I’m curious, if the suspension ligament gets cut for this procedure and has the potential to reattach. Can the internal portion of the penile shaft be surgically pushed forward an email Inch or two after the ligament is cut and then sutured back in place, cementing those results?
Let's begin with a basic review of penile anatomy (in layman's terms) as it relates to penis length, current medical thinking on procedure(s) used to improve length, and whether or not what you asked about previously is possible to ensure length.
Basic Penile Lengthening Anatomy
The penis is supported by a number of ligaments. Although distinctive, I’ve heard some patients (and clinicians) use them interchangeably.
1. The fundiform ligament is a thickened extension of the superficial fascia running from the lower abdomen. It begins at the pubic bone, wraps laterally around the sides of the penis like a sling, and then connects at the base of the penis before reaching the scrotum's septum. It's located upon the surface of the suspensory ligaments.
2. Suspensory Ligaments: The penis organ and pubic bone are linked by the suspensory ligaments. Even though they are all suspensory ligaments biologically, phrases like "top or upper ligaments" and "deep ligaments" are often used. The ligaments’ purpose is to keep the penis close to the body and to support an Erection, although that degree of need as not as overwhelming as when we lived in caves are procreation was often violent. Ligaments are not a uniform item: no two men have the same number and size of ligaments.
Every man is born with a predisposition to a specific penis size. The penis is a vascular human organ with complex function. Medical science has yet to discover a method for reproducing human organ tissue. As a result, you can’t go to a surgeon and request a kidney 30 percent larger than the one you already have. Genetically predisposed organ size is the biggest limitation to increased penis length.
Because all the ways to increase penile Girth entail adding some type of bulking agent to the subcutaneous tissue layers that surround the penis organ, boosting penile thickness is the variant of penis enlargement that most closely resembles breast augmentation. The amount of Girth you can add at one time is limited as skin needs time to stretch plus there’s a point which the penis becomes aesthetically out of proportion. Men who begin with a larger fat pad or micro penis are more likely to end up with a penis that appears shorter if only Girth is added.
Prevailing approaches to penile lengthening
Ligament Excision: The historical medical reasoning for surgically removing the suspensory and fundiform ligaments is that the penis will appear longer since more of it hangs outside the body.
Urologically-speaking, I don't think such a strategy actually works, with the exception of a small number of males born with abnormally tight ligament structures (less than 5 percent ).
The term "reattachment of the ligaments" is a bit misleading because the ligaments do not rejoin after excision. However, if the inner section of the relaxed penis subsequently adheres to the pelvic bone, they can "pseudo-reattach." Only six penile organs had reattached to the pelvic bone among the twenty-seven penile lengthening "Repair" treatments I conducted at Rejuvall over the last 24 months. Since the patient would be unable to show otherwise, it appears that some surgeons might utilize this explanation for the lack of increased length.
There are additional procedures like the "VY Plasty," which involves releasing ligaments and surgically pulling the skin above the base of the penis to provide the appearance of a longer penis.
The Question at Hand
Now, let's get back to your question: “I’m curious if the suspension ligament gets cut for this procedure and has the potential to reattach. Can the internal portion of the penile shaft be surgically pushed forward an email Inch or two after the ligament is cut and then sutured back in place, cementing those results?”
I'm presuming this question is connected to our new "guarantee to add one Inch of penile length" from our length procedure, as I didn't receive any earlier comments or background to this question. I'm not sure if our new website that explains this is live yet, but I understand it's in our sales materials. The "one Inch promise" does not apply to all patients, as I'll explain at the end of this response.
I'm not allowed to reveal the specifics about Rejuvall's penile lengthening procedure. I will, however, answer your inquiry as accurately as possible without revealing what’s considered intellectual property.
1. In my opinion, a penile lengthening treatment should incise all of the suspensory ligaments (including the deep ligaments). Anything less has proven to be a waste of time in my experience. If only the fundiform and top ligaments are removed, I’ve noticed patients sometimes lose length from contraction caused by scar tissue that occurs during recovery.
