Risk profiles vary for different penile surgeries, physician says

Acceptable surgery for penile enhancement should be predictably effective, low-risk and cause no harm. However, many men are undergoing cosmetic procedures that fail to meet these criteria, according to Gary Alter, M.D.

Speaking at the 2011 Cutting Edge Aesthetic Surgery Symposium, Dr. Alter discussed surgery to correct the hidden (buried) penis, which he says is a valuable and effective procedure, and he highlighted the problems associated with many of the surgical approaches being performed for penile girth enlargement and elongation.

"Properly done, surgery to correct hidden penis is relatively noninvasive and effectively provides functional and aesthetic improvement while also curing profound self-esteem issues," says Dr. Alter, an assistant clinical professor of plastic surgery, University of California, Los Angeles, and board-certified in plastic surgery and urology.

"However, many other purely cosmetic penile enhancement surgeries are being driven by media and marketing forces. Some are ineffective, most are associated with multiple potential complications, and they are often being done by surgeons who fail to provide honest informed consent," he says. 

HIDDEN PENIS Hidden penis, where the penis is buried in the pubic fat and scrotum, is relatively common in adults and children, but it is widely underdiagnosed and misunderstood, Dr. Alter says. When standing or sitting, the penis is partially or completely hidden in the pubic fat and skin or scrotum, causing embarrassment and/or discomfort.

The condition can be congenital or it can result from a variety of etiologies, including obesity, radical circumcision, chronic inflammation, aging, or various cosmetic procedures, (fat injection, abdominoplasty or penile lengthening with a VY advancement flap), Dr. Alter says.

The underlying abnormality for hidden penis is lack of a synchronous attachment of the skin and dartos fascia to Buck's fascia and the corporeal bodies, he explains. As a result, the corpora and skin do not stay connected as a unit. The corporeal bodies telescope proximally inside the scrotum and pubis, causing the penis to hide in the pubic fat pad, while the penile skin stays out.

"Some men with hidden penis will present for penile elongation, but that is not what they need," he says.

The goal of hidden penis surgery is to make the penile skin and erectile bodies one unit, Dr. Alter explains. In most men and boys, the penile skin on the pubic side is secured by elevating the pubic skin, removing the pubic fat and tacking the pubic skin to the underlying muscles. If the man does not have any excess pubic skin or significant pubic fat, the skin at the penopubic junction is tacked directly to the erectile bodies.

Despite the above techniques, the penis would still bury in the scrotum in some patients. In order to prevent this, the skin at the penoscrotal junction is tacked to the erectile bodies to stabilize the skin to the underside of the penis, Dr. Alter says.

"These relatively noninvasive techniques will keep the penis exposed, thus markedly improving self-esteem and also preventing the inflammation often associated with a chronic buried penis," he says.