TOPIC: Dr. Liu Q&A's

This topic will serve to publish periodic Q&A's from Moderators and Forum Members alike on all matters related to Dr. Victor Liu's Plastic Surgery Practice. He will share details about his services as well as his opinions & insights on all matters Male Enhancement.


(Q1.) Can you share with me what you provide in the way of testicular enhancement?
When one or both testicles are missing resulting from trauma, surgery or congenital, the appearance can be improved by putting in a testicular implant which can be done under local anesthesia with practically no downtime. In cases of testicles sitting "too high" it can can corrected by scrotal enhancement. The testicle is attached to the bottom of the scrotum by the cremasteric muscle. By enlarging and stiffening of the scrotal wall the testicle is pulled downwards back into the scrotal cavity thus giving the scrotum a more normal and pleasing appearance.


(Q2.) Could you describe your lengthening procedure?
The upper part of the base of the penis is attached to the under surface of the pubic bone by the suspensory ligaments. Up to 1/3 of the penis shaft is behind the bone and cannot be seen nor is it "functional" There are two suspensory ligaments, the superficial and the deep ones. The superficial one (fundiform ligament) is a continuation of a layer of the abdominal wall called the scarpa's fascia. The deep one is the commonly called suspensory ligament of the penis. By dividing these ligaments the penis can be pushed forward and therefore the functional part of the penis becomes longer. The amount of elongation depends on several factors: 1. How much of the penis is behind the bone; 2.The width and slope of the bone (pubic symphysis); 3.The soft tissues around the area (are they tight or loose, stiff or flexible are some of the factors) Each individual is unique and and the amount of lengthening is different for each person.


(Q3.) What type of fillers do you use?
Both temporary and permanent fillers, including Juvederm, Restylane, Voluma, Radiesse, and Bellafill.


(Q4.) Do you offer financing?
We do not but can use Credit Care.

(Q5.) If I had other treatments for penile enlargement (fat injections, Penuma, Surgimend, etc.) and am not happy with it, can I have still get filler injections?
Generally, filler injection after a person had surgical insertion of Penuma or Surgimend for penis augmentation is safe and do-able. However, it is not advisable to do surgical insertion after the person had filler injection because of the adhesions resulting from the surgery making it very difficult and even unsafe to perform. One of the problem with Penuma is that it is firm and sometimes it is palpable on the skin surface and does not look natural. One way to treat this would be with filler injection.
Some patients had fat injection for Girth enlargement and complain that the penis feels too soft and look uneven. This is a common problem with fat injection because some of the fat may be absorbed unevenly and of-course fat feels soft. This can be improved by injecting filler intradermally (inside the skin) to give a "shell" and also inject sub-dermally (underneath the skin) to even out.
It is best to see and be examined by the treating surgeon before a final decision on what is best for you.


(Q6.) I had penile implant done and my penis seems to be generally shrunken especially the head of the penis, can that be corrected?
When a penile implant is put in perfectly, it looks, feels and functions very well and most patients are very happy with the results. However, for one reason or another, sometimes they do not fit well and there will be irregularities to the touch, unwanted prominences or other problems. Even when they were put in with a perfect fit, problems do arise with the passing of time. The reason for this is because whereas the implants generally do not change, the penis itself does. The head of the penis may regress and become smaller which may result in the tip of the implant becoming prominent . When having sex the partner may complain of a poking sensation and occasionally even pain. The implant may be palpable along the shaft of the penis. All these could be improved by filler injections. At the same time, the penis shaft and the head can be enlarged as well.

(Q6.) Can I have the ligament detachment and Surgimend insertion done at the same time?
Yes, this can be done and is frequently done together, saving the patient a lot of time. The anesthesia and surgical incision at the base of the penis can be used for both procedures, and the recovery period for both procedures simultaneously is the same as doing the procedures separately. For instance, following a procedure, the patient should abstain from sex for at least 35 days. Therefore, if the two procedures are done at the same time, abstinence from sex is 35 days, but if done separately, the patient will undergo two 35-day recovery periods.