2. Because it's unlikely a surgeon could properly incise all the top ligaments and it's impossible to access any of the deep ligaments through the scrotum, there's no practical way to lengthen a penis through the scrotum, in my opinion.
3. You are correct: a piece of the penis must be surgically relocated forward and secured. Regrettably, there is a genetic limit to how much of a man's inner penis can be shifted forward. We've discovered that among men who qualify, we can always bring at least one new Inch out of them. Some males have an extra two inches to bring forward. Three inches can be gained by a very small group of males. We can't turn a guy with one extra Inch into a three-Inch result since this variable is entirely genetic. Because the amount of Erect organ tissue that is brought forth is more finite than the organ itself, the amount of Erect organ tissue that is brought outward differs per patient. Unfortunately, because the penis fluctuates in size between Flaccid and Erect states, and the surrounding neurovascular bundle prevents safe tissue displacement, the solution is a more involved than simply moving the penis outward and surgically sewing that new position into place. There's also the issue of preventing the organ from reconnecting with the pelvic bone.
4. I'll tell you that our length solution arose from my two-year traumatic and reconstructive Urology fellowship at the University of California, San Francisco, particularly from surgical restoration of severe hypospadias patients where the ureteral entrance was placed far down on the bottom of the penis at birth.
5. We take specific precautions to guarantee that the penis does not attach to the pelvic bone (hasn't happened yet, but it is medically feasible). The patient who engages in strenuous activity or exercise too soon after surgery poses the greatest risk to us. For the first 90 days after the treatment, we advise men to avoid any considerable physical straining of the abdomen area. It’s surgically secured, not cemented.
As I previously stated, there are some patients and instances in which we cannot guarantee a one-Inch increase in penile length. Before a surgery date can be set, all patients who have had any type of previous surgical lengthening operation must be personally assessed by me in the office.
Exclusions to our one-Inch penile length guarantee include:
Patients suffering from a congenital penile defect such as hypospadias or congenital curvature (chordee). Although our new penile length technology was born out of my work with hypospadias, there's only so much I can do in such cases, and some can't be done at Rejuvall and must be done in a hospital setting.
Patients who have previously undergone a lengthening operation. In these circumstances, I never know what I'm going to get. Even when a patient explains their knowledge of what happened in the past, it doesn't necessarily match what I find on the inside. In these circumstances, I almost always obtain an Inch, but it's impossible to guarantee.
Patients who have previously had a penile prosthesis to treat severe erectile dysfunction. If the implant is still in place, there's nothing I can do to improve length. However, once the prostheses is removed and before a new implant is placed, I can sometimes enhance length.
Patients who have previously had a silicone implant augmentation. I encounter a wide range of damage in these cases. In the majority of these instances, my main goal was to restore the patient's length to where it was before the implant was placed and removed.
Patients who have been diagnosed with micro-penis. Micro-penis is sometimes confused with a loss of size due to weight gain or vascular / ED concerns. Everything (both inside and out) is smaller than normal in micropenis, so I have a lot less organ tissue to work with right away. I normally achieve an Inch of extra length from a micropenis, but I can’t guarantee that outcome. I understand how difficult this diagnosis can be for the sufferer.
Obese patients with an engorged fat pad must consider one of our innovative LifeSize procedures, which combine surgical reduction of the suprapubic fat pad, as well as lower stomach reduction and contouring, with a lengthening operation. The locking device that holds the new length in place does not work if I merely perform length on these patients without fat pad reduction and contouring.
Patients who have been diagnosed with Peyronie's disease. This length technique cannot be used to correct patients who lost length due to fibrosis and scar tissue in the soft tissues of the penis. We've had success improving length after non-surgical plaque Removal, but each case must be evaluated individually.
Patients over the age of 62: This isn't a case of age discrimination. Most guys are aware that as they become older, their penis size shrinks. Regardless of physical health, the pliability of the sponge-like characteristic of the corpora begins to deteriorate after the age of 60. With males as old as 80, I've been able to add considerably more than an Inch of length. However, I've also had trouble achieving an Inch of extra length on guys as young as 60 years old. We've drawn a line at 62 years old on our guaranteed length based on all of these experiences.
