Male Genital Aesthetics

Male Genital Aesthetic

These surgeries, which are becoming increasingly common around the world, are performed at the request of the person, as in rhinoplasty or mammaplasty surgery.

Unfortunately, especially male individuals who have problems with the size of their penis can experience both material and moral losses by using various products or devices. The only way to enlarge the penis is cosmetic surgery.

Every man checks his penis several times a day. An aesthetic problem with a man's penis (length, thickness, etc.) can cause problems with his personality, psychological state, and sexual dysfunctions.

 

Apart from this, I also use cosmetic penile surgery procedures in cases such as penile curvature, natural impotence (penile prosthesis applications, etc.), treatment of rapid ejaculation (glans enlargement through glans injection, frenuloplasty, etc.), some scrotum surgeries (scrotoplasty, etc.) correcting circumcision errors.

 

Types of Penis and Genital Aesthetics?

• penis enlargement
• penis thickening
• penis enlargement + thickening
• Scrotoplasty (Scrotal lift)
• Micropenis Treatment
• Curvature and/or pain during erection (peyronie's) treatments
• Various surgical procedures used in the treatment of erection problems (importance)
• Procedures used to treat premature ejaculation
• Circumcision and procedures used to correct circumcision errors

 

WHAT IS THE NORMAL SIZE OF A PENIS?

This is entirely up to the individual. There is no standard data on penis size or thickness. I don't want to confuse you by presenting tables about penis size. The important thing is that the person is comfortable with his penis. If an aesthetic problem, the shortness or thinness of your penis bothers you, cosmetic surgery can be used. The exception to this Condition is the micropenis. Micropenis is the condition where the erected penis size is below 7-8 centimeters. Micropenis typically occurs in male patients with hypogonadism and hormonal status should be examined. Hormonal and surgical treatment can be applied when necessary.

 

Since coitus is only possible with an erect penis, it is the length and thickness of the erected penis that matters. In the form of a bottle, a 2-3 cm long penis can be erected up to 15-16 cm, or an 8-9 cm penis can grow up to 12 cm during erection.

 

Penis size depends on genetics and origin. It is generally considered small, under 11-12 cm during an erection. Penis thickness during erection is about 10-13 cm (according to researchers at King's College London and the Maudsley NHS Foundation Trust, the average penis size is 9.16 cm, erect penis is 13.12 cm).

 

• PENIS ENLARGEMENT SURGERIES

I have experience in various surgical techniques during penis enlargement surgeries. The most successful is a technique called reverse VY plasty and ligamentolysis, which relies on relaxation of the ligaments that prick the penis. Depending on the situation, ventral phalloplasty may also be added. In other words, in the penoscrotal region, which is the connection point of the penis and scrotum; z-plasty, c-y plasty or skin grafts can be used (average 1.5-4 enlargement)

 

Penis enlargement depends on and is related to one's anatomy and last but not least, the thickness of the ligaments. The thicker the ligaments, the larger the penis can be.

Abdominal liposuction and suprapubic lipectomy should also be added (especially for patients with a hidden penis). The aim here is to get rid of the excess adipose tissue covering the lower part of the penis, called proximal, and to fix the abdominal eminentia (there will be a total enlargement of 2-5 cm).

 

• PENIS THICKENING SURGERIES

I usually prefer autologous fat transplantation, which means using fats obtained from the patient himself. The areas I mostly use to obtain fat (as a donor) are the suprapubic (lower part of the penis), abdomen and medial thigh.

 

The resulting adipose tissue is then purified by centrifugation (3000 rpm for 3 minutes in Coleman, 2007). It is important to use slower centrifuge speed and less time to hold the oil (which is why I usually prefer 1000 rpm and 2 minutes)

 

Following this step, purified adipose tissue is transplanted. It spreads homogeneously under the skin of the penis. Fat migration and asymmetry that may occur due to erection are prevented by using an elastic penile bandage of sufficient length after the surgery. For the thickening of the penis, pplatelet-rich plasma prepared by taking approximately 20 cc of blood can also be used.

