Penile Lengthening Surgery: The Raw Facts

Scalpel held between the fingers of a surgical latex gloved hand.

Seriously…unless it’s out of life saving necessity, the only place something this sharp should go near is heavy facial stubble

The first question most men ask when they discover that the penis can be surgically lengthened is not surprisingly, ‘How?’

Does the surgeon implant some sort of prosthesis which transforms the little fella into some half organic / half artificial appendage that RoboCop would be proud of? Or is there some type of weird Chinese laboratory where they use stem cells to grow extra inches of penile tissue is a petri dish or on the backs of mice, which can then surgically conjoined with the original? Maybe they just use a bit of superfluous rib or cartilage to stretch the little guy out?

Believe it or not, all the above have been suggested and some have even been put into practice. A Serbian urologist by the name of Dr SV Perovic for example published a paper in the medical journal BJU International in 2000 where he detailed a surgical procedure whereby he’d ‘disassemble’ the patient’s penis into its component parts and then insert rib cartilage into a space created just behind the penile head. The pictures of Perovic’s procedure are quite horrific; and all I can say is this…any man who’s prepared to undergo that particular operation for the reported 2 – 4 cm length increase is certainly a better man than me.

Perovic’s ‘penile disassembly technique’ has not surprisingly, failed to catch on. Apart from appealing to only the most gung-ho of patients, most urologists consider it to be a technique that’s fraught with dangers – ‘disassembling’ the penile shaft carries with it a major risk of irreversible nerve damage…and as you’ll probably know, damaged penile nerves can quite easily equate to damaged erectile function.

N.B. If you’ve got the stomach for it, here’s the full text of Perovic’s penile disassembly research - click on the ‘Get PDF’ link to the right of the abstract if you want to see the above mentioned pictures up close and personal.

The ‘Standard’ Surgical Penis Lengthening Procedure – Cutting the Penile Ligaments

So putting aside the more weird and wacky methods of surgical penis lengthening, what’s the technique that most plastic surgeons use?

Well, you might be surprised to discover that the most common procedure doesn’t involve slicing and dicing your actual penile shaft at all – it doesn’t even add any ‘real’ length in fact. What it does do is try to help you to make the most of what nature originally gave you – by exposing part of the penile shaft which is by default hidden from view.

Your penis, you see, extends for several extra inches behind your pubic bone – first arching upwards before coming to rest on the pelvic floor. If you don’t believe me you can actually follow its internal course by feeling the underside of the shaft as it runs through and just behind your scrotum.

Interesting eh?

But the really interesting thing is that everything is held in position by virtue of two ligaments – called the fundiform and suspensory ligaments. And when these ligaments are cut, theoretically at least, part of the internal penis should shift forward into the light of day – giving all those who see you naked the impression of a bigger dick.

If you’re having difficulty visualising what I’m saying – try this handy finger (I know…bad pun) analogy:

Hold your hand up and bend your index finger (the one closest to your thumb) so it forms a sort of ‘n’ shape. Now imagine that’s a side on shot of your penis – with your finger tip representing the end of your penis and everything behind the first joint of your finger representing the part of the penile shaft that’s held internally. That’s pretty much how the little fella naturally looks – thanks to the suspensory and fundiform ligaments which are responsible for maintaining that internal arch shape.

Now just straighten your finger horizontally so that the arch disappears. What happens? That’s right…your finger tip protrudes further forward.

That’s exactly the principle used in penis lengthening surgery. Remove the internal arch (by cutting the aforementioned ligaments) and hey presto…your penis should look bigger.

How Do Surgeons Cut The Penile Ligaments?

An inverted V shape incision is made in the pubis.
The incision is closed in a Y shape to ‘create’ extra skin tissue.
Source: British Journal of Urology

The suspensory and fundiform ligaments are exposed and then severed through a deep incision made in the pubic area. That’s the short answer.

Unfortunately the long answer is a little bit more complicated…because although you’d think that all surgeons would use the same standard incision – that alas is not the case.

Some surgeons use extremely intricate, large incisions with names such as the V-Y plasty, the Z-plasty, the M-plasty…even the ZZ-plasty – to name but a few – all of which take their name from the shape of the cut that’s etched into your groin.

