Medical Expert Opinions

Medical Expert Opinions

Dr. Wall:

It depends on your baseline size, the goals of your treatment, and your budget. Most men can expect to gain anywhere from 0.75”, and up to 1.5” in girth in really large packages delivered over multiple sessions.


PhalloFILL:

The patient should expect an overall girth increase of 1/4 to 1/3 of an inch per session, or an average overall enhancement of 1 – 1.5 inches or more after multiple sessions depending on the goal of the patient.  Any reasonable girth can be achieved with multiple sessions.  Keep in mind that our most satisfied clients have received 3 – 6 sessions of PhalloFILL. It is important to keep the following averages in mind when creating a treatment plan tailored to your specific goals:

-The average flaccid penis is 3.5 – 4 inches in girth.  Most men would like to reach 4.5 – 5.5 inches flaccid.

-The average erect penis length is 5.5 inches.  (We do not change the length with PhalloFILL enhancement)

-The average girth of an erect penis is 5 inches.  Most men would like to achieve 6+ inches of erect girth.

-On average, 18 – 30 units are injected during a PhalloFILL enhancement plan over the course of 3 – 6 sessions.

With adequate sessions, the average girth increase is 1 – 1.5 inches. Depending on the patient’s desires, we have injected over 75 syringes during a PhalloFILL enhancement plan for TREMENDOUS girth enhancement results!


Dr. Tsay:

Generally speaking, for our fat transfer patients, we can put upwards of 50cc’s of fat at a time, and patients can expect a 15-25% increase in girth in a single session. For example, if you start with a flaccid circumference of 4 inches, you could reasonably expect to go to 5 inches in circumferential measurement (which can be visually significant).

For dermal fillers, we don’t want to put too much in at one time. I generally like to cap that out between 10-15cc’s per visit. You’re going to get a mild increase in girth in one session. When you build upon that over multiple sessions, I find that 50cc’s (in total) is the sweet spot for the average size penis to really see a significant girth enhancement.

Dr. Wall:

Usually, we achieve your ideal result in one session. Occasionally, we need up to two sessions in larger packages of 20 to 30ml. I would say 1 in 20 patients require top-up for very minor asymmetries. At Contour Clinics, any asymmetries are fixed for free! We guarantee our results, and we make sure that you buy a result, not a 1ml filler.


PhalloFILL:

When administring The PhalloFILL enhancement tecnique, we are somewhat conservative with the number of units (syringes) injected per session. We have observed more retention of the HA dermal filler and the most aesthetically pleasing results with the most reproducible outcomes using 6 units or less per treatment. The number of units injected per treatment is determined after examination of the patients length and individual anatomy. This often requires 3 – 6 sessions which are spaced about 3 weeks apart as mentioned above. However, our patients are extrememly happy with their results bedcause of our slow process of layering the dermal filler which delivers a very symmetrical outcome.

Dr. Wall:

It takes roughly 30 minutes in-clinic, and we do a dorsal penis block, which is a local anesthetic provided to the base of the penis, which can numb the entire area. This way you do not feel anything during the procedure.


PhalloFILL:

The PhalloFILL Clinics generally schedule 1 hour for each enhancement procedure. The initial visit requires more time because of the patient intake paperwork and the thorough consultation given to the patient to make sure his needs and desires are inline with the realistic outcomes of the procedure. For subsequent treatments the patient is usually in and out in 30 to 40 mintutes. We always schedule 1 hour so that there is never a rush with any patient.

For local anesthesia we start with small injections of lidocaine which make the patient very confortable for the actual injection of the HA dermal filler. The lidocaine injections are described as a small pinch but again this is only at the beginning of the procedure. We often ask our patients to describe their discomfort on a scale of 1 to 10 with 10 being the most painful. Generally the feedback given to us is a mild 1 or 2. This is not a procedure that should cause anxiety because of pain or discomfort before or after the prodedure.


Dr. Tsay:

This procedure is all done under local anesthesia. I find that this is generally sufficient enough, and we also offer nitrous oxide (i.e. laughing gas) if you are at all nervous prior to coming in. We can also prescribe sedatives that will give you a calming experience throughout the procedure.

Dr. Wall:

In the absence of complications, the answer is no (no effect on functionality). The main complications experienced with the procedure are asymmetry (which are 1 in 20 patients), bruising which is common, and swelling which is also very common. The risk of infection, whilst hasn’t been documented in papers, would sit roughly around 1 in 3,000 if we extrapolate from facial filler studies. There is also a risk of delayed-onset nodules; there is no evidence I can find in the literature, but from the face the risk of those are about 1 in 4,000-5,000. There is also a risk of injecting into a blood vessel, which we haven’t evidence of, but in the face the risk of what we call “vascular necrosis” is 1 in 100,000.


PhalloFILL:

Sensitivity is an interesting topic for girth enhancement. When it comes to sensitivity, we are told most commonly that there is an increase in sensitivity. Sex for these patients feels better and they have a more intense climax. This is because when nerves are placed on a stretch there is generally an increase in sensitivity. Other patients however report no change in sensitivity at all. One patient has reported to us that he was less sensitive, and it helped him with his premature ejaculation. This could be a psychosomatic observation.

