TOPIC: Dermal fat graft (before/after)

I posted before about my experience of having dermal fat graft 9 weeks ago, but I thought I would create this thread to focus more on the before/after result and include some pictures too. I hope I can get some comments too, especially from those with some first-hand experience.

Honestly, I am not quite happy with the shape, but the surgeon claims it will likely improve over time. I did read that the "Eiffel tower" appearance is common after having dermal fat graft, and supposedly the uneven asymmetry is one end of the dermal fat graft to the other and where the Sutures were made.

Before:



After:



After:

Honestly the shape isn't really what I would call bad, and given the significant before & after difference, I personally would take the overall result as pretty good. Again, that would be me in your shoes, we all have our own subjective take when it comes to our own dicks so I get it.

It looks like you jumped condom sizes before & after.

Skeptical_One wrote: Honestly the shape isn't really what I would call bad, and given the significant before & after difference, I personally would take the overall result as pretty good. Again, that would be me in your shoes, we all have our own subjective take when it comes to our own dicks so I get it.

It looks like you jumped condom sizes before & after.

I did think about why I do not like the aesthetic result? And I believe the glans is the problem. Because I am not Circumcised, the glans looks bigger, and it was already big before. Now I feel it looks like a lump at the top of the penis.

Because I still have Phimosis after the surgery (inability to retract the Foreskin), I might need a Circumcision, but I was told to wait at least one month to see if it improves. In that case I can be prescribed steroid cream, and I might not need a Circumcision, if it resolves by itself.

I would very much like to avoid a Circumcision, but at the same time it might improve the aesthetic result. I guess another option might be fat injection to make the shaft bigger and align more with the glans? But I would like to avoid any more penile procedures.

It's easy to be hyper-critical when it comes to our own penises, but honestly having a large glans is a blessing. Most men who have the opposite problem (small glans) don't have many avenues of correcting it, especially when their shaft dwarfs their glans as it gets thicker from filler.

I say give it some time plus some "use" before passing a final judgement. For now you should focus on correcting the Phimosis, get the important stuff out of the way first.

It has been almost 2 weeks, and I thought that I might give another update. The appearance of the penis does not seem to have changed, but the lumpiness is not very noticeable in Flaccid state, only in Erect state.

In fact, during Flaccid state the penis feels smooth, and I would describe it as natural; meaning I do not think it is any hardening or dead tissue; instead the lumpiness is one end of the other of the dermal fat graft.

Interestingly I read that it might be possible to remove the lumpiness at the base of the penis, but I am not sure how easy it is to do, and I did not ask the surgeon about it. Different sources also write that the lumpiness might be less noticeable in time, and the surgeon made the same claim.

I started using steroid cream for the Phimosis (inability to pull back the Foreskin), and it has had very good results, but I read that it might not be permanent and eventually a Circumcision might be needed anyhow. I have to wait and see if the Phimosis is resolved completely or for example by 80% and then worsens when the Foreskin is stretched.

Flaccid penis:




Erect penis (back)



Erect penis (front)



Buttock scars from surgery:

I think it is fitting with an update because I made some huge progress concerning the Phimosis: I can pull the Foreskin behind the glans without pain now. Technically it means that the penis is normal now, but there is still hardened scar tissue around the the phimotic ring, and I need to pull back the Foreskin slowly; meaning if I were to have sex now the scar tissue might worsen, so I am not completely out of the woods yet, however it shows that steroid creams can make a huge difference!

And why is this important? Because as evident by other posts on the board, and the many studies done, anyone who is not Circumcised can get Phimosis whether it is after filler or surgery (graft or even Ligamentolysis). The risk is definitely there, but if it happens it might not be necessary to have Circumcision done, and it can be an alternative to give it time and use steroid cream. I am not sure yet if I will not need Circumcision, but the progress is very encouraging, as shown by photos I have attached.

Wow these results look incredible. Can I ask how much you gained? And who your doctor was?

ioannis519 wrote: Wow these results look incredible. Can I ask how much you gained? And who your doctor was?

I did the surgery with Dr. Theerapong Poonyakariyagorn in Bangkok at Bangpakok 9 International Hospital (Interplast Clinic). Dr. Theerapong Poonyakariyagorn used to work at PAI Clinic for 12 years, where it seems a lot of penis surgeries were performed, and they learned some techniques from Dr. Sava Perovic who visited there.

It seems the technique Dr. Theerapong Poonyakariyagorn used for my surgery was his own refined technique however, but it seems to have some similarities with techniques I read about performed at Peking University People's Hospital.