(Q7.) I am 60 years old and am having some issues with Erection, can I have ED treatment and penis enlargement done at the same time?
Erectile dysfunction, when it exists, can be treated at the same time as penile enlargement. Usually, this is done with shock wave treatment followed by injection with PRP or bone marrow aspirate and then the injection for the filler can be done after that, or even Surgimend procedure can be done at the same time.


(Q8.) I am overweight and my pubic area has some overhanging fat which "hides" my penis, what can be done please?
It is a common problem for obese men to have the pubic area filled with fat and redundancy of skin, therefore hiding the penis and making it very short and almost non-functioning. This can be corrected by simply doing a liposuction or in some cases, when there is too much redundancy, a skin lift can be done at the same time. Being a plastic surgeon, I see this very often and this procedure is frequently done together with the augmentation.


(Q9.) My penis is 5 1/2 in when Erect, but my scrotum is attached to the middle of the penis shaft, so the "functional" length of my penis is only about 3 1/2 in, what can be done to improve this?
This condition is called scrotal webbing, in which the scrotum, instead of being attached to the base of the penis, is attached to some point along the penile shaft, or in some cases, even close to the glans, or head of the penis. This results, in effective, shortening of the shaft of the penis and will affect the normal course of sexual activity. This can be quite easily done with a simple plastic surgery technique to re-attach the scrotum to the base of the penis, and, therefore, increase the effective length of the penis by a significant amount.


(Q10.) I had my penis shaft enlarged but not the head of the penis, and frankly my penis looks strange and out of proportion because the head looks too small. My doctor said that he cannot enlarge the head of the penis with injection. Anything you can do to help?
It is true that if you just augment the shaft of the penis without augmenting the glans, it could become out of shape and out of proportion. This is the reason I almost routinely augment the shaft and glans at the same time. If surgery is done for augmentation of the shaft, such as using Surgimend, the head of the penis will be augmented with filler injection.


(Q11.) I had a consultation with a doctor for penis enlargement by filler injection and he said that I have to redo it every 12-18 months. Is there something better than that?
It is true most of the doctors treating Male Enhancement use a temporary filler for the enhancement. As the word implies, it is temporary and the procedure has to be repeated perhaps every six to eighteen months. However, the filler I use is a permanent filler and it is not necessary to repeat, except for occasional touch-ups when there is deterioration of the penis itself.


(Q12.) My penis Girth is 4 1/2 in and want to be about 6 in. My doctor said that I need to have 2-3 separate sessions to get that, and each time I do it, I have to abstain from sex for at least 5 weeks. Is there a faster way to do it?
Normally, when a penis shaft is augmented by filler injection, this can increase it by about ½ Inch to 1 Inch in circumference and, therefore, if the patient wishes to have it larger , multiple procedures will be required in separate sessions. The issue with doing multiple sessions is that each time it is done, the patient has to abstain from sexual activity for at least five weeks and this may be problematic for a lot of patients. One way to circumvent this problem is to use the Surgimend insert instead of the injection. This one Surgimend insertion can increase the Girth of the penis by as much as 1½ inches or more depending on what size Surgimend is put in. This is equivalent to at least two injections with filler. The advantage of this, of course, is that there is only one procedure and the patient does not need to have recovery period of a minimum of five weeks after each procedure. The Surgimend insertion is a good procedure because in addition to giving a significant amount of increase, further increase can be done with injections at a later date. The Surgimend forms a firmer base and will not be too soft, as may occur when too much filler is used. The Surgimend procedure is, therefore, getting increasingly popular among patients.

Thank you very much for your informative Q&A. I have read that the ligament detachment procedure does not have an effect on increasing Erect length and only increases Flaccid length. What is your opinion on this and if it is false, why would a physician with a well-established practice in the UK say exactly that?

