ANSWERS FROM DR. VICTOR LIU
Penis Enlargement – Length
The non-surgical approach to penis enhancement produces, in addition to girth enlargement, some increase in length when the penis is flaccid. However, when the penis is in the erect state, there is little or no increase in length compared to before the augmentation.
The only way to significantly increase the length of the penis in the erect state is by a minor surgery.
The penis is normally attached to the front of the pelvis (the pubic symphysis) by suspensory ligaments in such a way as much as one-third of the penis is hidden behind the bone and is not visible or “usable”. By detaching the suspensory ligaments responsible for keeping the penis in this position, the penis can be pushed forward so that the length of the visible part (and the functional part) of the penis can be increased.
When girth augmentation of the penis is done with filler or sheath, the length of the penis increases when it is flaccid. However, when there is an erection, the actual length of the penis is not increased. This may be confusing but let me explain. The actual penis, when erected, can not be increased. What we do to increase the “length” of the penis is to push the penis out so that more of the penis is seen or can be used. Up to about one-third of the penis is hidden behind the pubic bone. The only part of the penis that can be seen or used is in front of the pubic bone. This is kept in position by the suspensory ligaments of the penis.
When erection occurs, the “new” part of the penis will expand as well. The surgery can be done under local anesthesia with little or no downtime except for abstaining from sexual activities for a short period of time to be determined by Dr. Liu on an individual basis.
There are other ways to increase the functional length of the penis. In some patients, the fat in the pubic area around the penis can make the effective length shorter by “hiding” it behind the fat. Therefore, by removing the fat or tightening the pubic skin, the “length” of the penis can be increased. Normally, the scrotal penile junction is at the base of the penis. However, in some patients, it is attached further, near the tip of the penis, resulting in shortening of the penis, both visually and functionally.
With the older techniques, there is a tendency for the divided ligaments to reattach themselves resulting in a loss of the gain in length. However, the newer techniques prevent this and therefore, the increase in length is maintained.
There are two types of suspensory ligaments: the superficial one and the deep one. When the suspensory ligaments are detached, the penis can be pushed outwards, so that more of the penis is exposed and is usable. One criticism of this procedure is that the ligaments will reattach, and the increase in length is lost. This reattachment can be prevented by interposing fat, skin, or other tissues from adjacent parts of the body between the two cut ends of the ligament. Another criticism of this procedure is that it destabilizes the penis because the suspensory ligaments are cut. This can be prevented by not cutting the suspensory ligaments all the way, but instead, detaching only 80% to 90% of the ligaments; the remaining 20% to 10% of
the attachment is sufficient to maintain stability of the penis.
There are other ways to increase the functional length of the penis. In some patients, the fat in the pubic area around the penis can make the effective length shorter by “hiding” it behind the fat. Therefore, by removing the fat or tightening the pubic skin, the “length” of the penis can be increased. Normally, the scrotal penile junction is at the base of the penis. However, in some patients, it is attached further, near the tip of the penis, resulting in shortening of the penis, both visually and functionally. This condition is called scrotal webbing.
One way to ensure elongation of the penis is to put traction on the penis immediately after surgery. Initially, the traction is applied manually, and when the wounds have healed, weights can be put on the penis for traction for a period of time. This can be accomplished by using a device designed by Dr. Liu that can be easily hidden. This will all be explained to you during consultation. It is true that even without surgery, the penis can be lengthened by traction devices. However, when the traction devices are no longer applied, the penis tends to retract to its original position. By doing surgery to detach the suspensory ligament, there is a good chance that once the traction has elongated the penis, it will not be retracted.
I wish to point out that in spite of all these lengthening procedures, sometimes the penis will not be increased in length. In fact, some patients report shortening in length. This is the result of adhesions from the surgery itself. The traction described above is designed to prevent the adhesions.