 

Fat loss rate in six months is between 30-40%. Penis thickness does not change after six months. Considering the fat loss, I inject more adipose tissue during thickening operations.

 

• PENIS ENLARGEMENT + THICKENING PROCEDURES

The majority of my patients want to have these two procedures (enlargement + thickening) done at the same time. In addition, I recommend you to have both procedures done at the same time to preserve the width-length ratio and aesthetics of the penis.

 

Depending on the patient's preference, local anesthesia + sedation or general anesthesia is preferred as the type of anesthesia. Patients are released the same day after surgery. After resting for 1-2 days, they can continue their routine activities.

 

Patients are asked to refrain from any sexual activity (including masturbation) for 4-5 weeks after the procedure.

 

Procedure times (working time):

* Penis enlargement: about 45-50 minutes

* Penis thickening: about 50-60 minutes

* Penis enlargement + thickening: about 80-90 minutes..

 

RESULTS:

• The penis enlargement range is between 1.5 and 4 cm. The variation here depends on the properties of the ties, in other words the depth, length and width. If it is thicker, then it is better. ((Basal penile ultrasound allows partial visualization of the suspension ligament and allows us to know the range of possible lengths to be added)

• After penis enlargement surgeries, an increase of 25-35% in penis width can be achieved. The variation here depends on the individual Traits. It is related to the patient's metabolic status, lifestyle, anatomical structure (a larger area between the corpus and farts of the penis gives better results)

 

• For the penis enlargement + penis enlargement (together with suprapubic lipectomy) operation, which I generally prefer, the range I use the most is between 2 and 5 cm.

 

• The erection angle may decrease slightly after the operation.

 

WILL I HAVE LESS ERECTION AFTER PENIS ENLARGEMENT AND THICKENING SURGERY?

This is one of the frequently asked questions. There will be no changes after these erection surgeries. I participated and conducted many of these operations both in Turkey and abroad. So far we have not seen any problems like this with any patient.

I use a surgical magnifying glass during these surgeries. And I use the laser, which is very responsible for the separation of bonds. Thus, the structures, nerves and vessels (neurovascular bundle) that maintain the erection can be easily preserved. Also, there is no loss of sensation in the penis.

 

There is always a risk, not only in penile enlargement surgeries, but also in all kinds of penile and prostate surgeries. What is important here is the knowledge of the surgeon performing the surgery on the genital area, and especially the anatomy of the penis, and the surgeon's experience in this type of surgery.

 

RISKS AND COMPLICATIONS RELATED TO PENIS ENLARGEMENT AND THICKENING SURGERY:

– Injury of erectile structures, nerves and veins

– Decrease in the erection angle of the erected penis

– Penile instability

– Poor healing (v-y plasty, z plasty)

– Unresolved (unresolved) hematoma

– Extreme fat loss (Normally, 30-40% of the injected fat for penile thickening is absorbed by the body within 6 months. This loss can sometimes be more.)

– Fat aggregation and nodule formation

– Deformities (asymmetry and curvature of the penis)

 

• What is Peyronie?

Penis shape can differ from one person to another. A slight inclination of the penis to the right or left when erect is normal. This is normal as long as it's not too sloped. Penile curvature is a common aesthetic problem in terms of sexual intercourse. There are two different varieties. It can be both congenital (congenital penile curvature) and acquired (Peyronie's).

Although the causes are not known exactly, the most common cause is trauma experienced during sexual intercourse. Tearing in the tunic (the structure that protects blood flow in the penis) surrounding the corpus cavernosum, called tunica albuginea, occurs as a result of these traumas and fibrosis plaque occurs during the healing period of the tunic. Fibrosis plaque typically forms on the back of the penis and sometimes on the side of the penis. This formed fibrosis plaque causes penile curvature during erection. As a result, it may cause anterior, posterior or lateral asymmetry or curvature of the penis. Studies show that gene activation and connective tissue disorders associated with healing also cause Peyronie's disease. It is claimed that vitamin E deficiency, long-term use of certain drugs such as propanol, methotrexate, diabetes, gout, long-term smoking and surgical operations on the urinary tract may also cause the disease.