KR33 wrote: Thank you very much for your informative Q&A. I have read that the ligament detachment procedure does not have an effect on increasing Erect length and only increases Flaccid length. What is your opinion on this and if it is false, why would a physician with a well-established practice in the UK say exactly that?

A response from Dr. Victor Liu:

Hi

The amount of increase in length by detaching the suspensory ligament of the penis depends a lot on the anatomy of the area. It is true that in some patients there is hardly, if any, increase, but most often we see 1/2 to 1 Inch increase in length. It is important to divide both the superficial and deep suspensory ligament, move surrounding tissue to fill in the gap left by the divided ligaments to prevent re-attachment, and perform a V-Y advancement of the skin on the dorsal aspect above the base of the penis (small scar is covered by pubic hair) to increase the length of the skin. I also find it helpful to put weighted dressing on the penis starting immediately or one day after the surgery. I start with 1 lb and slowly progress to 3-4 lbs depending on whether the patient can tolerate it. This needs to be done for 1-2 months.
Please feel free to contact me for more details.

Thank you very much for your detailed and thoughtful description of how you approach the procedure. Just to confirm. Many/most men see between 1/2"-1" in Erect length gains?

KR33 wrote: Thank you very much for your detailed and thoughtful description of how you approach the procedure. Just to confirm. Many/most men see between 1/2"-1" in Erect length gains?

To save both you & him time, I can tell you that Dr. Liu reviewed this answer thoroughly before submitting it. In the answer he gave above he does state clearly: "It is true that in some patients there is hardly, if any, increase, but most often we see 1/2 to 1 Inch increase in length."

So the answer to your question is yes - this is his position from his experience.

Interesting.

Clearly, it was not clear enough for me or else I wouldn't have followed up.

I didn’t think it was clear either. Your question was about Erect vs Flaccid length, neither the word Erect or Flaccid was mentioned in the Dr.’s response. I’m glad Skeptical_one cleared it up…..but I don’t understand how he gathered that definitive conclusion from just what was posted by the Dr.
I would image Dr Lui gave him some clarification outside of what was just in the post.

Apologies, I misspelled Dr. Liu’s name in my last post. No disrespect meant at all, autocorrect!

A number of patients asked me whether Circumcision is a requirement for penis enlargement.

"One limitation of filler injection for augmentation is whether the patient is Circumcised. If
the patient is not Circumcised, the filler can migrate into the Foreskin and may cause a condition
known as Phimosis, which is thickening of the Foreskin, making it impossible for the head of the
penis to be extruded. This creates difficulty in cleaning the area, resulting in irritation or
infection of this area. The only effective treatment is to do a type of Circumcision. Therefore, when a
patient does not want Circumcision, injection of filler should either not be done, or done only
under the condition that the patient agrees to a Circumcision if Phimosis occurs."

Another common question is whether treatment should be surgical or non-surgical.
The following is an excerpt from my article "A Plastic Surgeon's Approach to Penis Enlargement"

"Many patients are scared of having surgery mostly because of fear of the unknown but after
discussing how it's done and the pros and cons of surgery, many of them would decide on having surgery.
I am not suggesting surgery for everyone seeking penis enlargement. What I am advocating
is the right procedure for the right indication. The right procedure can be either non-surgical
or surgical, or it could be both. Some patients do much better with non-surgical treatment
while others may require surgery to attain their desired results.

When is surgery indicated for penis enlargement? Generally, there are two aspects of penis
enlargement, the length and the Girth. For patients who want an increase in the erected length,
the only way is by minor surgery done through a small incision concealed by the pubic hair
above the base of the penis. The length of the penis when Flaccid, will also be increased with
this surgical procedure. However, very often the length of the penis when Flaccid will also be
increased after non-surgical Girth enlargement such as by injection of fillers or fat.

Briefly, the only way to get an increase in erected length is by a minor surgery."

Thanks,
Victor Liu, MD