Why do they use these large incisions? Are they just honing their scalpel skills like a child who practices writing his name with a stick in the sand? Well…apparently not.

Some surgeons favour these elaborate incisions because they can be used to manipulate the skin (when closing the incision) to ‘create’ extra skin tissue. These resulting ‘skin flaps’ provide extra skin at the base of the penile shaft, which should theoretically at least, help to prevent the penis from being restricted from achieving its full potential length due to lack of skin. Take a look at the illustration of a V-Y plasty incision above to get a better grasp of what I mean.

But there’s a problem…well actually quite a few problems…associated with these ‘alphabet’ incisions.

Firstly they can lead to significant ‘hypertrophic’ scarring – which are thick red scars that are raised above the surrounding skin. Whilst you could argue that the surrounding pubic hair can help to hide such scars to a degree, they nevertheless remain quite evident to the touch. Secondly, because the idea of these incisions is to shift skin from the pubic area down to the base of the penile shaft, men often find that they’re left with thick, hairy pubic skin on the first couple of inches of their penile shaft – which, as most will testify, doesn’t really leave you looking as nature intended.

Whilst many surgeons still favour the above alphabet-plasty incisions despite their potential complications, others take a more conservative approach with their scalpels.

A good example of this is the transverse incision – a small inch long incision made horizontally just above the base of the penis – as shown in the photo below.

A small inch wide incision is made just above the base
of the penile shaft.
Source: Dr. E. Douglas Whitehead

Surgeons who use this technique point out that it won’t cause the same degree of scarring and won’t leave you vulnerable to your girlfriend hurling abuse such as ‘Yeti dick’ at you during her monthly PMT fuelled rage.

There are still problems associated with even these less invasive incisions though – but we’ll touch on those a little later.

It’s worth noting now however, that it’s the lack of surgical technique standardisation (such as the type of incision used) that leads time and time again to criticism of not just the lengthening procedure, but the various penile girth enlargement procedures as well. With so many surgeons using so many different techniques, it can be difficult to know which is most effective – and it also means of course that the success of the procedure is in no small part to the skills and technique preferences of your chosen surgeon.

Does Penis Lengthening Surgery Work?

Gains Straight After Surgery:

If you have a look on the websites of the various surgeons who perform penis lengthening surgery you’ll often find that they’ll try to prove previous patient successes through pictures taken immediately before and then after surgery – with the patient still dead to the world under anaesthetic. And this pictorial ‘evidence’ can look quite impressive – with the surgical ruler often showing an immediate gain of maybe an inch or two in flaccid penis length.

But, regardless of how impressive these pictures may look, it’s essential to understand that any initial post-surgery improvements are in no way representative of the final outcome.

The success or failure of a penis lengthening operation can in fact only be determined once the area has fully healed (a process that can take up to six months) and is influenced by things such as how much scar tissue forms or whether the ligaments reattach to the pubic bone. What’s more, the final outcome is as much to do with the patient’s commitment to following a post-operative penile traction routine (more below) and other post-operative instructions as it is to do with the surgeon’s skills or the healing process.

In other words, there are a lot of variables to take into account – so never rely on post-operative pictures.

Average Eventual Gains in Penis Length

One thing’s for sure – penis lengthening surgery does more to improve flaccid penis length than erect length. In other words, it will help to transform you from a proverbial ‘grower’ into a ‘shower’.

As such, it tends to be men who suffer from ‘locker room’ syndrome who report the highest satisfaction rates, whilst those who are more concerned about their erect length tend to end up quite disappointed.

In terms of facts and figures, objective research suggests that a successful procedure will on average produce a flaccid penis length increase of between an inch and an inch and a half. Erect length gains however tend to average a meagre half inch or so.

So if you’re thinking of having penis lengthening surgery to impress of those who see you on next year’s holiday to that nudist beach in Acapulco, you could be in luck…lengthening surgery may help you to turn a few envious / lustful heads. But be warned…that look of excited anticipation in the eyes of the bronzed goddess you manage to pull by virtue of your improved asset may quickly turn to a look of disappointment when she finds, back at her place, that you don’t quite live up to her expectations.

