For the lengthening of the penis the technique that is mainly used is a cross-section of the suspensory ligament of the penis. This ligament is topographically placed in the pubic region and connects the root of the penis with the pubic bone. This is a rather thick, fibrous ligament whose main function is to provide support and stability to the penis during erection.

With its cross-section, what is achieved is to make visible a large part of the penis that is hidden under the pubic bone. After this operation beyond the extra length the patient will see in many cases a small change in the angle of the erection which means that the penis will be in a more horizontal position.

The results of the transection of the suspensory ligament are considered permanent, however, if the patient wishes in the future to restore the penis to its former state, this is possible.

It is worth noting that this procedure will only have impact on the flaccid and not the erect length. For those patients who wish to increase the erect length and at the same time enhance the results of the operation, the use of a penile extender is advised.

The main risk after such an operation is that the ligament may reattach back to the pubic bone, which means that the patient will not benefit from the surgery. For this reason, various techniques have been developed to avoid this problem, which mainly use autologous tissues, while the use of silicone spacers between the pubic bone and the penis, which were systematically used in the past, are now considered obsolete and outdated.

In general patients could expect an extra length of between 2-5 cm as it happens to 95% of our cases. We are very proud about those class-leading results we offer to our patients which is a result of our vast experience in this field, proper patient selection and guidance, meticulous surgical technique and continuous improvement of our protocol.

The surgical thickening of the penis is achieved by the lipotransfer technique which consists of an initial liposuction from the thigh or pubic area, cleaning the fat and transferring it to the penis. A basic prerequisite is the existence of a sufficient fat reserve so that the initial liposuction can be performed and therefore very lean patients such as professional athletes are not suitable for this type of surgery. Also, extremely important is to avoid transferring the fat directly as the liposuction aspirate is full of debris and fluids and therefore it must be cleaned before using it.

The results of this technique are considered permanent as the transferred fat with time gets its own blood supply and acts as a living tissue, however a percentage of approximately 30-40% of the fat is absorbed within the first two months. To avoid excessive absorption of the fat we have developed a special postoperative scheme which increases fat survival and reduces absorption and scarring. It is worth noting that apart from the increased girth when the penis is flaccid, the erect girth is also enhanced contrary to the lengthening techniques that have an impact only in the flaccid state.

The results of this operation are visible after a period of approximately 2 months as initially, mainly due to the swelling, the penis is considerably thicker than the final result.

Girth enlargement surgery can be repeated in case the patient wishes to further increase the size of his penis.

Those procedures are nowadays done in a daycase setting, which means that the patient goes home on the same day of the operation.
Following the operation, the patient enters the recovery period which depending on the type of procedure done ranges from 4-6 weeks. More specifically:

• For combined length and girth procedures we advise avoidance of strenuous physical activity for 4 weeks and no sexual activity for 6 weeks.
• For girth only procedures we advise avoidance of strenuous physical activity for 2 weeks and no sexual activity for 6 weeks.
• For length only procedures we advise avoidance of sexual and strenuous physical activity for 4 weeks.

Moreover, the patient enters a specially designed recovery program the maximises the gains from the operation and minimizes the risk of problems.

Originally a rare phenomenon, revision of penile enlargement surgery is now a not so unusual request from patients who regretted having surgery in the first place. To our experience there are two main reasons why some patients choose that:

• Misleading information about the outcome and aesthetic appearance of the genital area.
• Poor outcome or severe complications from improperly performed surgery.

It is important here to underline for one more time the significance of the surgeon’s experience in this field, who will offer proper and unbiased guidance and perform the operation in the highest standards.

It involves removal of the transferred fat and the anatomical reattachment of the suspensory ligament to the pubic bone.
Revision surgery is a very complex operation with, understandably, more risks compared to the initial one. As a result, patients need to stay in the hospital for one night or more and the recovery period depends on each case but is always longer than 6 weeks.
Given the rarity of those cases it is of utmost importance the experience of the surgeon in this exact type of surgery.

These techniques use the well-known hyaluronic acid fillers that have been commonly used in other cosmetic procedures. In general, the initial placement of 10 to 15 ML of long-lasting hyaluronic acid is recommended. The quality of the filler is of crucial importance so that the patient has a natural feeling and enjoy the best possible result.

