to be uncircumcised and have both Ligamentolysis and dermal fat grafts should not be a problem, but supposedly it will prolong the healing process, and uncircumcised or not it will also take longer before one can use a penile traction device.

Other than those two issues of not being able to pull back the Foreskin, and difficulty to use a penile traction device, the rest is just worries of possible complications I heard about but it is not something that I experienced myself. I still wonder how the angle of Erection will be affected and the possible loss of penile support? But based on what I read on this forum, it seems a highly exaggerated complication from long ago, and many surgeons seem to state it too. My surgeon said that I might experience the Erection pointing downward by a fifteen degree angle, and he said that riding a woman on top might be something to be avoided.

Thanks for the additional insight. As for the Erection angle, if it's only 15 degrees I wouldn't be too worried in the grand scheme of things. It sounds to me your biggest issue is the Foreskin which I assume can be corrected in subsequent procedures.

Mind if I ask about the other concerns you had in your original post? You mentioned possible nerve damage, possible Necrosis of the fat graft, and continued pain & swelling -- are any of these persisting or have they resolved themselves now that you are 7-8 weeks-or-so out?

Lastly, you are absolutely right about Thailand being a popular medical tourism spot, and I have no doubt there are qualified and sed surgeons there. My concern wasn't the place you were getting the procedure done, but by who. In the United States there are plenty of Doctors who are willing to perform procedures on your penis, but only a couple handful are any good. Same is true anywhere else, and that was what I was trying to insinuate. It doesn't make much of a difference now since what is done is done, I was just pointing that out to others who may be reading this thread.

Heck, if it weren't for the language barrier, I would love to have South Korean and Thai Sponsors on the forum, I'm certain there are advancements there that we know little of in ways of Male Enhancement.

I might have been unclear before. Those concerns I mentioned in my original post were precisely that: they were only concerns; however, it was not something I had experienced myself. Necrosis is a possible complication soon after surgery, but I did read studies where this happened to a small number of participants, and it was successfully resolved. Another complication that is much more serious would be infection caused by rejection of the dermal fat graft.

As for the dermal fat grafts dying, this is something that a few members here reported happening to them, but it seems to have been brought on after 1-2 decades by an addiction to nicotine. Whether or not dermal fat grafts can survive indefinitely is not something I have been able to find information on. If I were to make a very uneducated guess, I think eventually they might simply reduce so much in size that they simply become unnoticeable, rather than needing to be surgically removed. However, the member on the forum that had them the longest mentioned having them for over two decades without reduction in size.

As for penile retraction due to delaying using penile traction devices, I have read many clinics write that it is almost impossible to happen with the new surgical techniques. Some clinics even write that it is not necessary to use a penile traction device, but in this case most people would have no length gains from the Ligamentolysis. At the same time however, the surgeons surely know that many people give up using penile traction devices, and then it is a comfort to know that the penis will not retract.

I bought the Phallosan Forte Plus, and I must say that it is not a simple device, but it seems to have more ways to use it compared to other penile traction devices. I believe it is a good idea to buy one a few weeks before having Ligamentolysis done, in order to get comfortable using the device, because there is obviously a learning curve.

There are many medical tourism agencies that help people organize their trips to Thailand and South Korea, and these agencies are usually run by Westerners in countries such as Australia. I think it might be a good option to cooperate with them, rather than cooperating directly with those clinics and hospitals in Thailand and South Korea. If someone wants to travel by themselves though, it might not necessarily be hard. I think there are not so much language barriers as there are cultural barriers.

Finally I want to add one thing about selective dorsal neurectomy, which is not directly related to Phalloplasty, but many clinics in Thailand and South Korea will offer it as part of a combination procedure: lengthening, widening and selective dorsal neurectomy. One clinic in South Korea even claims that a huge number of Westerners come to them, and most of them will choice this combination procedure.

In Asia many people do not like the idea of pharmaceutical treatment for most ailments, and it is why selective dorsal neurectomy has become so common, whereas in the USA and Europe it is thought that there should be no reason to recommend anything other than a pharmaceutical treatment. Dapoxetine has been shown to be very effective, after all. It is just that many Asians are very uncomfortable with the idea of pills in general.

As I understand it, selective dorsal neurectomy can be very minor, so even people who do not experience premature ejaculation choose to perform it to "last a little bit longer". My surgeon told me that he can do a minor one if I have little to no problem with premature ejaculation, but I would still like to increase the time to ejaculation, and I choose this minor one.

Because it is such a common procedure in South Korea, its safety has been studied very thoroughly, and supposedly it is a very safe procedure. The risk of complications albeit extremely rare include possible nerve damage and nerve pain. So to summarize this point: anyone traveling to Thailand or South Korea for Phalloplasty will likely see selective dorsal neurectomy offered as part of a "package deal".