Average Gains According to Clinical Studies

In order to corroborate the typical results mentioned above it’s worth taking a look at the findings of a few medical studies.

In 1999 a study published in the Electronic Journal of Human Sexuality for example, assessed the outcomes of 58 surgical penis enlargement procedures performed by 12 different surgeons. The researchers found that whilst the patients realised a moderately impressive average increase of 1.2 inches in flaccid penis length, erect length gains were limited to an average of just 0.3 inches. And regardless of the improvements in flaccid length, sixty-nine percent of the patients felt that the surgery had failed to live up to their expectations.

More recent research published in the medical journal European Urology tells a similar story. In 2005, a team of urologists and plastic surgeons based in Athens, Greece recorded average ‘stretched penis length’ (SPL) improvements of 1.6 cm (0.6 inches) for 11 men on whom they’d performed penile lengthening surgery.

Breaking down the results further, they noted that whilst six had achieved SPL gains of between 1.5 cm and 1.9 cm (0.59 – 0.75 inches), three patients only managed a length increase of between 1 cm and 1.4 cm (0.39 – 0.55 inches). A couple of patients did manage a gain of 2 cm – 2.3 cm (0.8 – 0.9 inches) – but only thanks to the removal of surplus fat from their pubic areas (both patients were substantially overweight with Body Mass Indexes of over 35).

Interestingly, the authors of the above research noted that the majority of the patients did in fact experience improvements to their self-esteem following the procedure – despite conceding that the results had neither been ‘spectacular’ or fulfilling patient expectations. Although seemingly quite a contradictory conclusion, most of the patients included in the trial were suffering primarily from anxieties concerning their flaccid penis size – which again, provides a strong indicator that the lengthening procedure provides more of an ‘aesthetic’ flaccid size improvement than a ‘functional’ erect improvement.

Likewise, in 2006 urologists from St Peter’s Andrology Centre in London reported that the 42 patients they’d performed division of the suspensory ligament on between 1998 and 2005 had achieved an average stretched penis length increase of just 1.3 cm (0.5 inch).

They noted that the best results were achieved by the men who stuck rigidly to a post-operative penile stretching routine – who achieved up to an extra 3 cm (1.2 inches). But whilst that might sound fairly good, spare a thought for some of the unlucky patients at the other end of the spectrum – they experienced permanent ‘paradoxical’ penile shortening by as much as a 1 cm. Yes, you read right…they ended up shorter than they were before – thanks in no small part to the development of scar tissue that caused the penis to retract inwards (you’ll read more about this potential complication of the lengthening procedure below).

As with many studies, the researchers reported quite a low patient satisfaction rate of just 35 percent; and they concluded that due to the significant number of patients who were dissatisfied with the outcome that such surgery should only be undertaken as a ‘last resort’ – a sentiment shared by several studies both before and since.

Penis Lengthening Surgery and Traction

Penile Traction
A vital component for effective penile lengthening
following surgery.

Many men make the mistake of assuming that penis lengthening surgery offers an ‘easy’ two part route to a bigger penis – which simply involves firstly, entrusting themselves to the hands of the surgeon and then, secondly waiting a month or so for everything to heal.

The reality is unfortunately quite different – because the eventual success of the procedure is heavily reliant of the patient’s use of penile traction throughout the healing process.

The ironic truth is that those patients who fail to consistently stretch their penises following surgery can, and often do, end up with next to no gains or worst case scenario…can even end up shorter than they were before.

Regular penile stretching you see helps to control or even overcome two fundamental problems:

Firstly, consistent penile traction helps to reduce the formation of internal scar tissue.

Scar tissue is a real issue with lengthening surgery because it can pull the penis back into the body. By its very nature, scar tissue is highly inelastic (unlike normal skin and muscle) and tries to fuse damaged tissues – the exact opposite of what’s required to achieve results.

Secondly, regular stretching also goes some way to preventing the suspensory and fundiform ligaments from reattaching to the pubic bone – the very ligaments that are cut during surgery to facilitate penile lengthening. Obviously, if these ligaments were to reattach, the entire lengthening process would be completely undermined.

