Overview of the surgery:  

Penis Enlargement is also known as Ligamentolysis or ‘penis lengthening surgery’, a cosmetic surgery procedure involves specialized techniques to lengthen and widen the penis. To lengthen the penis, a suspensory ligament release procedure is done while a fat transfer procedure is done to add girth. These procedures can be performed together. On average, patients see an increase of ½ to ¾ of an inch in length and 15-25% increase in circumference. These results are expected to be lasting. 

For penis lengthening, the suspensory ligament is released at the base of the penis. The penis is attached to the pubic bone by the suspensory ligament, and when this ligament is released, the penis is allowed to slide forward, increasing its visible length. The release is done through a small incision in the pubic region, where it will be hidden in your pubic hair. In select cases, removal of pubic fat and/or skin rearrangement at the base of the penis and/or scrotum may also be performed to further enhance the results, 

For increasing girth, a variety of techniques are available. Fat transfer, in which fat is removed from the abdomen or thigh, purified, and skillfully injected into the shaft of the penis, is the most popular technique. Placement of tissue grafts such as dermal fat grafts and skin matrix may also be used. 

Preparation before the surgery: 

In the week before, you should not take any medications containing aspirin (acetyl salicylic acid), since these products affect the bloods clotting mechanism and therefore may lead to excessive bleeding during and after surgery, hence resulting in increased bruising. Taking high doses of vitamin E preparations, eating large amounts of garlic and consuming alcohol can also produce the same result and should be avoided. If pain medication is necessary, we recommend you take ibuprofen/paracetamol. 

It is in your own best interests to quit smoking, at least two weeks before and until 2 weeks after surgery. It is well known that smoking causes narrowing of the blood vessels, which leads to a decreased blood supply to the skin, thus slowing and interfering with the healing process. 

Be sure to inform your surgeon of any medications you take, as well as possible allergies including (drug, latex, plasters and so on). 

Your surgeon will decide whether preliminary examinations are necessary, such as blood tests, an electrocardiogram, or x-rays of the lungs. If this is the case, these tests should be performed several weeks before the surgery. 

If you are having lengthening of the shaft, it is best to shave your pubic area before your operation. 

During the procedure: 

Penoplasty can increase the size of the shaft by increasing either length or girth/width or both. To increase the length, an incision will be made above the base of the shaft. Through this we can release the penile suspensory ligament, thus allowing the shaft to be brought forward, thereby lengthening it externally by typically 1-2 inches. Men with prominent pubic fat pads will gain more length; if for example they have a 2 inch fat pad, and 1.5 inches is removed, the additional 1.5 inch gain will be supplemental to the extension gained by releasing the suspensory ligament. This increase in length is in the flaccid position only and some men may find that the angle of the erection may be slightly lower. 

The increase in girth, involves a small amount of liposuction of the stomach or thigh areas to collect fat, followed by re-introduction of the fat by injection along the shaft. The usual increase in girth (circumference) is between 1 to 2 inches. The fat injection procedure avoids incision scars and because it is a simpler technique, the recovery time is shorter. Furthermore, the benefits of abdominal liposuction will enhance the patient’s appearance. Possible post-operative fat re-absorption and nodule formation can be minimised by limiting the amount of fat injected at one time. The girth enlargement is restricted to be slightly bigger than the tip. The enlargement of the shaft will be evident in both the flaccid and erect states. 

To ensure a natural appearance, we increase both the length and girth at the same time, although it is possible to have either only the lengthening or enlargement (girth). The functioning will be completely normal both in terms of erection and urination. 

After  the surgery:  

In the case of lengthening, you will have deep dissolving sutures in the underlying muscle and tissue and some skin sutures as well as staples to the pubis. With the enlargement, you will have only one small suture to the abdomen (where we collected the fat) and one further suture to the base of the shaft (where the fat was injected), as well as some strapping across the abdomen for one week. You will remain at the clinic for about 2 hours, to allow us to monitor your recovery from the sedation. It is necessary to arrange for someone to come and collect you, as you are not permitted to drive or take public transport for 48hrs after having sedation. 

During the first two or three days after the surgery you may experience a slight amount of discomfort but this is normally controlled with oral pain relief. You may experience a small amount of bruising and some surgical swelling, which will subside after approximately two weeks. Massaging your shaft using Vaseline is recommended each day to resolve the asymmetry of the shaft and prevent lumps occurring. 

You will need to return to the clinic after one week to have your bandages and sutures removed by the nurse. In the case of lengthening, you return again in a further week for removal of the sutures and staples to the pubis. At the follow-up visits you will be examined to ensure that the healing process is proceeding satisfactorily. Further post-operative visits may be scheduled at your convenience to ensure that both yourself and the surgeon are totally satisfied with your results. 

One week’s holiday is recommended after surgery for rest and recuperation before returning to work. A 3-4 week break from aerobic exercise is recommended and couple’s ‘activities’ can normally be resumed after one month, however it can take 3-6 months to achieve maximum length gained from elongation. 

All surgery carries risks and uncertainties 

Like all operations, Penoplasty is not without complications, they are rare but can occur. These include infection, bleeding, collection of blood under the skin, known as haematoma or blood clot; however this occurs in less than 1% of patients and drains and heals spontaneously. 

In some cases with enlargement surgery the shaft may be asymmetrical or lumps may occur due to the position of the fat. Gentle massage should normally resolve this problem.