Fillers are not a permanent treatment as they must be repeated every 18 to 24 months, depending on the quality of the filler injected if the patient wishes to have a stable result. An advantage of this technique is the fact that it is performed under local anaesthesia in the doctor’s office and the patient can return to his daily activities immediately.

Also due to the specific lifetime of the fillers, the results are reversible and therefore the are especially recommended for those who are willing to proceed with penis enlargement, but they are either unsure what to decide between surgical and non-surgical options or they don’t want to take the risks and downtime of a surgical procedure. They are especially recommended for patients with very low body fat counts in whom lipotransfer is technically difficult and with poor results.

Like surgical girth enlargement the increased girth is present in both the flaccid and erect state.

As mentioned above penile enlargement with fillers is a procedure that’s done at the office under local anaesthesia and the patient can immediately return to his normal daily activities. We also advise avoidance of sexual and strenuous physical activity for 1 week.

Following the procedure, the patient is given detailed instructions about how to manage the filler for the first few weeks to speed up recovery and have the best possible outcome.

Buried penis is a condition that can affect children and adults and is a condition in which the penis is of normal size but is hidden under the skin of the abdomen, thigh, or scrotum.

Some causes include:

• Abnormalities that are present at birth: The ligaments that attach the penis to underlying structures may be weaker than usual.
• Obesity. Excess fat around the abdomen and genital area can make the penis appear to be hidden.
• Lymphedema.Swelling around the scrotum area due to the collection of lymph fluid may cause the penis to become buried inside tissue.
• Iatrogenic. This is usually the result of improperly performed circumcision when not enough or too much skin is removed.

This is often accompanied by symptoms such as:

• Inability to urinate while standing, or even sitting, without getting drops of urine on the skin of the scrotum or thighs or clothes.
• Infections in the urinary tract and the genital area due to constant moist skin.
• In uncircumcised individuals, the skin covering the head of the penis may become inflamed.
• Inability to get an erection. If they do get an erection, it may be painful and/or may be unable to have proper sexual activity.
• Psychological problems like low self-esteem and depression.

Treatment of a buried penis has the characteristics of a cosmetic procedure when no problems are present but when the patient suffers from the aforementioned symptoms it is definitely non-cosmetic as it aims to restore the normal urinary and sexual function.
Generally, treatment of buried penis can be quite difficult, and a one size fits all approach is not possible. Apart from scrotoplasty other techniques can be employed individually or in combination such as removal of scar tissue, suspensory ligament division, abdominoplasty and skin grafts.

Some people want a scrotal procedure for strictly cosmetic reasons. Cosmetic scrotoplasty can lift a sagging or loose scrotum ,a procedure called scrotal lift. This type of scrotoplasty is more common in older adults when their scrotum naturally begins to sag as they lose muscle tone but there is also a considerable amount of younger individuals with a scrotum significantly larger than usual ,which will also benefit from this type of surgery.

People with an enlarged scrotum may find sexual activity, exercise or other physical activities uncomfortable due to their scrotum getting in the way.

In those cases, scrotoplasty is much simpler compared to when it’s performed for hidden penis and involves removal of the excess skin from either the anterior or posterior scrotal wall. Patients can go at the same day of the operation and will need to wear a scrotal support for 2-4 weeks to avoid swelling and subsequently discomfort. We also advise to abstain from strenuous physical activity for 2-3 weeks and from sexual activity for the first two weeks.

Webbed penis is when skin from the scrotum is attached too high on the penis which creates a web-like appearance when the penis is pulled away from your scrotum. Webbed penis is also called penoscrotal webbing or congenital penile scrotal fusion.
During childhood, webbed penis doesn’t cause any problems. But after sexual debut it is common to cause painful erections and make sexual intercourse challenging. Many people pursue treatment to relieve erection pain and for cosmetic reasons.

There are two types of webbed penis:

• Congenital webbed penis: Most of the time, webbed penis is present at birth.
• Acquired webbed penis: This type of webbed penis develops after birth, usually due to circumcision that removes too much skin.

Scrotoplasty is the most common treatment for webbed penis. During the surgery, the skin connecting your scrotum to the penis is removed.
This procedure creates a typical penoscrotal angle and eliminates uncomfortable or painful erections and any cosmetic concerns as well.