When it comes to a manhood makeover it might come as no surprise that penoplasty is, pardon the pun, on the rise. So what’s involved and is it safe? Helen Garston reports.

We know penises come in different shapes and sizes but are they so different to make a man go under the knife? The answer, it seems, is yes.

Private clinics aren’t obliged to keep data so it’s very difficult to determine how many operations are carried out each year but anecdotal evidence suggests the procedure is on the rise. According to a study by the International Society for Aesthetic Plastic Surgery (ISAPS) carried out in 2013, Germany was the penoplasty capital of the world with almost 3,000 procedures carried out that year alone.

In the UK it’s not that easy to get figures as many plastic surgeons, although qualified, are not registered with either ISAPS or the British Association of Aesthetic Plastic Surgeons, (BAAPS) making it impossible to quantify.

So what exactly is involved? There are two main types of penoplasty or phalloplasty – enlargement which involves increasing the girth, or lengthening.

1. Medical penoplasty for enlargement

This involves injecting either hyaluronic acid, the patient’s own fat, or platelet-rich plasma (PRP) into the penis.

With PRP injections, blood is taken from the patient and mixed with PRP and fat and then injected back into the penis. This can increase the penis’s girth by up to one inch (2.5 cm).

2. Phalloplasty or Penoplasty (lengthening)

This involves lengthening and making the flaccid penis longer by up to two inches. The surgeon severs the suspensory ligament and then reattaches it at a point further down the pubic bone. This allows the penis to droop further forward and in effect, lengthens it by 1-2 inches.

Consultant Plastic and Aesthetic Surgeon Dr Roberto Viel, from the London Centre for Aesthetic Surgery, was one of the first surgeons in the UK to perform penoplasty more than 25 years ago. He says he does up to 150 a year, but he claims demand is so high he could easily do more.

“I used to do more each week but then there is no time for anything else so I limit it now to two or three,” Dr Viel says.

Dr Viel pioneered a technique of using the patient’s own fat, rather than hyaluronic acid, to increase the penis size.

He says managing expectations is a big part of the job.  “I will always be honest and tell the patient if I feel we cannot achieve what he wants.”

The operation takes between one and two hours with the patient under sedation; although he isn’t under general anaesthetic, he won’t feel or remember anything. Costs range from £3,000 to £9,000 depending whether the patient has thickening, lengthening or both.

Dr Viel extracts the fat from the patient’s stomach by a process called liposculpture and ‘prepares’ it for re-injection into the penis.

About 30-40 per cent of the fat gets reabsorbed back into the body so the client needs to return to be reinjected.

“Afterwards, the patient will be very sore and will need to take care with hygiene as infection, although rare, can be a problem,” he adds. “They mustn’t do any exercise for four weeks, nor have sex for six.”

Like the fat injections results from the hyaluronic acid and PRP injections, aren’t permanent and the procedure will have to be repeated after a period of time.

It’s not all about sex

So what compels a man to go through with it?

“It’s more about how the man feels about himself,” says Dr Viel. “Most girlfriends and wives wouldn’t dream of telling the men they love they are not big enough. It’s other men my patients are self-conscious about.

“It can, and usually does, transform their lives. One man said to me: ‘Thank you, I can take my son swimming now.’”

“Naturally, making the penis thicker can help them have a better sex life but not with lengthening. I also tell my patients that their penis has to be in proportion. I would never operate if I thought what they wanted was unreasonable. I would try to talk them out of it or send them for counselling.”

Interestingly, none of the 230 surgeons represented by BAAPS, which accounts for about 40 per cent of the industry, offers penoplasty, and Dr Viel is not a member.

A spokesperson for BAAPS said: “It’s not an operation any of our members perform so it’s hard to know just how many people have had it done in the UK. There is some suggestion that it can affect the natural mechanism of having an erection so we don’t encourage it.”

Nigel Mercer, a consultant plastic surgeon and former president of BAAPS, says, “It’s not something we say every surgeon should offer because there have been lots of unhappy patients in the past.”

The up and downsides?

As with any surgical procedure there can be complications. Infection, bruising, bleeding and nerve damage are just some. There’s also the risk that the penis will be lumpy or lop-sided and there are even reports of men going back to have the fat implants removed because they look so unsightly. Sometimes when the penis is erect those areas may not feel hard, which some men may find distressing.

If you are considering one of these procedures (or both)  it’s important of make sure sure you see a surgeon has a proven track record in performing the procedure. There is no formal training in the UK so asking questions about results, experience, and complications is crucial.

And, it must be noted this is not a cure for erectile dysfunction which should be treated by your doctor as it is often a sign of an underlying cardiovascular condition. Not everyone is suitable for penolpasty – heart conditions, blood coagulation problems or unrealistic expectations could preclude some people from having the procedure.

Urologists aren’t convinced that messing around with the ligament to lengthen the penis is a great idea and advise that anyone considering this treatment see a urologist first. They claim there is a lack of evidence about the long term effect of such a move and that a short term gain may result in a long term problem. There are also reports that the penis may not ‘stand up’ so well once the ligament moved.

On the upside, penoplasty doesn’t pose a risks to erection, ejaculation, sensitivity, orgasm or fertility.