If You're Considering Penoplasty, Buyer Beware

The fascination with penises, particularly larger specimens, is as old as human history. The ancient Romans were especially fond of phallic art—naughty mosaics and scrawled penis graffiti adorned bathhouse walls across the empire. Even Roman generals wore amulets that depicted monster phalluses to symbolize power as they marched off to war.

Modern guys don't generally wear necklaces featuring penises with wings. But many of us are subject to the same insecurities as the Romans apparently were when it comes to the size of our genitalia. In a culture that's obsessed with physical appearance and home to a cosmetic surgery industry worth billions of dollars, we're constantly told no one is stuck with the body parts they were born with—including penises.

Penis enlargement surgery is often touted in cheerful ads with confident men, but almost every medical procedure has side effects—penoplasty included.

What is penoplasty?

If you're looking into penoplasty, you'll find clinics advertising procedures that promise to increase the length and girth of your penis. You might read about laser penis lengthening or "lipofilling," a procedure in which fat is transferred from your butt to your penis.

However, if you talk to actual urologists who perform medically necessary penile surgeries, you'll get a very different view of what penoplasty means.

"Penoplasty is a word that has several different uses," said Petar Bajic, M.D., a urologist who specializes in reconstructive and trauma surgery with the Cleveland Clinic. "One of them is describing a surgery done typically on children for something called buried penis, or sometimes it refers to a surgery that corrects a penile curvature. There's not a universally agreed-upon definition. But it is not the same thing as penis enlargement surgery."

The procedures

The difference between what legitimate urological surgeons call penoplasty—technically, any kind of plastic surgery on the penis—and what so-called penis enlargement practitioners claim to do isn't the only crucial distinction.

Suspensory ligament release

The definition of "enlargement" isn't set in stone, because the most common "penis-lengthening" procedures merely make the penis look bigger without actually adding to its size.

"Many of the procedures simply increase the appearance of penile length without actually increasing the size of the penis itself," Bajic said. "So, for example, one surgery called suspensory ligament release causes more of the internal part of the penis to hang outward. But that can also have very negative effects on the angle of the erect penis and can lead to an unnatural appearance."

Fat or other injections

Another common type of penile enhancement involves having your own purified fat tissue injected into your penis. Small incisions are made along the sides of the penis shaft, and fat or other filler material, such as silicone, is injected under the skin.

On the face of it, this sounds like a procedure that might actually give a penis more girth, but it doesn't always go as planned.

"Unfortunately, many of these injections can lead to pretty disastrous complications, some of which I have had to do major reconstructive surgery on to correct," Bajic said. "I've seen anything from silicone injections that men have had done in other countries to fat injections that have led to calcified scar formation, almost like bone formation in these very irregular-appearing nodules under the skin. Some of those results have had to be fixed by removing all of the skin from the penis and replacing it with skin from the thigh."

The Penuma

Bajic pointed to one procedure that appears to be helpful for men who are "growers," not "showers," meaning their penises appear small when flaccid but "grow" significantly when erect. Called the Penuma implant, it's a silicone sleeve inserted under the penis skin. The manufacturer states Penuma is the first penile implant approved by the Food and Drug Administration for cosmetic enhancement and has been successfully implanted in thousands of men since 2004.

"However, although a number of these have been performed, the vast majority have been done by a single surgeon," Bajic said. "So further research is needed to know whether this is really a safe, longer-term option."

Editor's note: Since this story was published, further research has been conducted and more surgeons are performing the procedure.

It's also important to note that the Penuma implant doesn't actually make your penis longer. It enhances penile girth. Research from 2018 suggested patients experienced a 56.7 percent increase in penis circumference.

Does anyone need penis enhancement surgery?

The truth about size is that virtually no one's penis is too small. Apart from some men with specific and rare conditions—buried penis, severe Peyronie's disease or extreme weight loss causing the skin above the groin area to hang loosely over the genitals—pretty much no one actually needs surgery to adjust penis length.

"Who's a legit candidate, and when is it necessary? Yeah, so no one in my mind," said Jesse Mills, M.D., director of the Men's Clinic at UCLA and author of "A Field Guide to Men's Health," due out in December 2021. "Penile length and girth are difficult to change, and men that feel as though their penis is too small is a tough situation. But, sadly, there is no legitimate way to safely and effectively enlarge a man's penis."

What can be done?

For urologists like Bajic and Mills, counseling, not surgery, is the key to treating men who have issues regarding their penis size.

Bajic tries to get to the root of why a man feels so insecure about his penis size, and he often steers patients to a sex therapist or general therapist. He also finds counseling couples together about what they want and need goes a long way toward alleviating men's anxiety.

"For example, I've had a lot of patients who have been very concerned about satisfying their partners with penetration," Bajic said. "For a hetero male, a large percentage of women actually don't climax just with penetration. Sex doesn't necessarily begin with penetration and end with male orgasm. There's a lot more to it and a lot of other ways a man can satisfy his partner."