I am writing this blog to give you a sense of my experience with fillers in the penis.
To be clear, I do not use any fillers in the penis for the reasons discussed below. I
am aware that there are many doctors using fillers in the penis. It is my
understanding that I am one of the few surgeons in the world with a large
experience of managing the complications of fillers. So my role here is to outline the
complications and their management.
The first statement that I tell patients is that no filler is approved for use in the penis
in the United States. I do not know the regulations in other countries. I have seen
patients for more than 10 years who have had complications of fillers placed in
other countries including Britain, South Africa, Mexico, Australia, South Korea and
the United States. Doctors in the US, to my knowledge, tell their patients that they
are injecting the filler as an “off label” use. I cannot speak to the legality of this.
However, it makes little sense to me from a medical perspective.
All fillers used in the penis are known as dermal fillers. This includes a variety of
products known as hyaluronic acids (HA’s), polymethyl methacrylate (PMMA),
hydroxyapatite paste, poly L-lactic acid and liquid silicone. Each of these materials
may be described by a brand name so it is smart to ask what type of material the
doctor is using if you are getting injected. Each of these materials acts in a slightly
different way once it is injected. Some patients in my practice have had more than
one type of material injected over time.
Dermal fillers are designed to be injected into the dermis layer of the skin. This is
the layer directly below the epidermis. Typically a small amount of material is
injected to correct a fold in the face or add volume to the cheeks. The volumizer
materials are injected deep in the face along the bone layer. The dermis of the penis
is very thin. Placement of a volume of material that would provide Girth to the penis
in the dermis would not be possible due to the small layer present. Therefore,
injections are placed in a deeper layer known as the Dartos. This is a layer of tissue
that surrounds not only the penis, but the testes. Material injected into the Dartos of
the penis shaft can migrate to the scrotum. I have seen this with HA, PMMA and
Some of these materials are touted as safe because they reabsorb, but I have seen
patients with HA that has created lumps and lasted for years. Other materials are
promoted as creating a reaction in your body that adds Girth. This is true, but none
of us has any control over that response. It may work for some men, but not for
others. This is because materials such as silicone and PMMA incite a reaction
known as granuloma formation. Granulomas are microscopic foreign body
reactions that are a normal response to a foreign body injected into any part of the
body. For example, liquid silicone often gets injected into the buttocks and hips
(especially outside of the US, but illegally in the US as well) and the response is the
same as in the penis. It looks good for a while, but over time, granulomas form and
get firmer and distort the appearance of the injection site.
Granulomas are Balls of scar tissue. They can occur with any of the injectable
materials if the material remains in place for a long enough amount of time. You can
think of this like a snowball. Once the process of granuloma formation starts, it will
continue as the body tries to “wall off” the foreign material. With time, these lumps
will get larger.
Another issue that people do not often consider is that these fillers and the
responses to them occur just under the penile skin. The penile skin is thin with a
tenuous blood supply. The filler and the reaction can invade the deep layer of the
skin so that when the granuloma is removed, the blood flow to the overlying skin
may be compromised. This can cause loss of skin of the shaft when these materials
are removed. Again, doctors who perform injections may not have surgical expertise
in the management of skin loss on the penis, so they will be unfamiliar with this
Removing these granulomas is a surgical challenge. Care must be taken to remove
the material and preserve the surrounding skin. Sometimes, I have had to remove
skin of the shaft and reconstruct it at the same time. This requires planning to place
the scars that will occur in a way that provides the optimal cosmetic result. Again,
doctors who are not surgeons will not have any experience with these concepts. I
am aware of at least one injection doctor who continues to inject more material in
an attempt to camouflage the lumps. He also charges patients for these subsequent
injections. Over time, these patients end up with a bigger surgical problem. My
advice is that if you have an undesirable result from a filler, do not add more filler.
This will only make the problem larger over time.
Before I end, let me discuss fat injections. I am aware of the popularity of fat
injections because they seem quick, easy and safe. However, fat grafts do not make
sense to me in the penis. As a plastic surgeon, I have placed fat grafts in many parts
of the body: face, breasts, and buttocks among others. But fat grafts are soft and
supple. The result of fat grafts to the penis is certainly a larger penis, but also a
mushy one. It is not really useful for sex since the goal of penis enlargement is to
have a larger penis that is firm when you want to have sex. Much like other fillers,
fat is injected into the Dartos layer and I have seen skin and wound healing
problems from fat grafts as I have from other fillers.
I am aware that there are doctors who will disagree with me. Some are not
surgeons, so they have a different experience than I do. Certainly, I have a skewed
perspective since I only see fat and filler patients with complications. I assume
there are some who do not have complications. But I write this so that you consider
all of your options before getting treated. And if you have had injections with fat or
filler and do not like the outcome, there are surgical options to treat you.