I thought I would put up some pictures here. The dermal fat grafts have shrunk a lot, but I think it might be normal, and I am pretty sure that a 30% gain in Girth remains.

I tried to pull back the Foreskin,but it does not go far at all. Not far as in pretty much not one tiny bit. I could probably force it a bit, like the surgeon did, however it has been 3 weeks since my last checkup with him. I don't think it has become any easier at all to pull back the Foreskin since then.

I am not sure if my previous pictures got uploaded?

Anyway, I have another update: as it has been 8 weeks post-surgery now, and the Foreskin still does not pull down, I decided to visit a doctor. The general physician referred me to an Urologist who I will see tomorrow.

Based on what I have been told by several doctors, Circumcision might not be necessary. It is possible nothing at all has to be done and it will heal by itself. One alternative might be a more minor surgery than a Circumcision, where only a tiny bit of skin is removed, because according to what all the doctors have been saying my Foreskin should be able to be pulled down right now.

The only problem is the excess skin at the very tip of the penis. It is possible it is just inflamed. I will have to see what the Urologist says tomorrow.

Screen2584 wrote: I am not sure if my previous pictures got uploaded?

You should be able to see them now. Thanks for your reporting.

Now I am going to attach photos of the penis in Erect state, and here is where I would really appreciate some feedback, because there are two big lumps/bumps on the penis. I figure it might be normal, with the dermal fat graft being inside, and it might be the way it is supposed to look?

But at the same time, I do not really like the way it feels to the touch, and I think it looks slightly odd too. I think when dermal fat graft is inserted that fat transfer is done at the same time, and it is why the penis ends up so big right after the surgery. It will literally look like a huge eggplant.

Then in the coming week about 70% of the fat is supposed to dissipate. It makes me wonder, is it not possible for the fat to be unevenly distributed and for there to be lumps? But I did not read about this happening with fat transfer, only with some filler, and especially with silicone or paraffin oil where the outcome tends to be absolutely catastrophic.

Skeptical_One wrote:

Screen2584 wrote: I am not sure if my previous pictures got uploaded?

You should be able to see them now. Thanks for your reporting.

Yes, I can see it now, thank you!

PS. I hope the pictures attached properly this time too.

Worrying news today: I saw an Urologist today, and he said the inability to pull back the Foreskin pose a serious risk of infection. Even so, he suggested for me to wait to see if the psimosis (inability to pull back the Foreskin) will disappear by itself. At the same time, there is supposedly a serious risk of infection, so I do not feel at ease at all.

He also looked at the penis, and he said even though he has zero experience in Phalloplasty, it seemed he was quite concerned about the look and shape of the penis and suggested everything might not be well with the dermal fat graft.

Screen2584 wrote: Worrying news today: I saw an Urologist today, and he said the inability to pull back the Foreskin pose a serious risk of infection. Even so, he suggested for me to wait to see if the psimosis (inability to pull back the Foreskin) will disappear by itself. At the same time, there is supposedly a serious risk of infection, so I do not feel at ease at all.

He also looked at the penis, and he said even though he has zero experience in Phalloplasty, it seemed he was quite concerned about the look and shape of the penis and suggested everything might not be well with the dermal fat graft.

Without sufficient vascularization post-op, you may lose some of that graft. Also I'm not sure what resources are available in China (where you said you resided), but would a trip to the U.S. be too cost-prohibitive for you? The only reason I ask is that your situation probably ought to be looked at a Urologist with experience in Phalloplasty. The whole "inability to pull Foreskin back" is a complication I've never seen (and if I have, it's been so long and so rare that I simply don't remember). So this is new territory to be frank as far as complications go - getting expert opinions will ensure not only a resolution to your Foreskin, but allow you to retain as much newly acquired Girth as possible.

Look into seeing if Dr. Carney or Dr. Solomon are willing to do a Virtual Consultation, worth the cost given the nature of your situation.

If you believe you you are experiencing any infection due to the Foreskin, be sure to revisit that Urologist for the necessary treatment protocol. Good luck.

---

And a courtesy reminder to all readers that if you get procedures done abroad (i.e. medical tourism), be prepared to calculate unforeseen outcomes in advance.

Skeptical_One wrote:

Screen2584 wrote: Worrying news today: I saw an Urologist today, and he said the inability to pull back the Foreskin pose a serious risk of infection. Even so, he suggested for me to wait to see if the psimosis (inability to pull back the Foreskin) will disappear by itself. At the same time, there is supposedly a serious risk of infection, so I do not feel at ease at all.

He also looked at the penis, and he said even though he has zero experience in Phalloplasty, it seemed he was quite concerned about the look and shape of the penis and suggested everything might not be well with the dermal fat graft.