True complications with The PhalloFILL enhancement are rare. We have only experienced one infection which was resolved in 3 days with oral antibiotics. The patient admittedly did not follow the post care and instructions and had sex before he was instructed. We have never had any other complications. We do consult with the patient prior to treatment and explain that with any cosmetic enhancement or medical procedure there are risks, some of which may be unknown, or a complication could arise that has never been encountered before. That being said we perform around 1000 procedures per year so the risk of a complication is very low.

There are other hurdles to deal with when performing girth enhancement that aren’t considered complications. Each penis is different as far as retraction and “constriction bands” that get tight when the patient takes certain medications, experiences cold, or anxiety. Retraction and bands that tighten can cause the filler to migrate slightly forwards or backwards. Generally if this occurs we correct by adding more filler to compensate for the migrated filler. In worst cases the asymmetrical filler can be dissolved using an enzyme called hyaluronidase which works almost immediately leaving an aesthetically pleasing result.

Other side effects that wouldn’t be considered a complication would be bruising. Bruising can occur in one part of the penis and because of the anatomy of the penis and gravity can more to the glans or head of the penis and cause bruising. This bruising can often look scary for the patient but resolves itself with no treatment other than time in about a week. Occasionally there can be some tenderness, but this isn’t reported very often. An over-the-counter anti-inflammatory will usually resolve any tenderness.


Dr. Tsay:

Some of the common complications are bruising and swelling. This is usually self-limited and lasts 7-10 days. We usually recommend not to use the organ (penis) for at least one week after the procedure. Not only will the penis be sore, but there will be open wounds that need to be completely healed before resuming any sexual activity.


Dr. Shafer:

The vast majority of patients report either the same sensitivity or enhanced sensitivity and enhanced / thicker erections. We have no studies on semen quality. If you have pre-existing issues such as erectile dysfunction, this is not a treatment for that. As for complications, swelling and possible bruising are the most common, and usually resolve within a week if they occur. We give you a sulumedrol steroid pack which can help the swelling go down faster.

Dr. Shafer:

Most patients describe the effect as if their penis gained weight. So imagine a thicker / fatter / heavier penis.


Dr. Wall:

Immediately after the procedure it will feel quite swollen and you may develop a full feeling in the area. It can also feel a tiny bit squishy for those that have large volumes placed; this is because you have a lot of swelling because of the trauma from the cannula during the procedure. This all resolves within 1 to 2 weeks to provide a really natural, realistic feel to the area.


PhalloFILL:

The first 2 weeks we advise the patient to follow post care instructions and to wear the appropriate compression garments. Because the swelling and lidocaine used in the procedure, the patient may see an exaggerated result that will decrease over the first two weeks as the swelling subsides. Often the patient perceives this as their result going away but the HA dermal filler is still in place and the anticipated 1/4 to 1/3 of an inch increase will be observed.

After the recovery the patients often report less retraction or shrinkage because HA filler does not shrink as normal tissue does. HA dermal filler also has weight so the penis will not only be fuller, thicker, and heavier, but can also hang longer. Patients tell us that when they wake up in the morning and see the larger penis and feel what they describe as a completely natural feeling result, their mood changes completely, self-confidence increases, and their day starts off in a more positive vibe. HA dermal filler in the penis feels totally natural because your body is made up of a large percentage of hyaluronic acid.


Dr. Tsay:

We usually follow up with the procedure about 2-3 weeks afterwards, and at that time the swelling is gone, the bruising is gone, and you can really appreciate the final result from either the fat transfer or dermal filler placement.


Dr. Carney:

FFT is almost identical to the feel of Ellanse in subsequent texture for the first couple of years after your augmentation. In years later as the augmented subcutaneous tissue stretches, it gets a little softer – but never as soft as HA – unless a patients receives multiple surgeries of FFT over time. Patients who add 2-3 inches of FFT girth with multiple procedures will often end up with a “squishy” hand when erect.

I’m sure you’re already aware a female partner can’t detect a difference in the rigidity of the penile shaft – they only feel the variation in total measured girth. Most sex toys involving vaginal penetration in today's market have a softer outer finish for improved comfort.

Dr. Shafer:

We generally recommend one week.


Dr. Wall:

Strenuous activity after 3 days, this includes gym, running, and exercise. Contact sports can be done after 1 week.


PhalloFILL:

We recommend the patient avoid anything that could cause an infection such as a swimming pool, hot tub, ocean/lake, or sweating for 72 hours post procedure. We advise the patient to avoid sex or self-pleasuring for 14 days for the best aesthetic result.

Dr. Wall:

You can gain significant flaccid length. To use a colloquial expression, “you can go from a ghower to more of a show-er.” Because you’re stenting the fascia underneath to allow it to not retract as much.


Dr. Tsay:

So the procedures (fat or dermal filler) don’t give you an increase in length per se, but more than half my clients who state they appreciate the increase in girth, also say that their flaccid length increases as well. So that is a beneficial “side effect” of girth enhancement.


PhalloFILL:

No. There is an illusion in some of the before and after photos on our website that there IS an increase in length, but in reality you simply have less “shrinkage” after the PhalloFILL enhancement therefore you maintain a “fuller length” when flaccid.  Research shows that the only safe and effective way to lengthen the penis is with “stretching” or traction using a penile extender device or stretcher such as the Phallosan® which you can use at home. Learn more about Phallosan here.