So how long do you need to use penile traction to prevent the above?

Most specialists agree that a minimum penile stretching routine of at least 8 hours per day throughout the healing process is required. One well known specialist surgeon, Dr Harold Reed, summed up the importance of a minimum 8 hour per day penile stretching routine by saying, ‘If a patient tells me that he’s been using penile traction consistently for 7 hours a day after surgery…I’ll tell him that he’s just wasted 7 hours a day’.

So just imagine, a few days after surgery (when every thing’s still very tender) the first thing you’ve got to do is start stretching the little fella for a not insignificant 8 hours per day to preventing him running for cover back inside your body. And if you’ve just had girth enlargement surgery as well, the scenario is even worse. Girth enlargement surgery involves ‘degloving’ the penis (use your imagination) through an incision made all the way around the penile shaft just behind the head – the very place in fact where traction exerts the most pressure.

Penile traction without surgery?

The real irony is that recent research suggests that it may in fact be the traction, and not the surgery, that’s responsible for promoting penile length improvements.

The results of an independent clinical trial published in the urology medical journal BJU International in 2009 for example recorded flaccid length gains of 2.3 cm (0.9 inches) and stretched flaccid length gains (equivalent to erect length) of 1.7 cm (0.7 inches) in 15 patients who used a penile traction device for a minimum of 4 hours a day over a six month period – all achieved without having lengthening surgery first. In terms of percentages the patients increased their average flaccid penile length by a significant 32 percent.

In other words, the patients achieved similar gains to surgery…but without of course the inconvenience, pain and potential complications of surgery. The researchers were sufficiently convinced of the benefits of penile traction to recommend that they concluded that such a treatment option should be considered a ‘minimally invasive’ and ‘effective’ alternative to lengthening surgery.

Potential Problems with Penis Lengthening Surgery

Putting aside the obvious risks of any surgical procedure (such as infections, slow healing wounds and visible scarring etc.), surgical penile lengthening carries with it a few extra potential pitfalls to be aware of.

Penile shortening…

As touched on before, a cruel twist of fate that apparently afflicts around 1 in 20 men who undergo lengthening surgery is rather paradoxically…penile shortening – resulting from either scar contracture at the incisional site dragging the penis back into the body or from the ligaments reattaching to the pubis.

Although a skilful surgeon can go some way to minimizing these problems, as can the patient through consistent penile traction following surgery, the potential for penile shortening can never be entirely dismissed – simply because everyone’s healing processes are different and some people naturally scar more than others. In fact, urologists emphasised in a 2006 study published in the medical journal European Urology that whilst surgery can provide modest improvements of around a 1 – 2 cm in flaccid length, patients should be warned of the possibility of penile shortening.

Unavoidable drawbacks of lengthening surgery…

Apart from penile enemy number one above, cutting the penile ligaments also has a couple of unavoidable permanent consequences that should also be taken into account.

The fundiform ligament for example, keeps your penis pointing upwards during erection. Once that particular ligament has been cut, never expect to look particularly sexually aroused again – because your erections will be more horizontal than vertical. In fact, some men who’ve undergone the lengthening procedure would be happy with a horizontal erection – because they find that they’re left with an angle of erection that looks pretty similar to when they’re flaccid.

The suspensory ligament on the other hand, tethers the penis securely to the pubic bone; and without it, you’ll possess the same sort of penile agility as Mr Elastic. Sure, being able to penetrate your partner at right angles by dislocating your dick may offer some small amusement, but it does nothing for penile stability. The trade-off of having an unsecured penis is that you’ll be more prone to injury during your moments of passion.

A reduced erection angle and increased penile instability are inevitable trade-offs of the penile lengthening procedure. Other complications that may arise however are simply down to the competence of each surgeon or the specific techniques they use.

Other potential complications…

In a review of medical literature published in 2006, doctors from the Department of Andrology, Cairo University for example, noted a number of potential complications linked to the use of V-Y Plasty’s – one of the most common incisional techniques used by surgeons for the lengthening operation.