The scars are almost not visible, but incisions were made on the left and right side. For the procedure the penis will be degloved. He also did Ligamentolysis, selective dorsal neurectomy and scrotal lift. Selective dorsal neurectomy is common in China and Korea.

For the Ligamentolysis I was told there are several techniques that he can use to prevent retraction. I feel that my aesthetic result has improved since I last took the picture. There is less of a bulge at the base of the penis. The Phimosis has also healed, but the Foreskin is still a bit tight.

In one study 7/20 people who got dermal fat graft without Circumcision got Phimosis, but all the cases resolved in 1-4 months. I would definitely not recommend doing Ligamentolysis at the same time, as the penis will be very swollen after having dermal fat graft. It will not be possible to use a penile traction device for at least 2 months.

Elsewhere where I read that dermal fat graft is performed is in Serbia by Professor Djordjevic and Dr. Borko Stojanovic, and in Australia it seems that Dr. Oates offers dermal fat graft. Other alternatives to consider might be AlloDerm, performed by Dr. Reed in the USA, and Dr. Solomon (Surgimend).

For Girth increase the result is consistently 30%, supposedly slightly better with dermal fat graft, unlike fillers where the result is very individual. If you want the maximum possible Girth increase, then any kind of dermal graft procedure is not the right choice, however for an even result it seems a very good choice. With fillers however, you can keep injecting until you have achieved your desired Girth increase, but along the way you might have complications. If you do HA filler then it is easy to correct, but with other fillers it might be very hard to correct.

Everything still healing nicely and happy with the results? Anything that you would have added or prefer not to have done? Being in Korea and not having a Korean number my access to the internet is limited as it automatically assumes that I’m a minor and restricts what I can view. However last night my home carrier AT&T must have picked up or something because for a hour or so I could search and watch anything so I YouTubed 5S surgery and watched the entire procedure with the degloving, megaderm, liganomettolysis,etc It hurt my stomach so badly, I’m such a whimp. You commented on the other thread I was in about the degloving. That Proud must use a different terminology they must because that video I can only assume that was degloving they removed all the skin from the shaft to put on the dermal graft. I see that you had degloving are you happy that you went this route and just didn’t get filler? Dr Kim is very clear on his website to avoid surgery which he offers and just do filler because it’s safer.
You’ve been such a huge help @Screen2584 with me making the decision to move forward with this with everything that you shared. I’m a little over a week away from surgery. I called Proud last week to see if we could move the surgery sooner but they said that they’re booked up and no spaces were available.

Pepperoni wrote: Everything still healing nicely and happy with the results? Anything that you would have added or prefer not to have done? Being in Korea and not having a Korean number my access to the internet is limited as it automatically assumes that I’m a minor and restricts what I can view. However last night my home carrier AT&T must have picked up or something because for a hour or so I could search and watch anything so I YouTubed 5S surgery and watched the entire procedure with the degloving, megaderm, liganomettolysis,etc It hurt my stomach so badly, I’m such a whimp. You commented on the other thread I was in about the degloving. That Proud must use a different terminology they must because that video I can only assume that was degloving they removed all the skin from the shaft to put on the dermal graft. I see that you had degloving are you happy that you went this route and just didn’t get filler? Dr Kim is very clear on his website to avoid surgery which he offers and just do filler because it’s safer.
You’ve been such a huge help @Screen2584 with me making the decision to move forward with this with everything that you shared. I’m a little over a week away from surgery. I called Proud last week to see if we could move the surgery sooner but they said that they’re booked up and no spaces were available.

I have been thinking about you, knowing your surgery is coming up, and I can imagine that the wait must be hard. Naturally, there is a lot of hesitation, but I believe that the wait can be good because it also gives you opportunity to reconsider whether or not you want to go ahead with the surgery.

When I read about any kind of dermal graft surgery, it seems that many clinics want to avoid mentioning "degloving". It sounds scary, and when you look it up, it sounds very alarming. I saw some videos of it, and it is enough to watch just for a few seconds to be terrified. Even a picture of it looks terrifying.

I wish I could say it just looks scary, but there is definitely a risk to this kind of procedure. As I understand it, the risk is damage to the neurovascular bundle, which is what gives you an erection. Other complications of nerve damage are persistent pain.

That is also the risk with permanent fillers that if there are complications then degloving is needed to remove as much of the filler as possible. This is a risk with for example Ellanse or PMMA. Based on what I read, some of it might not be able to be removed, and during the removal procedure there is a risk of damage to the neurovascular bundle.