Phallosan® exerts gentle tension to the penis.  A few small studies have reported length increases of a 1/2 inch to nearly 2 inches using devices such as this.

Surgical methods for lengthening the penis such as separation of the suspensory ligament is risky and often ineffective.  The surgery can result in complications such as infection, scarring, and loss of sensation or function.  Often the ligament reattaches and causes a retraction of the penis from tissue scarring which can cause the length to actually decrease after surgery.


Dr. Oates:

I have had a few guys tell me they feel they have gained length from Girth augmentation and this was a bit of a surprise. I do believe that stretching can make a difference in length but most guys using stretching devices don’t see it because it takes a lot of dedication with hours of daily use over months. Are these guys getting constant mild stretching from the ‘weight’ of the product in the shaft? Is it just the Flaccid penis does not retract as much because of the product? But I have had a guy swear that his erect penis was longer. In general I tell guys not to expect any increase in length and if they get some it is very lucky. Hopefully I have something in development that can do something to help here and it should be released later this year.

Dr. Oates:

When initially put in the swelling can cause some migration. It is mostly not a big issue. If you are thinking 8 - 10ml total then 6 ml first session usually won't cause that much swelling. And even if you did get some flair at the base towards the scrotum remember it is your own collagen. I dont think it is going to do anything to your count. So many lifestyle factors will be so much more important.


 PhalloFILL:

During the PhalloFILL Enhancement, even and symmetrical columns of filler will be laid from the base to the head of your penis for an overall increase in girth.  The columns can be laid thicker or thinner in different areas if your goal is to correct irregularities in your natural anatomy.  Once the filler has been placed, you will be fitted for a compression sleeve that will be placed to keep the penis extended and the filler in place while the encapsulation and bonding process takes place with the existing collagen and elastin in your natural tissue.  Once bonded, the filler will remain in place offering patients long lasting, natural, and durable results.  Limited lymphatics in the space the filler is placed allows it to last considerably longer than other areas of your body.  While Hyaluronic Acid and other fillers bond to your natural tissue, they are not indestructible and can shift over time depending on the care, sexual lifestyle, and metabolism of filler which varies by patient.  A significant benefit of PhalloFILL and the utilization of Hyaluronic Acid filler as opposed to more permanent options such as PMMA or fat transfers is that we can dissolve and correct almost any irregularity that may arise as opposed to surgery which is often necessary to correct the migration, nodules, and granulomas associated with more permanent fillers.  With Hyaluronic acid, a simple injection of Hyaluronidase can be used to dissolve any unwanted area of filler and touch ups of additional filler can be added at any time to fill in areas that may have shifted or absorbed over time.  Unlike other treatments, PhalloFILL is highly customizable, and the non-surgical approach involves no downtime and a minimal recovery aside from the post-treatment responsibility of wearing your sleeve.

Dr. Oates:

I have seen granuloma in the face with Ellanse that has lasted 4 years. They were manageable with steroid/5FU injections and not too much of a problem because they sort of gave her the result she wanted. Would not be good in the penis. It is more getting thickening and irregularity that worries me.


PhalloFILL:

The risk of a granuloma, inflammation, and lumps are extremely rare when using HA dermal filler. A true granuloma is rare with an estimate occurrence of 0.01 to 1 percent. Generally, this is with auto immune comprised patients but can occur in healthy patients also. Granulomas are generally easy to deal with. Sometimes we can break them up with saline and a technique we use in the clinic. We also have hyaluronidase at our disposal if needed to dissolve. Steroid injections could be used as a last resort.


Dr. Solomon:

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.


 Dr. Wall:

The usual risk of delayed onset hypersensitivities, delayed onset nodules and granulomas is somewhere in the realm of 1:4000 depending on the study. I would imagine a more realistic number would be 1:1000 given our experience in Australian clinics. Things that increase the risk of delayed onset nodules are:

(a) Choice of product. Certain allergen products have been shown to have a greater risk of hypersensitivity reactions in the face.

(b) Poor sterile technique can cause a biofilm to develop that can increase the risk of such reactions, leading to granuloma formation

(c) Unclear immunophenomena that cause an overreaction to the filler by the body’s immune system causing immune cells to wall off dermal filler components to create a granuloma.

Fortunately, they can be treated with prompt recognition prior to reaching the granuloma stage with anti-inflammatory steroids, antihistamines and antibiotics. Occasionally, they will require more invasive treatment with hyaluronidase injections. If this does not resolve the issue corticosteroid intralesional injections +/- injectable 5 fluorouracil injections may be required. These are very specialist medications requiring close monitoring by your phalloplasty physician.

Dr. Oates:

I have been using HA for PE (penile enhancement) since 2013. Guys had been asking if there was anything that could be done for the size of their penis without surgery. I found the original Korean papers describing using HA www.sciencedirect.com/science/article/pii/S1743609515333543 plus this Italian article www.ncbi.nlm.nih.gov/pubmed/23388646 . But they were done by Urologists who are not experienced cosmetic injectors. I thought the procedure could benefit with refinement.