They noted that this technique (as well as other elaborate incisions) often resulted in an abnormal downward repositioning of the penis – resulting in the penile shaft protruding from the scrotum. To compound the problem, they further noted that these techniques also often leave the base of the penile shaft shrouded on either size by flaps of scrotal skin – a condition nicknamed ‘scrotal dog ears’.

Together with this weird penile repositioning, the researchers also highlighted the tendency for patients to suffer from very noticeable thick, raised ‘hypertrophic’ scarring at the base of the penis; together with thick, pubic hair covered skin on the first few inches of the penile shaft. This latter complication they attributed to the repositioning of ‘skin flaps’ taken from the pubic area, which although were intended to aid the lengthening process, instead tended to cause significant aesthetic abnormality.

Not surprisingly, in consideration of the above, the study was pretty critical of surgical penile augmentation techniques in general – noting that the procedures suffered from a ‘serious lack of standardization’ which produced ‘unconvincing’ results. They emphasised that such surgery remained ‘highly controversial’ in medical circles – pointing to the results of a recent poll conducted by the International Society of Sexual Medicine that showed that the majority of its members didn’t support the use of such procedures specifically because of the combination of frequent complications and minimal successes.

How Much Does Penis Lengthening Surgery Cost?

Funnily enough, it’s not just surgical penile augmentation techniques that lack standardization – so too do the prices. Reputable surgeons based in the places you’d want this type of surgery undertaken (such as the US, Canada UK and Western Europe) charge anywhere from between U.S. $5000 – $10000 for their services – which luckily includes the anaesthetic.

Of course, a surgeon’s fees aren’t necessarily a good indicator of his overall competence or the quality of the surgery you’ll receive – good surgeons can be quite reasonably priced whilst bad surgeons can be the opposite. I include this word of warning because quite obviously decisions regarding your choice of surgeon should be limited to genuine previous patient recommendations and overall reputation.

Moreover, there are undoubtedly places around the world (for example Eastern Europe and Thailand) where you’ll find a surgeon who’s happy to wave a scalpel in hazardous proximity to your genitals for a fraction of the above mentioned price. But again, don’t make the assumption that all surgeons are created equal – because that would be far from the truth.

Risking the wellbeing of your prize asset by putting it quite literally in the hands of a surgeon with questionable or unverifiable credentials simply due to the allure of a bargain basement price is a recipe for disaster just waiting to be baked. The fact of the matter is you only have one penis…and if you’re seriously considering this surgery then it’s clearly pretty important to you – and as such, never take needless risks based on economic factors.

Should You Opt For Penis Lengthening Surgery?

Answering the above question is in no small part dependent upon where your anxieties lie. If the prospect of getting a hard-on in front of the girl of your dreams makes you break out in a cold sweat, then penis lengthening surgery isn’t the answer…because improvements in erect penile length are usually insignificant. But…if you’re more concerned about how your team mates perceive you in the shower room after the weekly game, then you might find that you’re able to swing your thing with new found confidence – because done correctly, surgery can offer a modest, but noticeable 1 – 2 cm increase in flaccid length.

But remember, these gains don’t happen overnight – they’ll be reliant on your daily use of penile traction for months following surgery. If you’re not prepared to embrace that responsibility, then the significant cash outlay and weeks of discomfort will in all likelihood have been made in vain. And remember, with or without traction, there’s also the possibility that you’ll experience the stuff of nightmares – permanent penile shortening.

Furthermore, as if often emphasised in medical research, techniques are have neither been perfected nor standardised – leading to inconsistent results. Not only does this mean that you’ll have the ‘intrinsic’ problems of increased penile instability and reduced erection angle to contend with, but more serious aesthetic complications such as abnormal penile repositioning and significant scarring may, if you’re unlucky, leave you with more to worry about than your penis size.

As such, penile lengthening surgery should be approached with a high degree of caution – remember it’s considered a last resort treatment option even in medical circles. Just about every legitimate medical paper on the subject recommends that patients should first exhaust all other avenues – from psychoanalysis and counselling through to alternative non-surgical options.

And assuming that you don’t feel that lying on a couch talking about the size of your penis is the answer, penile traction offers the one irrefutably effective non-surgical answer.

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