 

Peyronie's curvature can sometimes be too obvious, making sexual intercourse impossible, making partners uncomfortable. Mass and curvature in the penis is not seen in every male individual and its severity is not the same. It's a progressive disease. It initially starts with pain during erection and this pain goes away without any treatment. When a person begins to feel the hard plaques on their penis, they also notice the curvature and inclination during an erection. Therefore, if you have pain or a feeling of mass in the penis, you should immediately see a doctor without any doubt or embarrassment. Because it can affect your sex life.

 

DIAGNOSIS OF PEYRONIE'S DISEASE

Anamnesis and physical examination are sufficient for the diagnosis of Peyronie's disease. The plaque is hand held. While obtaining the anamnesis; The time and form of its occurrence (chronic or acute), the way the disease progresses, the drugs used and habits are evaluated. In the sexual history; The possible difficulties of the patient for erection are questioned. Ultrasound can help determine the exact size and location of the plaque.

 

HOW TO TREAT PEYRONIE? WHEN DO YOU NEED SURGERY?

For treatment, it is necessary to know the stage of the disease first. The disease has two stages. In the first unstable period, which is called the "active phase, acute inflammation phase", the patient feels pain during erection. There is a plaque on the penis and there is a slight curvature. This stage lasts for about 12-18 months.

 

In the second and stable period, which is called the "chronic inflammation phase", the disease is certain. This is the period when there is a significant curvature of the penis, problems with erection occur, and the size of the plaque does not change.

 

Knowing the stage of the disease is important for the choice of treatment. Because it has been reported that the symptoms may disappear spontaneously in some patients and the disease progresses in 50% of them.

 

If patients presenting with Peyronie's symptoms are in their active period, oral medications and injection treatments are mostly preferred to prevent the progression of the curve. These patients pass into the chronic stage in about 1 year. The only reason for treatment in patients whose pain disappears in the chronic period is the difficulty experienced in sexual life due to the fixed angle and the curvature causing problems between the spouses. The preferred treatment in this period is surgery.

 

• Oral medicine

If the disease is in the unstable stage, the plaque is small, there is a slight curvature of the penis, there is no pain and there is no sexual dysfunction, medication can be recommended. In early stage patients, drug therapy is preferred. But it is a fact that they are not that successful in treatment. The aim is to prevent progression, reduce pain and maintain erectile capacity.

 

Vitamin E: One of the most popular treatments for early-stage disease. Because it has almost no side effects and is easy and inexpensive to use. It is believed that molecules responsible for the formation of hard plaque structure are called free oxygen radicals by reducing their production on penile tissue.

 

POTABA (Potassium Para-Aminobenzoate): It is a substance that prevents the formation of abnormal fibrotic tissue. It should be used for a period of 3 to 6 months. It is also an expensive drug that can have side effects on the gastrointestinal system.

 

Colchicine: It suppresses the inflammatory response in the tissue, reduces the production of collagen and increases their destruction. It has side effects on the gastrointestinal tract and may cause diarrhea. .

 

Tamoxifen: This non-steroidal anti-estrogen drug has been shown to reduce fibrosis by suppressing inflammation and scar tissue formation. It has side effects on the gastrointestinal tract and may cause hair loss.

 

• Drugs Applied on Plaque

In this type of treatment, the drug is injected directly into the penile plate and is an alternative to oral therapy. This is called intralesional injection. It is a more popular treatment option among male individuals who do not want to have surgery or who are in the early stages of the disease.

 

-Clostridial collagenase (collagenase clostridium) injection: It has been observed that the angle of curvature, plaque width and length are significantly eliminated during intralesional treatment. (This drug is not yet used in our country.)

 

Various alternative techniques such as cortisone injection into plaque, shock waves from outside the body (arguable to correct curvature and reduce plaque size). However, it can reduce pain.), penile traction and vacuum devices (to prevent shortening of the penis size) are also used.