My starting point was initially safety. I already had a successful facial plastic surgery practice. One penis dropping off would be bad for business. So certain steps were put in place to make it as safe as possible.

  1. This including using HA rather than a permanent or non dissolvable filler. The great advantage of HA is that it can be 'tuned' with tiny doses of a medication called Hyaluronidase or even totally dissolved with larger doses. In the early days this was very reassuring.
  2. Next was to use 'blunt' cannula. Most injections were being done with needles which have a cutting point. Cannula look similar but are blue ended. We need to puncture the skin with a needle first then use the cannula once in. Injecting is the space between the superficial (Dartos) fascia and deep (Buck's) fascia. Inject circumferentially.
  3. Circumfrential. Most described techniques were just injecting on the 'top' surface of the penis and looked a bit like a turtles shell. People (still) worried that injecting underneath would put pressure on the urethra - tube that passes urine out - but this is just not the case (not even with stimulatory fillers).
  4. Doing as a sterile procedure. In the face skin fillers were just being done as a 'clean' procedure we wanted it to be done sterile like a surgical procedure.
  5. Doing the procedure in at least 2 stages, this allows us to get better symmetry as the penis is often variable in size over the day.
  6. Getting it numb with topical cream. The idea of needles in the penis is scary enough, best if numb first. The vast majority of guys are surprised how comfortable it is.

My belief was if we had a walk in, walk out, no downtime, painless procedure that gave you a penis that looked normal, felt normal, worked normally but was bigger then a lot of guys would be interested. In following threads and post I will fill you in on more of development since.

Comment and questions open on the forum are best. I have answered hundreds of PM's but they dont benefit anyone else. You are probably here anonymously, let everyone benefit from your question if possible.


Dr. Tsay:

At Ageless MD, we offer a variety of different fillers, as well as fat transfer, to enhance the overall girth of your flaccid and erect penis. We also use dermal fillers to enhance and increase the size of the glans.


 PhalloFILL:

After careful consultation with the trained and credentialed PhalloFILL injector, a patient will first be given a local anesthetic around the desired injection area to prevent any discomfort or pain during the procedure. The injector will then perform a series of dermal filler injections, injecting a total volume of 4 to 8 units of filler per session depending on the patient’s anatomy. At the end of the procedure, patients are fitted for a compression sleeve which will initially be worn for 72 hours while refraining from sex and self pleasuring.  A follow up phone call will be scheduled one week post-procedure.

Dr. Oates:

We use 'blunt' cannula. Most injections were being done with needles which have a cutting point. Cannula look similar but are blue ended. We need to puncture the skin with a needle first then use the cannula once in. Injecting is the space between the superficial (Dartos) fascia and deep (Buck's) fascia. Inject circumferentially.


Dr. Wall:

I prefer the use of a blunt tip cannula. I perform a dorsal nerve block to the base of the penis first to numb it along its whole length. I then use a slightly larger size cannula then most practitioners to avoid the risk of damage to veins and arteries. Smaller gauge cannulas can more easily penetrate the deep fascia, which can lead to scarring of the fascia that can result in permanent deformities to the shaft, along with damage to underlying erectile tissue/nerves and vessels. A needle is used to inject the head of the penis. It is performed in a similar way to lip fillers. 3-5ml into the glans is the usual amount for best results. Rarely, you may need to use a needle in some circumstances such as previous use of collagen stimulating injections such as Ellanse. The collagen stimulating process causes a thickening of the internal architecture between the fascial layers making it hard to pass a cannula. This situation is uncommon.

Dr. Wall:

A good candidate is anyone wanting to inject confidence into this area of their lives. They should be above 18, be fit and well medically and have a goal to increase flaccid and erect girth, and increase flaccid length. Men experiencing retraction of the penis during sport/cold weather or just in general, notice a significant improvement in flaccid length after this procedure. They typically go from being a 'grower to a shower'. Men who suffer from premature ejaculation are excellent candidates for glans dermal fillers. This decreases sensation in the head of the penis resulting in significantly longer lasting performance without the need for medications.


Dr. Solomon:

Let me answer the last question first. I turn away almost one third of the men who seek my opinion. Most often, these are men who are either very unrealistic in their goals, or they have a very normal to large penis and I do not think the benefit of surgery outweighs the risks involved. The ideal candidate is a healthy male who wants to make his penis larger in one or more dimensions and has no issues with erectile dysfunction. The reality is that I see men of all types with variation in their health, so I do make exceptions for different medical conditions. I do not do girth procedures on smokers. I have found that smokers in particular have a high complication rate from girth procedures, so I will no longer treat them. The corollary of that is that men who have complications of fillers and are smokers are also at high risk of complications. I ask them to stop smoking for 3 weeks prior to surgery and 3 months after surgery. I have had men who start smoking after surgery and inevitably they need more surgery to get them healed.


PhalloFILL:

The immediate patient that comes to mind when we think of a “good candidate” is a HEALTHY patient. This is a cosmetic, elective procedure and we simply do not perform elective procedures such as girth enhancement on patient who have diseases or risk factors that could lead to a complication. Now let’s discuss the anatomy of the penis of different men that may make one a better candidate than another. The best candidate the PhalloFILL girth enhancement will have the ability to achieve a good erection, absence of pubic fat pads, constriction bands often referred to as phimotic rings are not observed, no excessive retraction or “turtling”, free of blood thinners, no major surgery to the penis or urethra, and clear of sexually transmitted diseases.