When it comes to inserting dermal grafts, I read different terms used, such as describing it as a procedure similar to circumcision while avoiding mentioning "degloving", but I believe that they are always doing degloving. The dermal graft has to be stitched using sutures, and I do not see how this can be done without degloving the penis.

I even read clinics describe that the dermal graft is "injected" into the penis, but again I do not think this is accurate. As far as I know, the dermal graft always needs to be sutured, and this can only be done by degloving the penis. Clinics simply avoid mentioning the term.

Besides the risk during surgery, there is the risk that the dermal graft has to be removed for some reason in the future, and then the penis has to be degloved again. Then there is the risk of neurovascular damage occurring.

As you can imagine, I do not want to encourage anyone to have this kind of procedure. At the same time however, many people do have permanent filler, and there is a risk with that too. Then dermal graft might certainly be an alternative.

Knowing what I know now however, the only procedure I would be comfortable to have in retrospect would have been HA filler, and it is the only thing I would think is safe enough to recommend to others. If something goes wrong, it can just be dissolved, unlike permanent filler.

I am glad that you read about alternatives, such as MegaFill, but I do not know if Dr. Kim truly prefers it because it is like he claims superior and safer, or because it is simply much more simple than MegaDerm. It astonishes me however that Proud Urology can perform the 5S procedure as quickly as they say. Everywhere I read that when degloving the penis it is a lengthy surgery.

As for my own recovery: everything generally seems okay, but the sites of the incision do still get irritated easily, for example when wearing underwear that rubs against the incision sites. Like I mentioned, the incisions are barely visible now, and the pain there is minimal and usually not noticeable at all.

I have no pain in the penis, except once in a while there can be a sudden sensation of pain that lasts for a couple of seconds. It can happen once a day or less frequently. I do not feel so worried about it, because if it was nerve damage, I think the pain would be persistent.

The foreskin is still a bit tight and swollen, but I can pull it back behind the glans during erection. I do some stretching every day, and I believe that might be causing the swelling, but it is also important in order to loosen the foreskin. I am not sure if this is going to become an issue or if it will pass.

It is so mild that I think no honest urologist would do anything about it. There is preputioplasty, which is a much milder form of circumcision, but I think my tightness is too mild for it to be an option, as I believe circumcision is risky. Outside of the USA it is not a common procedure in many parts of the world, and strongly discouraged.

As for erections, it does seem no different from before, and I do not believe I had any penile retraction. I believe this would be noticeable, so I think it did not happen. There is no curvature either, but during erection the dermal fat graft can be felt.

The bulge I previously mentioned definitely seems less noticeable from when I first noticed it, both when erect and flaccid, however I think it is unavoidable that the dermal fat graft will be felt or noticed in some way. Fillers generally seem much more noticeable, with a less pleasing aesthetic result for many, it would seem.

For me the hardest thing post-surgery has been the constant worry. Not because there have been complications, but because there is the risk of complications, especially during the recovery period.

There’s so much to all of this! I’m glad to hear that you’re healing well and thankful for all the information!
I just scheduled a meeting with Dr Kim as you suggested he’s going to see me Wednesday morning. I’m most likely just going with the 5S but I’ll first hear what he has to say. I want more permanent results.
Proud’s Dr I spoke with I believe Hong said that, he’s like a machine,I come in everyday and do the same exact thing it’s simple and I get it done. I watched multiple videos of them doing the 5S on YouTube last night just cringing the entire time thinking WTF is wrong with me hahaha. I wanted to see it all, how they do it, and how it could become just a simple process for him by doing it everyday. Whichever Dr that is in the video he just gets right in there and gets it done.
The liganometolysis do you see a difference from that? Proud said that they don’t use traction devices afterwards because they developed a diamond stitch technique that prevents retraction. I’m hesitant on getting that part done since it only does Flaccid length. However if extra Flaccid length means that I can get more filler for greater Girth than I would be open to that. I need all the gains that I can get.