• Scrotoplasty

As the age progresses, loosening, growth and enlargement of the skin surrounding the testicles, called the scrotum, can be seen. We encounter these conditions more frequently in individuals with a history of varicocele, hydrolytic, inguinal and scrotal hernia. This growth in the scrotum can cause problems such as contact-related redness, pain, excessive sweating in the genital area, rashes and pain during sexual intercourse. Scrotoplasty can be applied if this situation disturbs the person in his social life (for example, during sitting, standing, exercising) or if it causes loss of confidence in the person's sexual life. This surgery can be performed under local anesthesia supported by sedation and the patient can be discharged on the same day.

 

• Adult Circumcision with Local Anesthesia (No Narcosis)

Adults who have not been circumcised or have not been circumcised in childhood feel the need to be circumcised when they reach a certain age due to social pressure or social, psychological or religious reasons. For this reason, from time to time, adult individuals may apply to us with a request for circumcision. People often have difficulty in describing the situation and expressing their demands for circumcision. In addition, uncircumcised adults often hide their uncircumcised status from their relatives, even from their spouses, because they are uncomfortable with this situation. Therefore, they do not want anyone to be with them during the circumcision, and even after circumcision, they do not want the situation to be known. For this reason, adult circumcision is performed in an environment where no one is present in our clinic, where confidentiality is protected and where the individual feels comfortable, and you will not be in contact with anyone other than the doctor during the circumcision.

 

Adults have a lot of anxiety before circumcision. Therefore, before the circumcision, the individuals' questions about the procedure and its aftermath are discussed in detail and psychological relief is provided. After this psychological relief, adult circumcision can be performed much easier and painlessly than child circumcision. First of all, since it is easier to communicate, the details of circumcision and post-circumcision care can be easily explained to adults. In adults, the foreskin is naturally more retracted as the penis has completed its development. Therefore, a small part of the foreskin is removed compared to children. Therefore, a minor surgical intervention is sufficient. Pain sensation does not occur after the penis is anesthetized. After circumcision, the person can put on his pants and return to his normal life. However, it is recommended to come with wide clothing such as sweatpants. Individuals can go to work the next day, if they want, they can not stay away from their work. After the wound healing is completed after the circumcision, there is no change in his sexual life. It is important for the adult who does not want it to be known that the circumcision is done, and goes to work the next day.

How is numbing (local anesthesia) done in adult circumcision?

Before circumcision in adults, the penis is anesthetized with local anesthesia. This procedure is done with a needle, but in patients who are afraid of needles, it is possible to prepare the area with numbing cream or cold spray before the injection. The effect of this numbness starts within 10 minutes and the penis remains completely numb for 3 hours. Circumcision takes about 30 minutes. Circumcision in adults does not prevent driving. For this reason, adults can come to our clinic alone and with their own vehicles for circumcision, in terms of both privacy and ease of transportation. After the circumcision procedure, they can easily return to their homes by using their own vehicles.

 

How to care after circumcision in adults?

Adult circumcision does not require an additional attendant, so you can provide confidentiality. After the circumcision, you will be described in detail the necessary drugs. Painkillers are recommended on the first day, if you do not need them on the following days, no painkillers are required. If the wrap itself does not fall off in the first two days, it will not open. After 48 hours, after a warm shower, the dressing is opened and local antibiotic creams are applied. It is enough to apply the cream 2 times a day for 3-4 days. The stitches will dissolve on their own in 3-6 weeks. Although the recovery is completed in the first 2-3 weeks, it can sometimes take up to 4 weeks. The reason is that with morning erection in adults, sometimes the sutures can be opened by stretching. In this case, the healing process will be prolonged. Post-circumcision swelling and slight redness of the wound are normal. However, in case of increased redness and swelling and increased sensitivity, it would be appropriate to reevaluate in terms of infection. Under normal conditions, the risk of infection is very low as sterility conditions are followed in our clinic. However, personal hygiene is important. It is important to change underwear daily, to choose underwear that absorbs cotton moisture, and to take a foamy daily shower after 48 hours without staying in the water for a long time. It is recommended to stay away from sexual intercourse for 1 month and even avoid sexual stimuli (films and visuals, etc.), that is, an erection is not desired as much as possible. After 1 month, intercourse with a condom is allowed. After 2 months, it is possible to have intercourse without a condom.