Patients getting our PERMMAXL procedure. Our PERM MAXL is designed to increase length and width at the same time. Unfortunately, I am unable to complete all of the processes necessary to guarantee one Inch of new length when congruently adding thickness.
ivan808 wrote: Wasn't length enhancement more of a pipe dream than reality? What is this 1 Inch guarantee or I don't understand it right>
No it was never a "pipe dream." Historically it's been regarded as "hit-or-miss," however, Rejvuall is backup their claim that their proprietary method in-fact yields at least an Inch for (presumably) most patients, and this is a huge step forward. I may even partake in a year or two after I've worked on my fat pad (I'm not obese but have stubborn pubic fat).
lewis.87 wrote: Does the size of the patients penis matter prior to surgery? Like if one patient has a big/bigger penis are they likely to gain more length or does it not matter?
In my conversations with them, there is no sure-fire way to know for certain how much length you'll get based on your starting penis size; gains vary patient-to-patient and you'll also have to take the post-op commitment into account.
I feel if you're committed to the program, you will see some gains, to what extent is hard to say.
IN MY OPINION, this is ideal for men in the 4-6 Inch range, as I see no reason to endure the costs and risks associated with surgery if you're already long to begin with. But to each their own.
Dthom wrote: All the online evidence and logic says that initial length is an indicator of increase . There are numerous places that state this in the web . It only makes sense .
Really? Considering the lack of evidence for Ligamentolysis on the web, and the fact that human anatomy is correlation at best (i.e. big hands don't always mean big penis), I'm not so sure why what you're saying is sensible? There may be "correlation," but no guarantees that your starting size will indicate your end-result.
Really SO . The longer the penis , on average , the longer the increase , on average . That's just obvious . We're not talking about correlation to other body parts .I did quite a bit of looking , and there were numerous references to the fact that the bigger you start , the more you should expect .
Dthom wrote: Really SO . The longer the penis , on average , the longer the increase , on average . That's just obvious . We're not talking about correlation to other somatemetfic psarameters .
That's not how this works. How much inner penis that can be brought forward through Ligamentolysis cannot be determined by external factors like your starting penis size, plain and simple. This assertion has been backed up by multiple practitioners of the surgery.
Your comments regarding "all online evidence" doesn't make sense either, as most claims not found on this site are made by doctors selling their procedures. Ligamentolysis is probably the most obscure of all Phalloplasty procedures and most information is outdated at best.
In this Q&A alone, Dr. Carney, a reputed Reconstructive Urologist Surgeon states:
Regrettably, there is a genetic limit to how much of a man's inner penis can be shifted forward. We've discovered that among men who qualify, we can always bring at least one new Inch out of them. Some males have an extra two inches to bring forward. Three inches can be gained by a very small group of males. We can't turn a guy with one extra Inch into a three-Inch result since this variable is entirely genetic. Because the amount of Erect organ tissue that is brought forth is more finite than the organ itself, the amount of Erect organ tissue that is brought outward differs per patient.
You notice no mention of starting stats?
Besides, in the many years I've been following this topic, there has been so much variability in gains that I just can't see how anyone could prove the indication that a longer penis = a more successful Ligamentolysis.
I'm telling you what's well established. Perhaps it may be wrong, but the information available now says otherwise.
Dthom wrote: Take a look online then . The amount of inner penis is correlated with the amount of outer penis -- again on average .
Why ask me to look online? Why not provide your sources? I mean besides, I've read a plethora of articles, journal publications, and medical opinions, and I can tell you that the field of male augmentation is one of the most poorly researched & developed. We live in a world where Dr. Elist claims his Penuma device will give you length because of the weight of the implant. Lengthening information is either skewed or outdated. This is why this forum has its role, and which is why I publish this Q&A's to bring more standardization to these questions & concepts.