Pepperoni wrote: There’s so much to all of this! I’m glad to hear that you’re healing well and thankful for all the information!
I just scheduled a meeting with Dr Kim as you suggested he’s going to see me Wednesday morning. I’m most likely just going with the 5S but I’ll first hear what he has to say. I want more permanent results.
Proud’s Dr I spoke with I believe Hong said that, he’s like a machine,I come in everyday and do the same exact thing it’s simple and I get it done. I watched multiple videos of them doing the 5S on YouTube last night just cringing the entire time thinking WTF is wrong with me hahaha. I wanted to see it all, how they do it, and how it could become just a simple process for him by doing it everyday. Whichever Dr that is in the video he just gets right in there and gets it done.
The liganometolysis do you see a difference from that? Proud said that they don’t use traction devices afterwards because they developed a diamond stitch technique that prevents retraction. I’m hesitant on getting that part done since it only does Flaccid length. However if extra Flaccid length means that I can get more filler for greater Girth than I would be open to that. I need all the gains that I can get.

I found that video you were referring to, and it is 15 minutes long. The whole procedure from start to finish supposedly takes 60 minutes, according to their website.

They do it very quickly, and there is no hesitation. It is really like seeing a machinery working. It does look very simple to the surgeon, and like he said: he just gets it done efficiently.

In one sense it is admirable, but it is scary when thinking that it is a penis that they are degloving in just a few seconds with sharp instruments. If it is true that they do up to 20 procedures in one day, they have done a huge number of procedures.

When doing these kind of surgeries, only one failed surgery might turn into a big scandal. It is enough to check one clinic on Google that messed up, and usually some forum posts or things written on Reddit will show up. Surprisingly, I could not find anything like that about Proud Urology.

It would be interesting to know what a competitor like Dr. Kim might say about their procedure. He has surely heard about the clinic. They combine both MegaFill and MegaDerm, while Dr. Kim only does one of them, and he insists on his website that MegaFill is the best, but supposedly he can do MegaDerm too. One board member claimed though that Dr. Kim does not actually do MegaDerm.

As for selective dorsal neurotomy, he mentions on his website that he has done over a thousand such procedures, but I remember that he wrote that he does not recommend the procedure either. I remember that you opted out of it, so it is not relevant for you.

And as for Ligamentolysis, I do not remember what he writes about it, if anything at all. That thing with diamond stitching is not a technique that I ever heard about. Usually these days some pubic fat is taken, and in the rare case there is no pubic fat, then a silicone spacer would be used.

I assume my surgeon used fat. On his website it says that he uses fat or silicone spacer. I read that those people who had a silicone spacer can feel it, and I cannot feel anything like it, so I assume fat was used. A silicone spacer could increase the risk of infection.

Now this is very important: clinics will claim that there will be initial gains, and even if retraction is supposedly very rare, everyone claim that further gains can only be gained by using a penile traction device.

I did read some study from China where they claimed to use some innovative stitching technique, and it seems a penile traction device was not necessary according to them, but it would contradict what every other clinic is saying.

Assuming you really have to use a penile traction device to get maximum gains, I would advice you to skip Ligamentolysis. Some people claim to have had great gains after stretching the whole day for like 1-2 years, but I believe the norm is small Flaccid gains after surgery, and then presumably very few people commit to a stretching routine with a penile traction device.

Most people probably do it for a few hours for a few weeks, maybe a couple of months, and then they give up. Doing the stretching with a penile traction device is very demanding. I doubt you could even do it before 2-3 months after having MegaDerm. I remember it took two months for my swelling to go down enough that I could even fit the penile traction device.

Personally, I think my length gain was very minimal, but I did not do any stretching using the penile traction device. I hope to start eventually, but because I am stretching the Foreskin at the moment, I think using the vacuum of the device would be counterproductive. Furthermore, the incision sites easily get irritated, and to have a big device tightly attached to the penis does not feel good at the moment.

So your only cut is at the base of your penis? I imagined it would be a lot more cut up looking after watching the videos and thinking the worst. That looks great!

Pepperoni wrote: So your only cut is at the base of your penis? I imagined it would be a lot more cut up looking after watching the videos and thinking the worst. That looks great!

There were two incisions at the sides of the base of the penis. They are not really visible, but on the left side a small scar can be felt when touching.

Otherwise, when something like underwear is rubbing, it can get a little bit red and feel slightly swollen and painful.

For scrotal lift I had an incision near the scrotum; meaning there are three incisions in total. That one cannot be seen or felt, but it took one week longer for the incision to close, compared to the others. They took 3 weeks to close.

Hey @Screen2584 , somewhere I read that you can feel the dermal graft. What do you mean by that? I also read in this thread in flaccid state you mention it feels natural.
Do you just mean that you know it’s there you sense it or does the feel to touch feel differently when erect or flaccid?
I’ve thought about that a few times since I’ve read it.
Thanks