 

Benefits of Adult Circumcision? 

It is very useful for hygiene. Microbes hidden in the foreskin easily reproduce and cause odor and infection. If the foreskin is removed sufficiently after circumcision, the hygiene problem is no longer experienced.

Cervical cancer is less common in spouses of adult circumcised individuals.

It is known to reduce the rate of penile cancer.

The rate of transmission of sexually transmitted diseases such as HIV and hepatitis decreases in circumcised individuals.

Individuals with narrow foreskin may have a painful erection. This is because the foreskin is narrow, making it difficult for the pipi head to come out. Congenital stenosis of the foreskin is also called phimosis among the people. The condition of stenosis in the foreskin acquired afterwards is called Balanitis Xerotica Obliterans (BKO).

 

 

• Penis Rejuvenation

Erection PROBLEMS REJUVATİON® CELL THERAPY OPTION

      There has been a general stagnation in the treatment of erectile dysfunction since the discovery of PDE5i drugs. These drugs with Sildenafil and Tadalafil active ingredients are effective in 70-80% of men who have erectile dysfunction. When this group of drugs taken orally does not help, some patients may prefer self-administered needle treatments (self-injections for the penis) before each sexual intercourse in the second step. In cases where the first two treatment steps are not effective, we recommend penile prosthesis surgeries as a last option to our patients. Apart from these treatments, there is no other treatment method that has been put into clinical practice, has fully proven itself, and has a place in the guidelines. However, many patients are quite distant from penile prosthesis and self-injection treatments. Or their current health conditions are a major obstacle to the implementation of these treatments. Again, many patients also dream of getting rid of oral medications and having sex in a more natural way. For these reasons, restorative and regenerative treatment models to be applied to the penis have become very popular today. Low-intensity shock wave therapies (EDSWT), penile PRP injections are the main regenerative treatment methods applied by many clinics in our country and considered to be successful. It is clear that more randomized controlled clinical studies are needed on the effectiveness of such treatments. However, unfortunately, evidence-based medical science progresses very slowly and many of our patients do not have time to wait for stronger scientific evidence. These conditions lead physicians and patients to some practical and effective alternative treatment methods with minimal side-effect potential within the understanding of “translational medicine”. One of the newest of these treatment methods is the new generation personalized cellular treatments that we call REJUVATİON CELL THERAPY.

 

    “The Rejuvenation®” is a technology of American origin with an international patent that separates (separates) and concentrates (concentration) stem cells, platelets, mononuclear cells in a blood or bone marrow aspiration sample with the help of optical sensors in a closed circuit system. The system and the kits used are fully FDA approved. And first of all, treatment applications in orthopedic fields are also approved by the FDA. In other words, Rejuvenation is a technology that has proven itself scientifically. Today, its use is rapidly becoming widespread in dermatology, plastic surgery, cardiology, gynecology and urology branches, and scientific articles on its use in diseases have begun to be published. The concentrate obtained from the blood with Rejuvenation is definitely a product that is too strong to be compared with the classical tube PRP (platelet rich plasma). In its simplest form, 10-12 times more platelet cells per mL can be obtained from the plasmas obtained by using high quality and well-known tube PRP kits. Again, at the end of the separation process using Rejuvenation technology, 4-14 times more growth factor (TGF-β, IGF-1, PDGF, VEGF) and anti-inflammatory cytokines (IL1, IL4, IL10, TNF) originating from thrombocyte and mononuclear white blood cells ) is obtained. More importantly, CD34+ hematopoietic stem cells and endothelial progenitor cells can also be differentiated from blood with Rejuvenation technology. When all of them are brought together and this product is injected into the damaged tissue, a great cellular power is obtained that will ensure the regeneration, rejuvenation and restoration of that area.