During the consultation we will ask questions to determine if the patient has unrealistic expectations which is a contraindication to treatment. Those patients are discouraged from moving forward with the procedure. Many men suffer from penile body dysmorphia which is common in over 50% of men, but if the condition is within the normal scope of penile body dysmorphia the patient will be coached about what is realist and limitations of the treatment before we proceed.


Dr. Oates:

There are 5 sort-of characteristics I think about when I’m thinking of the ideal penis for the CALIBRE procedure, and that’s basically: (1) being of normal size; (2) being circumcised; (3) not being too much of a “shrinker;” maybe having a bigger head than the shift; and (5) then not being overweight. See more on the topic discussed in Episode #1 of my Podcast:

Dr. Wall:

We use Emcyte PRP for erection enhancement P-Shots. The feedback I have about this is really remarkable. I hear many of my patients say it takes them back to when they were in their early 20s in regards to strength and longevity of erection. The caveat I will put on PRP results are that not all PRP is created equal. When investigating which clinic to attend for PRP, I suggest looking at the amount of platelets concentrated per ml. Most inferior PRP concentrating systems have 400-600 thousand platelets per ml. Emcyte PRP has 1.2-1.5 million platelets per ml. To explain how it works, Platelet Rich Plasma treatments harness the natural healing and regenerative capabilities of platelets. In normal physiology, these cells are the first to arrive at the scene of an injury. They help in the clotting process, but play a special role in healing, releasing growth and healing factors. The more platelets, the more growth and healing factors. That is why it is important to choose a device with superior concentrating abilities. Most of my patients choose to have both PRP and Filler phalloplasty as a complete downstairs rejuvenation package.


Dr. Tsay:

Many of our patients combine their penile enhancement with PRP. When that happens, the PRP has regenerative properties, so it increases the quality of the erection, the duration of the erection, and the sensation around the glans.


 PhalloFILL:

PhalloFill does inject PRP as well as exosomes in the penis. Often we inject these “biologics” on the same day as a PhalloFill enhancement. However, we inject it for the “health” of the penis not for size enhancement. We have seen some great changes in the functionality of the penis for better erections however we have never noticed a change in the length or girth of the penis.

Dr. Wall:

Such a great question, and one I would imagine not many consider prior to adult circumcision if one plans to have filler phalloplasty. I prefer the high and loose cut (not overly loose). This is especially appropriate if one has significant size goals with a plan for 20ml or more. It allows easier expansion of the tissues and a more smooth, symmetrical result.


Dr. Horn:

I’d recommend a low and tight or low and loose circumcision for dermal girth injections. They key aspect being the scar close to the glans.


Dr. Shafer:

You do not need to be circumcised. We treat both circumcised and uncircumcised patients.


Dr. Casavantes:

Circumcision isn’t required but strongly encouraged before injection.


Dr. Carney:

Circumcision isn’t required by strongly encouraged before injection. (re-wording)


 PhalloFILL:

The question was related to which circumcision is best for girth enhancement, but I

will answer as some others have about if we do or don’t treat the uncircumcised penis.</p>

The PhalloFill enhancement can be performed on a circumcised or uncircumcised penis. We will admit that it’s easier to offer the enhancement to a circumcised penis and we can generally provide more girth with a circumcised penis. That being said we have hundreds of satisfied patients with an uncircumcised penis. There is more stringent aftercare required when uncircumcised and we must inject less syringes of dermal filler per treatment, therefore requiring more visits.


 Dr. Oates:

Generally we prefer a well Circumcised penis over an intact Foreskin. But since most guys in Australia now are uncut it is routine for us to treat uncut guys. But the Circumcision can give its own issues. Some guys, especially when done as adults, get hypertrophic (thickened) scars. These can be difficult to get past with a blunt cannula. Even some very smooth well healed scars can be stuck down and give a depression – especially in the midline on the ‘top’ side of the penis.

We like the Circumcision to be closer to the glans maybe 1cm from the rim of the corona. I saw one recently where it was sutured directly to the glans which is not idea either. The skin past the Circumcision tends to be very thin and a bit more difficult to get perfectly smooth. Some guys get skin ‘bridges’ from the healing of their circ. That is there are little tunnels of skin. The problem is recognizing them and ensuring they are sterile when doing the procedure and they can harbour bacteria.

Dr. Shafer:

Juvederm Voluma XC is the longest lasting reversible product. This is Dr. Shafer’s favorite product to inject for patients as it’s the thickest of the injectable gels and lasts the longest.


Dr. Wall:

I prefer Teosyal Ultimate. This is the best filler that seems to have the best safety and efficacy data in the literature, plus it most mimics the look and feel of the natural penile tissue.


Dr. Tsay:

At Ageless MD, we use a variety of different filler products to enhance the girth of your penis. The most obvious would be fat tissue; this involves a fat transfer via miniature liposuction from your lower belly. We process the fat to be micronized, and used in a syringe to be injected all along your shaft to increase your girth. I believe fat is the best filler, assuming you have enough to harvest for girth enhancement.

