By Dr Chen Tai Ho
Sexual organs are a part of our biological make up. Yet, it is often taboo to discuss our anatomical bits openly among families and friends.
With growing sophistication and affluence, many men all over the world (including Malaysia) are considering getting larger “manhoods”. Requests for penile enhancement is on a steady rise.
Penile enlargement is used to treat medical conditions such as micro-penis, which can be attributed to hormonal deficiency.
However, the large majority of clients opting for penile enlargement procedure have penises in the range of normal size. For 99.999% of men (not an official statistic, but a percentage I can imagine to be true), bigger penis equals masculinity, better performance in bed and imagined or real higher satisfaction from sex partners.
Having a small penis may affect a person’s self esteem, making one feel insecure, and also in some cases, may cause marital breakdown.
The marital breakdown might not come from the wife’s dissatisfaction with hubby’s appendage size per se, but rather with stress and unhappiness caused directly and indirectly by erectile difficulties and poor performance in bed when the man feels lack of confidence and poor self esteem from his own perceived inadequacy.
Awkwardness aside, patients are usually confronted with the dilemma of where to get help with lengthening their “member”. Who is the best doctor one can trust for this sort of procedure?
Usually, male plastic surgeons or urologists are sought for their expertise.
There are numerous creams, oral supplements, herbal concoctions, massages and even stretching gadgets in the market, many of which are sold online, which claim to increase the length and girth of the male genitalia. It’s fair to say that most of these products have misleading claims, as studies show that they don’t work and do not give long term results.
There are a few methods that do work though. A surgical procedure involves cutting the suspensory ligament, which allows the internal part of the penis to move forward and outside of the pubic area. This gives a one to two inches increase in length.
Several weeks of recovery is needed before sexual activity can resume.
As with any surgery, penile lengthening surgery comes with risk of bleeding, infection and downtime. Scarring is a possibility, with the scar tissue causing retraction and decrease in penile length.
So instead of having a longer penis, there’s a small but possible risk of getting an even shorter “member”!
A procedure growing in popularity is penis enlargement using hyaluronic acid dermal filler injection.
This is the same filler used for reducing wrinkles on the face or augmenting facial features such as creating a sharper nose bridge, higher cheeks or more luscious, kissable lips.
Hyaluronic acid (HA) is a substance naturally found in the human body. It can be found in connective tissues, the eyes, cartilage, joint fluids and skin tissue.
HA is a gel-like water-holding molecule. It is a space filler and cushioning agent in all mammals.
When HA gel is injected, it acts as an inflated cushion to support facial structures and tissues that have lost volume and elasticity due to the ageing process.
HA also draws in water to make the face look fresh and supple. Thus, HA filler injection is a very popular and sought after procedure to beautify one’s face.
Interestingly, more and more doctors and surgeons worldwide are using HA fillers to increase the girth of the penis.
Penile enlargement by dermal filler is a delicate procedure and should be left to experienced doctors. This procedure is minimally invasive and usually does not usually cause major complications.
It takes about half an hour to complete, and the client can go on with their daily chores comfortably in just a few days.
Doctors usually start by anaesthetising the patient with an injection to ensure they are comfortable and without pain throughout the procedure.
Filler is usually injected with a blunt tip cannula around the shaft of the penis to increase its circumference. Up to 15 millilitres of HA fillers can be used, depending on how much improvement is desired.
Of course, the client’s budget also may limit the volume of fillers used. The doctor identifies the right entry point for injection of the filler in order to enhance the girth of the penis shaft.
The glans or head of the penis can also be injected to increase its diameter.
The result is often instantaneous. In fact, clients can see better results once the filler properly integrates with collagen tissue inside the penis.
The typical result is an increase in circumference of up to 20%, depending on the amount of filler used. Results can last over a year before needing more top-up fillers.
A friend of mine, Shah (not his real name) decided to have the procedure done for cosmetic purposes.
A week after his procedure, Shah dropped by his doctor’s clinic to personally thank him for his results. Shah was that ecstatic over his improvements. I can imagine his wife grinning from ear to ear.
Added Notes Not by the above author
The American Society for Aesthetic Plastic Surgery 2010 statistics on cosmetic surgery emphasized the steady increase in the frequency of minimal invasive cosmetological procedures as a result of increasing public awareness. Many of these products work very well for people, but they should be used appropriately by qualified physicians who understand the intricacies of the medications used and how to combat with complications that may arise. Even if advertising about drugs and medical procedures are prohibited by law in some countries, through the internet banners on popular web pages or via spam mails, the information about the procedures and the commercials of these products are still distributed freely. Disturbing stories arising from all around the world tell us that there is an unsafe climate for patients looking to enhance their appearance with non-invasive procedures with lower prices in the current economy. There is a growing need for physicians to be properly trained to respond to adverse events.
A Google search with the brand name of the well-known hyaluronic acid filler ends up with more than 4 million web pages. Some of these web pages distribute the uncontrolled wrong information about the dermal fillers and soft tissue augmentation procedure. Some others are designed to market these products on internet. Easy accessibility of these products, increased popularity of such procedures and the underestimation of the possible risks of the procedures resulted in a rise in illegal injections with dangerous, non-branded, non-approved or unsafe substances used by unlicensed or unqualified people or even by patients themselves.
Penile size is a big problem in many men’s mind. A man is often troubled by concerns that his penis is not large enough to satisfy his partner or himself. He is ashamed to have others view his penis, especially in the flaccid state. Such concerns might be unfounded in reality and might be a presentation of social anxiety or some other clinical problem, such as erectile dysfunction. The effects of media and internet usage make this problem more serious.
Most men who request for penis enlargement have a normal–sized and fully functional penis but visualize their penises as small. Most patients who seek appearance–enhancing medical treatments report some degree of body image dissatisfaction, which is believed to motivate the pursuit of these treatments. However, patients with extreme body image dissatisfaction may be suffering from a psychiatric disorder known as body dysmorphic disorder (BDD), which is a serious disorder of body perception. Although patients with BDD frequently seek cosmetic treatments to address their appearance-related distress, such treatments are rarely beneficial.
There are other sporadic cases of self-induced subcutaneous injected substances, such as liquid paraffin, cod liver oil, metallic mercury or mineral oil into the urogenital region in the literature mainly for the purpose of penis enlargement.
Despite the debates on penis augmentation, demands for enhancement are increasing. Surgical procedures and various fillers are being used widely. Vardi et al performed an extensive systematic review based on a search of 34 selected articles and concluded that the use of cosmetic surgery to enlarge the penis remains highly controversial. There is a lack of any standardization of all described procedures. Indications and outcome measures are poorly defined, and the reported complications, such as penile deformity, paradoxical penile shortening, disagreeable scarring, granuloma formation, migration of injected material, and sexual dysfunction, are unacceptably high.
Kwak et al aimed to identify the feasibility and efficacy of penile girth enhancement by injection of hyaluronic acid gel. A total of 50 patients with subjective small penises were enrolled and prospectively followed for 18 months. There were no inflammatory signs or serious adverse reactions in all cases. According to their follow–up results they concluded that penile girth enhancement is a very effective and safe technique for penile augmentation.
Therefore, although some data have been accumulated for hyaluronic acid gel as penile soft tissue filler, there is no evidence–based clinical guideline for dermal fillers for penile augmentation yet. Long term data are still required before a general consensus can be reached. Recent findings point to the absolute need for a thorough psychological assessment of men requesting penile enhancement procedures. Physicians who perform the penile augmentation procedure should work in a very close collaboration with psychologists before the procedure and afterwards. This will verify the eligibility for surgery and counselling.