Without sufficient vascularization post-op, you may lose some of that graft. Also I'm not sure what resources are available in China (where you said you resided), but would a trip to the U.S. be too cost-prohibitive for you? The only reason I ask is that your situation probably ought to be looked at a Urologist with experience in Phalloplasty. The whole "inability to pull Foreskin back" is a complication I've never seen (and if I have, it's been so long and so rare that I simply don't remember). So this is new territory to be frank as far as complications go - getting expert opinions will ensure not only a resolution to your Foreskin, but allow you to retain as much newly acquired Girth as possible.

Look into seeing if Dr. Carney or Dr. Solomon are willing to do a Virtual Consultation, worth the cost given the nature of your situation.

If you believe you you are experiencing any infection due to the Foreskin, be sure to revisit that Urologist for the necessary treatment protocol. Good luck.

---

And a courtesy reminder to all readers that if you get procedures done abroad (i.e. medical tourism), be prepared to calculate unforeseen outcomes in advance.

Some positive news today: my friend abroad who is a general physician read up about the procedure, I sent him my own pictures, and he looked at pictures of other people who had dermal fat graft inserted. He says that he doubts there is any problem with the dermal fat graft. He claims the lumps is likely the suture and the graft.

Furthermore, the surgeon who did the surgery replied to me very briefly that everything is normal, based on the pictures I sent him. Personally, I am still concerned about the appearance and the lumps. I asked him to elaborate what the lumps are? And if the size and shape of the lumps are normal? I will attach some pictures in this post showing the penis in a different angle.

As for the Foreskin, as I understand it there is no infection now, only a risk of infection. No one seems surprised about the inability to pull back the Foreskin. My friend (the general physician) told me that it can happen after any surgery to the penis, especially in my case because the wound was very close to the tip of the penis, causing something called a stricture, resulting in a condition called psimosis (inability to pull back the Foreskin).

The Urologist, my friend and the surgeon say that I should wait, and that Circumcision is likely not needed, but that it is also much too early to consider it. I actually asked the surgeon before the surgery if it is not possible this could happen? And he said there is a slight chance, but he thought it so small that it is better to leave the Foreskin rather than perform a Circumcision as a preventive measure. Supposedly, adult Circumcision seldom has satisfying results.

I am scheduled for a fat transfer for Girth in November. I am not Circumcised. The doctor will remove fat and then transfer it to the penis. He also adds Renuva to the fat that he transfers. Does you penis feel soft (squishy) to touch? Do the veins show up more in the shaft post transfer? Did you do penile massage several times each day after the transfer? How much of the fat do you feel you have lost post transfer? Do you you have prior and post measurements of penis Girth? Sorry for all the questions but I am trying to absorb any and all the information I can gather. Thanks! Sam

samsmithms wrote: I am scheduled for a fat transfer for Girth in November. I am not Circumcised. The doctor will remove fat and then transfer it to the penis. He also adds Renuva to the fat that he transfers. Does you penis feel soft (squishy) to touch? Do the veins show up more in the shaft post transfer? Did you do penile massage several times each day after the transfer? How much of the fat do you feel you have lost post transfer? Do you you have prior and post measurements of penis Girth? Sorry for all the questions but I am trying to absorb any and all the information I can gather. Thanks! Sam

First off, you should know that dermal fat graft is very different from a fat transfer, but I believe that with the knowledge I have obtained I can still give you some advice. Generally, Circumcision is NOT necessary, but if you had past problems with Phimosis some doctors performing Phalloplasty will recommend it. I even saw some clinics that seem to insist on performing Circumcision as a preventive measure. Anyway, you should not be concerned at all about not being Circumcised, I believe.

Different clinics use different fillers, but I never saw any clinic that advertised combining different fillers. It would be interesting to read what more experienced members think about this? From what I read; I believe that is when complications usually occurred when people got many different kinds of fillers over a long period.

Because different fillers apparently have very different qualities, resulting in different outcomes, and possibly different complications that can arise. With some fillers, it seems that massaging the penis each day is mandatory even. Then with some other fillers, the need for massage is not even mentioned, but it says there is still a risk of fat moving and forming lumps. Again however, I believe this is least likely to happen with fat transfer, because the fat will be absorbed gradually.

Fat transfer seems to be the safest, but at the same time the results seem temporary, with much of the fat being absorbed. I read that 70% fat absorption is expected, and 30% fat can remain, but here is where the information I found is contradictory: some clinics claim it is permanent, but I read on way too many places that this is NOT the case, so personally I cannot believe the claim that the result would be permanent. I believe eventually all the injected fat will be absorbed.

It sounds like an interesting approach then to combine fat transfer with some filler. As for what filler is best, it is very hard to say. In the USA, Europe and Korea they all seem to use different fillers. I cannot even say what is the safest, and I doubt anyone can say for sure, because different doctors in different regions use different fillers and they will surely all say that their choice is either the safest and/or has the best results.