If you don’t have enough fat, there are a lot of other choices such as fillers made of Hyaluronic Acid (HA). There is also another filler called Radiesse that we use and that’s made of Calcium Hydroxyapatite (CaHa). The reason I like this filler in particular, is that CaHa is found in your bones. What better product that is already naturally occurring in your body, that we can use to put into the penis to mimic a firm, hard erection.


 PhalloFILL:

The PhalloFill enhancement is performed with Revanesse Versa +. During the development of the technique, we evaluated Juvederm Ultra Plus, Juvederm Voluma, Resylane Defyne & Refyne as well as Revanesse Versa +. After evaluating migration, firmness, ease of injection, and volume of syringe we decided that Revanesse Versa + is the superior product for penile girth enhancement. This was also based on scientific knowledge of the molecules of HA dermal filler including the firmness and flexibility of the product.


Dr. Liu:

I use Juvaderm, Restylane, Voluma, Radiesse, and Bellafill.

Dr. Wall:

There are no documented reports of HA causing ED I am aware of in the shaft. However, overfilling of the glans can cause a reduction in glans blood flow causing it to be less hard during an erection. It is for this reason I am conservative in filling no more than 3ml per sitting in this area.


 PhalloFILL:

Theoretically any minimally invasive procedure involving the penis could lead to erectile dysfunction or ED. The likelihood of the PhalloFill enhancement technique causing this issue would be extremely rare. This is because we do not enter the corpora cavernosum which holds the blood for the erection, nor do we inject anywhere near the nerve bundles that affect the erection. Anything could happen with non-FDA cleared products such as infection that could lead to ED. Make sure your provider is using FDA cleared dermal filler and clean technique to ensure a safe injection.

Dr. Horn:

It is possible but a consultation would be required.


Dr. Wall:

I do not recommend dermal filler over the top of an inflatable implant, or any penile implant for that matter. Placement of filler can cause damage to the implant. In rare cases of infection, there would be no option but to surgically remove the inflatable implant. Hence, in my opinion, risks outweigh the reward here. For this reason I do not place filler in an area of previous implant/prosthesis.

Dr. Solomon:

Liquid silicone is the injectable form. Its use in medicine for soft tissue augmentation is no longer permitted in the US. It is permitted for some ophthalmic uses. It is prohibited for soft tissue augmentation because the complication rate was unacceptable when it was studied in the past. Liquid silicone was initially thought to be useful when injected in microdroplets into the dermal layer of skin. Injectors of silicone in the penis do not inject silicone into the dermal layer of the penis skin because this layer is quite thin and microdroplet injections in this layer would not provide any significant girth to the penis. In my experience, it has been injected into the Dartos layer of the penis, which has relatively loose tissue and no dermis in which to seat the silicone. Liquid silicone acts by reacting with the body, forming something called a foreign body granuloma. Over time, these granulomas enlarge and become hard nodules. These nodules can be difficult to remove, They can erode through the skin causing ulceration. More importantly, there is only one type of liquid silicone approved for human use in the US. Some patients get injections with non-medical grade silicone that has impurities. The body reacts to these impurities, often causing oozing and ulceration. For these reasons, liquid silicone is not a useful product in the long run for penis enlargement.

Dr. Solomon:

I perform Surgimend graft surgery (similar to Alloderm & Belladerm). Alloderm and Belladerm (among others) come from human sources. In particular, Alloderm is a donation from someone who has died while Belladerm often comes from remnants of abdominoplasty (tummy tuck) tissue that is removed at surgery. Human dermis is then prepared from these materials. Human dermis varies in thickness depending upon what part of the body it is from and the age of the donor. Human dermis gets thinner with age. As a rule, the thickest human dermis is not more than 2 mm and on average about 1.5 mm. Surgimend comes from fetal calf tissue. This has several advantages. It has never been exposed to bacteria, so it is sterile. Calf dermis is thicker than human dermis. This tissue is cut by machine. So its thickness is uniform and because calf dermis is thicker than human dermis, it is available in thicknesses from 1 to 4 mm.

My average Surgimend graft is 3 mm thick. This seems to be the "sweet spot" between giving a good result while allowing it to revascularize in a reasonable amount of time. I have used 4 mm grafts in some patients, as well as 2 mm grafts in some.

You can have a second wrap, but recovery is long and in several cases, the penis has been almost too thick for comfortable intercourse. I warn patients about these issues before performing additional girth enhancement.

Dr. Solomon:

I have tried many methods for glans enlargement. None of them provides a permanent solution, so I do not offer this to my patients. I am aware that some physicians use injections, mostly hyaluronic acid. This generally goes away, but has, on occasion has left some nodules that I have had to remove surgically. I have also tried fat grafting the glans and using dermal graft material. None of these methods provided a natural, long lasting glans enlargement, so I do not perform this procedure any longer.


 PhalloFILL:

Hyaluronic Acid (HA) filler can safely be used to increase the size of the glans (head) of the penis, although with less aesthetically appealing results.  The glans is tissue rich in vascularity and lymphatic drainage and the treatment in the glans may only last 3 – 4 months.  The PhalloFILL enhancement was developed for increased girth to the shaft of the penis.  Hyaluronic acid injections to the glans of the penis are effective for increased size, however patients should not expect the consistent and lasting results as seen on the shaft of the penis.