 

• PRP Penis Rejuvenation

PRP (Platelet Rich Plasma), also known as "Platelet Rich Plasma", is a yellowish liquid obtained from one's own blood. With the help of the PRP preparation kit, 10-20 ml of blood is taken from the patient first. Then, this blood is separated with disposable special filters and centrifuge devices and the unwanted parts are removed. This special portion of 2-6 ml, which is separated by staying at the top, contains plasma rich in platelets and thus growth factors (PDGF, VEGF, TGF-α and TGF-β). The obtained PRP is injected into the damaged area, which is the problem, and the treatment is performed. PRP applications are used today in many fields of medicine such as orthopedics, cosmetology, dermatology and plastic surgery to stimulate tissue healing and rejuvenation. PRP is not a stem cell treatment. However, thanks to the growth factors it contains, it is aimed to activate the stem cells. The effectiveness of PRP has been clearly demonstrated in many scientific studies apart from clinical observations. PRP should be applied in sessions at certain time intervals. Of course, there is no point or benefit in doing it once. Since PRP is obtained from the person's own blood, it is not possible to have any side effects depending on the content. However, it may cause some local problems (bleeding, ecchymosis, infection, etc.) at the injection site.

 

    The use of PRP in urological fields is still very new and controversial. Intrapenis applications have been popularized in the USA and abroad under the name Priapus Shot (P-Shot). Especially with the claim that it enlarges and thickens the penis, many urology and aesthetic surgery centers in the USA and Far East countries apply the session to men widely, with a cost of around 1500-2000 dollars. Fewer centers are trying PRP as an alternative treatment method for erectile dysfunction. Since PRP itself is an FDA eventful procedure, there is currently no legal obstacle to its use in the USA. However, we read from the media that warning letters were also sent to some doctors who used it indiscriminately.

 

    We know that in the erection problem that develops due to organic reasons, apoptosis (cell death), increase in collagen production and development of fibrosis in tissues decrease elasticity. In other words, solid fibrotic tissues replace cavenosal smooth muscles. Therefore, the ability of the penis to get an erection or to maintain an erection disappears over time due to the decrease in stimulation due to neuropathic reasons or decrease in oxygenation due to vasculogenic causes. At this point, it is thought that intracavernosal application of PRP can provide regeneration (regeneration) and rejuvenation (rejuvenation) of tissues together with angiogenesis (new vessel formation). Scientific data on this subject are not yet at a sufficient level. In several scientific publications on mice, it has been shown that neuropathic damage in cavernosal tissues heals faster with PRP. Again, according to the preliminary results of a small study of 9 patients by Banno et al (from a private center named Midwest Urological Group of America) published in J. Sex Med in 2017, the mean Erection score (IIEF) with PRP was 19.9 from 15.6. increased, but the difference was not statistically significant. However, scientific studies on men who have erection problems are still being continued by some researchers. In addition, there are some clinical observations that the curvature of the plaques decreases with the application of PRP to the plaque areas on the tunica albugiena in Peyronie's disease. It is said that high rates of success can be achieved in the injection of PRP into the plaque in combination with hyaluronic acid. Apart from all these, for men who think that the penile skin is getting old and wrinkled, PRP can also be applied under the skin for purely cosmetic purposes.

 

   However, approaches such as PRP or the application called P-Shot alone solve the problem of erection or enlarge the penis are currently far from scientific reality, and what is written on this subject should be viewed with caution. However, based on my own clinical experience, I think that it can have a synergistic effect, especially in combination with ESWT, for erectile dysfunction. Since its side effect profile is very low, there does not seem to be a reason why it should not be used together with ESWT, within the ethical rules, in moderately advanced erection problems or in Peyronie's disease that does not benefit from medical treatment. Undoubtedly, randomized controlled studies are needed on this subject.