The question that is frequently asked is how much of an increase in length is obtainable. The answer depends on the anatomy of the area and on how much of the penis is hidden behind the bone. If more of the penis is behind the bone, then more can be pushed out. If not much of the penis is behind the bone, then very little can be pushed out. There are other factors that determine the actual length of the “usable” penis. This includes fat in the pubic area just above the base of the penis. For people who have an increase in fat or redundancy of skin in this area, the base of the penis is obscured by the fat and skin. Sometimes as much as one or two inches can be covered. By removing that fat and, sometimes, by tightening the skin, the base of the penis can be exposed, and, thereby, increased by one or two inches.
Another factor that causes shortening of the penis shaft is a condition called scrotal webbing. Normally the scrotum and penis join at the base of the penis. In some patients, the junction of the scrotal skin and the skin of the penis is closer to the tip of the penis. Therefore, the penis appears much shorter as a result. By reattaching the junction of the scrotal skin with the penile skin, the functional length of the penis can be increased, sometimes by as much as 3 to 4 inches.
From the above, you can see that enlargement of the penis both for the length and the girth is a complicated matter and there are many choices. Therefore, it is essential that you see Dr. Liu for a one-on-one consultation to discuss your best options. Dr. Liu offers free consultation for anyone interested in this procedure.
Common Enlargement Questions
Over the last 25 years, the number of male patients seeking aesthetic, cosmetic and plastic surgery services has increased by 500% — from 3% of patients to more than 15% and growing every year. Not only are we seeing an increase in cosmetic procedures that enhance men’s physiques, but we are also seeing a growing number of procedures that improve men’s physical and sexual health as well as libido.
If I had other treatments (fat injections, Penuma, etc.) and am not happy with it, can I still get filler injections?
Generally, filler injection after a person had surgical insertion of Penuma or Surgimend for penis augmentation is safe and do able. However, it is not advisable to do surgical insertion after the person had filler injection because of the adhesions resulting from the injections making it very difficult and even unsafe to perform. One of the problems 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 injections. Some patients had fat injection for girth enlargement and complain that the penis feels too soft and looks uneven. This is a common problem with fat injections 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.
Can I have ligament detachment and Surgimend insertion done at the same time?
Yes, this can be done and is frequently done together, saving the patient a lot of time. The anesthesia and surgical incision at the base of the penis can be used for both procedures, and the recovery period for both procedures simultaneously is the same as doing the procedures separately. For instance, following a procedure, the patient should abstain from sex for at least 35 days. Therefore, if the two procedures are done at the same time, abstinence from sex is 35 days, but if done separately, the patient will undergo two 35-day recovery periods.sometimes it is palpable on the skin surface and does not look natural. One way to treat this would be with filler injections. Some patients had fat injection for girth enlargement and complain that the penis feels too soft and looks uneven. This is a common problem with fat injections 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.
I had a penile implant surgery and my penis seems to be generally shrunken especially the head of the penis. Can this be corrected?
When a penile implant is inserted, it sometimes does not fit perfectly, resulting in areas of pressure and protrusion which may cause problems and deformity. Even when the implant is put in perfectly, there may still be problems because while the implant remains unchanging, the penis will change in shape and deteriorate with age. For example, the head of the penis, the
glans, has engorgement of blood during a normal erection, but in the case of erectile dysfunction, there is no engorgement. Therefore, this will atrophy with time. The outline of the implant may become visible or palpable, causing pain to the patient or his partner. This can be corrected with filler injection into the area, smoothing out the edges and enlarging the penis as well, often a very welcome addition to the treatment for the patient.sometimes it is palpable on the skin surface and does not look natural. One way to treat this would be with filler injections. Some patients had fat injection for girth enlargement and complain that the penis feels too soft and looks uneven. This is a common problem with fat injections 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.
I am 60 years old and am having issues with my erection. Can I have ED treatment and penis enlargement done at the same time?
Yes. Erectile dysfunction can be treated at the same time as penile enlargement. Usually, this is done with shock wave treatment followed by injection with PRP or bone marrow aspirate and then the injection for the filler can be done after that, or even the Surgimend procedure can be done at the same time.