Our goal is for patients to be happy with their aesthetic results and the longevity of their filler retention.  We do not believe the majority of patients will be happy with the results in the glans, where as we can achieve years of longevity in the shaft using the same filler.


 Dr. Wall:

Yes. Using a medium thickness filler with good cohesivity, excellent elasticity and a moderate hyaluronic acid content such as: Juvederm ultra plus/RHA3/or restylane Lyft into the substance of the glans itself provides impressive size improvements to the glans. This should be done under ultrasound guidance to avoid the dorsal arteries to prevent occlusion of important penile vasculature. This is a hallmark of the Contour Clinics enlargement experience, where safety is our priority when performing such procedures.

Dr. Solomon:

Penis length surgery, sometimes called ligamentolysis is one of the most common procedures that I perform. It has a high degree of patient satisfaction and the questions here are good ones. I tell patients that the average increase in flaccid length is 1 inch (2.5 cm). The most I have ever seen is 2 inches (5cm). This is related to the amount of penis that is beneath the ligament. The increase in length that occurs is always in the flaccid state. Some men tell me that they are longer when erect, but there is no way to know in advance if there will be a gain in erect length. Moreover, I do not measure patients in the erect length, so I have no data to answer this question in any greater detail. To my knowledge, there is no large study that discusses this. There are some reports of about an average of one-half inch (1 cm) increase when erect after surgery. Many men think the angle of their erection will change after surgery, but I have not seen this in my patients. I do several things in the surgery itself to restore the angle. I also have my patients wear a weighted condom for 6 hours each day for 6 months after surgery to help prevent scar tissue from pulling the penis back.


Dr. Liu:

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 deep one is commonly called the 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 factors). Each individual is unique and the amount of lengthening is different for each person. 

Dr. Solomon:

Scrotal webbing is an issue for many men. It can interfere with intercourse and be a source of irritation during exercise. There are several methods of correcting the web. The oldest method is known as z-plasty. Other methods include a U shaped skin excision and a V shaped skin excision. The decision about which pattern to use is based upon the extent of the problem, which varies with each patient. The surgery itself is not associated with much postoperative discomfort, but there is a large a mount of swelling. This takes the better part of a month to resolve and in that time men are restricted in terms of physical activity and sexual activity. Surgery is performed as an outpatient. Some patients require a drain to be used while others do not. This is a decision that I make at the time of surgery. The scars from these procedures are well hidden due to the nature of the skin of the scrotum. I use dissolving sutures that do not need to be removed.

Dr. Liu:

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.


Dr. Solomon:

I do perform testicular enhancement. This is one of the areas where I will use fat grafting. I work with a urologist in Beverly Hills to assure that the fat is placed in the proper plane around the testicle. The fat provides a natural feel along with a modest augmentation. Most men who seek this treatment have been taking testosterone and note a change in the size and consistency of their testes. I will occasionally place implants in the scrotum, again, working with a urologist in my Beverly Hills location. These can be placed alongside the existing testes or for men who have had their testicle removed. These implants are firmer than normal testes. I do not place caps on the testicle because they make it difficult to examine men for testicular tumors.

Dr. Solomon:

I have performed surgery on men with true micropenis. The nature of the procedure is quite customized since there are often several components to the problem. The goal for these men is improvement. It is often impossible to get a true micropenis to be more than a modest penis, but for these men, that is often enough.


Dr. Wall:

This is a difficult area to improve with non-surgical or surgical options. Small amounts of filler can provide improvements in micro-penis thickness, and platelet rich plasma has anecdotally been suggested to increase penile size, although improvements are modest and unproven in the scientific literature.

Dr. Tsay:

Injection technique is extremely important. The reason for this is that the injector has to possess masterful control over the syringe, because we’re dealing with delivering exact amounts of product. The reason this is important for girth enhancement is to ensure the product is administered evenly and smoothly.


 PhalloFILL:

The founder of PhalloFill and creator of the PhalloFill enhancement began to inject neuro toxins such as Botox and Dysport and the first FDA cleared HA dermal filler Restylane in 2005. After more than 15 years of injection experience of dermal fillers, 10 years of injecting the P-shot with Platelet Rich Plasma, and after training with and shadowing multiple urologists and plastic surgeons with attempts of performing penile girth enhancement, the PhalloFill enhancement was developed.

Dr. Carney:

When girth is added to the penis via any sort of injectable or FFT, that enhancement occurs by adding the bulking agent into to the subcutaneous tissue “surrounding” the vascularized penile organ. The incredibly small capillaries located within the subcutaneous tissue are not affected by total body blood pressure – they are simply too minuscule and remote to be impacted. If you added additional girth augmentation later, our limitation is the degree of stretch within that subcutaneous tissue – not the penis organ. Human tissue is very stretchable with time. You just can’t force stretch it without risks.

Your erection process to attain a full engorgement is an automated sealing process within the organ. If you provided increased blood force it won’t change the amount of blood provided to the penis as it locks itself closed once a full dose of blood is in place for optimal penetration size. Alas, high blood pressure tends to cause an opposite effect on men and their erections as veins in the body can and will harden from high blood pressure, resulting in erectile dysfunction symptoms from insufficient arterial blood flow. Remember, your penis is located on the very edge of your body. That means it gets lower priority of blood flow when resources are limited – as with patients exhibiting cold hands and feet.

