Published Studies: Non-Surgical Penis Enlargement
Efficacy and Safety of Penile Girth Enhancement Using Hyaluronic Acid Filler and the Clinical Impact on Ejaculation: A Multi-Center, Patient/ Evaluator-Blinded, Randomized Active-Controlled Trial
Sun Tae Ahn , Ji Sung Shim, Woong Jin Bae, Sae Woong Kim, Je Jong Kim, Du Geon Moon
World J Mens Health. 2022 Apr;40(2):299-307. doi: 10.5534/wjmh.210007. Epub 2021 May 7.
Purpose: We aimed to evaluate the efficacy and safety of penile girth enhancement (PGE) using hyaluronic acid (HA) filler with different physical properties from previous studies. Additionally, we evaluated the clinical impact on ejaculation after PGE.
Materials and Methods: This was a prospective, patient/evaluator-blinded, randomized, active-controlled, multicenter trial. Patients recruited between December 2017 and March 2018 were randomly assigned to the HA filler or control group (polylactic acid [PLA] filler). Penile girth, satisfaction level, Premature Ejaculation Profile (PEP), and self-estimated intravaginal ejaculation latency time (IELT) were assessed at baseline and at 24 weeks post-injection.
Results: Sixty-four subjects (32 in each group) completed the trial. The mean increase in girth was 22.74±12.60 mm and 20.23±8.73 mm in the HA and control groups, respectively. Satisfaction level regarding penile appearance and sexual life significantly increased in both groups. There was no statistically significant difference between the groups in terms of increase in penile girth or change in satisfaction level. Both groups showed significant improvements in PEP index scores. Self estimated IELT also significantly increased in the HA group (from 5.36±3.51 to 7.86±4.73 minutes, p=0.0001) and control group (from 5.23±3.55 to 6.43±4.22 minutes, p=0.021). No serious adverse events (AEs) were reported.
Conclusions: PGE with HA and PLA fillers resulted in significant enhancement of girth without serious AEs with no significant differences. Furthermore, PGE using filler improved clinical symptoms related to ejaculation.
The effects of penile girth enhancement using injectable hyaluronic acid gel, a filler
Tae Il Kwak 1 , MiMi Oh, Je Jong Kim, Du Geon Moon
J Sex Med. 2011 Dec;8(12):3407-13. doi: 10.1111/j.1743-6109.2010.01748.x. Epub 2010 Mar 11.
Introduction: Despite the debates on penile girth enhancement (PGE), demands for enhancement are increasing. Recently, various fillers have been widely used for soft tissue augmentation with proven efficacy and safety.
Aims: To identify the feasibility and efficacy of PGE by injection of filler.
Methods: Fifty patients with subjective small penis who visited Korea University Guro outpatient clinic were enrolled and prospectively followed. Restylane Sub-Q (Q-med, Upssala, Sweden) was injected into the fascial layer of penile body via 21G cannula with “Back & Forth Technique” and homogenized with a roller.
Main outcome measures: From April 2006 to February 2008, 50 patients were enrolled and 41 patients were followed until 18 months after PGE. Changes in penile girth at midshaft were measured by tapeline at 1 and 18 months. Patient’s visual estimation of residual volume (Gr 0-4), patient’s satisfaction (Gr 0-4), and any adverse reactions were also evaluated.
Results: Mean injected volume was 20.56 cc (18-22). Compared with basal girth of 7.48 ± 0.35 cm, maximal circumference was significantly increased to 11.41 ± 0.34 cm at 1 month (P < 0.0001) and maintained as 11.26 ± 0.33 cm until 18 months. In patient’s visual estimation, two patients complained the decrease as Gr 3 with focal depression at 1 month. At 18 months, all patients answered as Gr 4 without asymmetry. Patient’s and partner’s satisfaction score was 3.71 ± 0.46 and 3.65 ± 0.48 at 1 month and 3.34 ± 0.53 and 3.38 ± 0.49 at 18 months. There were no inflammatory signs or serious adverse reactions in all cases.
Conclusions: Considering the property of material, methods, and follow-up results of 18 months, PGE using filler is a very effective and safe technique for penile augmentation.
Semipermanent and permanent injectable fillers
Derek H Jones 1
Dermatol Clin. 2009 Oct;27(4):433-44, vi. doi: 10.1016/j.det.2009.08.003.
Abstract
Today, an impressive array of injectable dermal fillers for facial soft-tissue augmentation is available in the United States. These agents, most of which were introduced in the last half decade, represent a variety of semipermanent and permanent fillers across several categories. Physicians can choose between semipermanent fillers, such as hyaluronic acid derivatives (HA), calcium hydroxylapatite (CaHA), and poly-L-lactic acid (PLA), and longer-lasting, so-called “permanent fillers,” such as polymethyl methacrylate microspheres (PMMA), highly purified forms of liquid silicone, and hydrogel polymers.
Penile Girth Enhancement With Polymethylmethacrylate-Based Soft Tissue Fillers
Luis Casavantes 1 , Gottfried Lemperle 2 , Palmira Morales 3
J Sex Med. 2016 Sep;13(9):1414-1422. doi: 10.1016. Epub 2016 Jul 25.
Introduction: An unknown percentage of men will take every risk to develop a larger penis. Thus far, most injectables have caused serious problems. Polymethylmethacrylate (PMMA) microspheres have been injected as a wrinkle filler and volumizer with increasing safety since 1989.