Finally, some blood pressure medicines are notorious for triggering significant ED issues as they medicate the same sort of situation I just described. The hypertension drug we recommend patients not use for their blood pressure condition relative to penile performance is Propranolol. We’ve discovered it not only causes ED but also triggers penile fibrosis: the building block of Peyronie’s disease.

Dr. Carney:

Surgically-speaking, a penile FFT is considered to be a fairly simple procedure. However, as you’ll soon discover it’s deceiving in that regard.

I regularly perform organ transplants in the hospital that are considered dangerous and overwhelming to some surgeons. I can tell you with assurance that an FFT penile procedure is far more challenging to achieve a successful transplant than most doctors and patients realize.

An FFT is a “transplant”, and like every other type of human transplant procedure, there’s a lot of places it can fail since we’re trying to move a living organism from one location to another. When a patient gets an FFT and ends up eventually “losing it all”, that simply means the transplanted tissue eventually died and was reabsorbed into the body as waste.

To succeed in this procedure, your doctor must get six points just right. Shortcomings with any aspect will affect the final outcome.

  1. The Right Patient: Not every man is a good candidate for an efficacious FFT. A patient has to possess the right proportion of height and weight. He needs to be fairly healthy as patients addicted to potato chips and comparable junk food usually have fat that won’t transplant with success. Significant obesity usually triggers a poor outcome. Men who’ve had a previous girth enhancing procedure utilizing a permanent man-made injectable like PMMA or Silikon are not good candidates for FFT unless that material is first removed since the injected agent blocks the tiny blood vessels in the penile shaft necessary to ensure the transplanted fat cells stay alive. Likewise, men beyond the age of sixty-five will almost never get a good result – regardless of overall health – as human fat rapidly degrades to a more viscous state after a certain age. Such fat tissue simply won’t survive a transplant. Finally, this is a surgical procedure that requires mild anesthesia. If a patient has health contra’s for anesthesia, this procedure won’t be a viable option.
  2. The Right Harvest: Improper attention to delicateness during the adipose tissue harvest is another source of failure. The fat cells must be extracted in a quantity that will provide a size increase worthy of a surgical investment AND they must be kept flourishing during that substantial withdrawal. Fat cells are rather fragile and although damaged cells can be transplanted, few will survive over the long term in such cases. Exactly “where” the tissue harvest occurs is another source for disappointing results. You can’t extract fat from just any location and expect it to succeed as there are variations in the quality of fat tissue in different parts of the human body. Likewise, some fat material has characteristics more akin to subcutaneous penile tissue compared to other more pliable fat that can leave patients with a distinguished “squishy” outer finish.
  3. The Proper Treating of the Fat: Once harvested, the fat must be reconstituted in a manner that will make it suitable for subsequent reimplantation. We use an FDA cleared fat transplant filtration system to optimize purity, but I credit Dr. Morganstern and his many years refining these procedures with developing a novel shaping technology that optimizes the reimplantation procedure. Again, during this particular process within the treatment is yet another incidence where the fat cells can become damaged and/or die.
  4. The Fat Injection & Placement: Finally, the harvested fat tissue gets transplanted into the penis. The most common mistake I’ve seen in this aspect of FFT is with doctors using the wrong needle for a particular patient. There’s no such thing as a “one size fits all” in any aspect of phalloplasty. Also, there’s an art form to the distribution technique that when poorly executed usually results in unevenness or lumps within the shaft several months down the line. Another common error is when the surgeon attempts to add too much fat into a singular procedure. We understand most men want the biggest possible outcome in a singular procedure but if you add too much at once, it increases the likelihood you’ll eventually end up relinquishing almost all of the transplant. One other mistake I’ve seen is where the doctor agrees to perform too many congruent procedures along with an FFT. Certain procedures are notorious for triggering excessive hematoma which prolongs any healing process. Living tissue transplants stand little chance of long-term viability if the time window for healing is overextended.
  5. Survive the 72-hour “Tissue Vulnerability” Window: Assuming everything I just discussed was performed to perfection, the number one reason most fat tissue transplants will fail to live up to expectation is because of a 72-hour post-transplant assimilation period. For about three days after post-procedure, the transplanted cells will be unable to access any life-essential blood supply. Some of the cells will almost always die during this nutrient-starving phase. We pre-treat the penis before each procedure with a patented device that Dr. Morganstern developed that triggers endothelial cell production for healing penile trauma / Peyronie’s disease. We found this technology bridges the lack of blood flow nutrients immediately following surgery to a level that minimizes the loss of viable fat cells.
  6. Following Prescribed Aftercare: Given the delicateness of the vulnerable cells during transplant and variations in how quickly healing occurs between one individual and another, it’s crucial to follow any prescribed aftercare program indicated by your surgeon to ensure long term success. Regardless of how capable your surgeon and how well your particular transplant procedure came out, it can fail quickly if you don’t follow recommended post-operative care.

Dr. Liu:

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 subdermally (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.

Dr. Liu:

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.