Aim: To report on a safe and permanently effective method to enhance penile girth and length with an approved dermal filler (ie, PMMA).
Methods: Since 2007, the senior author has performed penile augmentation in 752 men mainly with Metacrill, a suspension of PMMA microspheres in carboxymethyl-cellulose.
Main outcome measures: The data of 729 patients and 203 completed questionnaires were evaluated statistically.
Results: The overall satisfaction rate was 8.7 on a scale of 1 to 10. After one to three injection sessions, average girth increased by 3.5 cm, or 134% (10.2 to 13.7 cm = 134.31%). Penile length also increased by weight and stretching force of the implant from an average of 9.8 to 10.5 cm. Approximately half the patients perceived some irregularities of the implant, which caused no problems. Complications occurred in 0.4%, when PMMA nodules had to be surgically removed in three of the 24% of patients who had a non-circumcised penis.
Conclusion: After 5 years of development, penile augmentation with PMMA microspheres appears to be a natural, safe, and permanently effective method. The only complication of nodule formation and other irregularities can be overcome by an improved injection technique and better postimplantation care.
Penile Girth Enhancement With Polymethylmethacrylate-Based Soft Tissue Fillers
T I Kwak 1 , M H Jin, J J Kim, D G Moon
Int J Impot Res. 2008 Jul-Aug;20(4):425-8. doi: 10.1038/ijir.2008.26. Epub 2008 Jun 12.
Abstract
The authors created the glans penis augmentation by injectable hyaluronic acid gel and reported the 6-month result for premature ejaculation. In a total of 38 patients, long-term effects of 5 years were compared to those of 6 months in terms of residual volume of implants and efficacy on premature ejaculation. Maximal glandular circumference measured by tapeline significantly decreased by 15% (P<0.05) but mean patient’s visual estimation (Gr 0-Gr 4) did not decrease (3.60 vs 3.56, P>0.05). Compared to 6-month follow-up, intravaginal ejaculatory latency time and vibratory threshold decreased at 5 years (P<0.05), but still well increased considering those of preaugmentation. Hence, 76% of patients and 63% of partners were still satisfied. There was no serious adverse reaction. In the 5-year long-term follow-up of glans penis augmentation by filler, the implants were well maintained and effective for glans penis hypersensitivity in premature ejaculation patient
Long-term effects of glans penis augmentation using injectable hyaluronic acid gel for premature ejaculation
T I Kwak 1 , M H Jin, J J Kim, D G Moon
Int J Impot Res. 2008 Jul-Aug;20(4):425-8. doi: 10.1038/ijir.2008.26. Epub 2008 Jun 12.
Abstract
The authors created the glans penis augmentation by injectable hyaluronic acid gel and reported the 6-month result for premature ejaculation. In a total of 38 patients, long-term effects of 5 years were compared to those of 6 months in terms of residual volume of implants and efficacy on premature ejaculation. Maximal glandular circumference measured by tapeline significantly decreased by 15% (P<0.05) but mean patient’s visual estimation (Gr 0-Gr 4) did not decrease (3.60 vs 3.56, P>0.05). Compared to 6-month follow-up, intravaginal ejaculatory latency time and vibratory threshold decreased at 5 years (P<0.05), but still well increased considering those of preaugmentation. Hence, 76% of patients and 63% of partners were still satisfied. There was no serious adverse reaction. In the 5-year long-term follow-up of glans penis augmentation by filler, the implants were well maintained and effective for glans penis hypersensitivity in premature ejaculation patient
Semipermanent and permanent injectable fillers
Derek H Jones 1
Dermatol Clin. 2009 Oct;27(4):433-44, vi. doi: 10.1016/j.det.2009.08.003.
Abstract
Today, an impressive array of injectable dermal fillers for facial soft-tissue augmentation is available in the United States. These agents, most of which were introduced in the last half decade, represent a variety of semipermanent and permanent fillers across several categories. Physicians can choose between semipermanent fillers, such as hyaluronic acid derivatives (HA), calcium hydroxylapatite (CaHA), and poly-L-lactic acid (PLA), and longer-lasting, so-called “permanent fillers,” such as polymethyl methacrylate microspheres (PMMA), highly purified forms of liquid silicone, and hydrogel polymers
Penile Girth Enhancement With Polymethylmethacrylate-Based Soft Tissue Fillers
Luis Casavantes 1 , Gottfried Lemperle 2 , Palmira Morales 3
J Sex Med. 2016 Sep;13(9):1414-1422. doi: 10.1016. Epub 2016 Jul 25.
Introduction: An unknown percentage of men will take every risk to develop a larger penis. Thus far, most injectables have caused serious problems. Polymethylmethacrylate (PMMA) microspheres have been injected as a wrinkle filler and volumizer with increasing safety since 1989.
Aim: To report on a safe and permanently effective method to enhance penile girth and length with an approved dermal filler (ie, PMMA).
Methods: Since 2007, the senior author has performed penile augmentation in 752 men mainly with Metacrill, a suspension of PMMA microspheres in carboxymethyl-cellulose.
Main outcome measures: The data of 729 patients and 203 completed questionnaires were evaluated statistically.
Results: The overall satisfaction rate was 8.7 on a scale of 1 to 10. After one to three injection sessions, average girth increased by 3.5 cm, or 134% (10.2 to 13.7 cm = 134.31%). Penile length also increased by weight and stretching force of the implant from an average of 9.8 to 10.5 cm. Approximately half the patients perceived some irregularities of the implant, which caused no problems. Complications occurred in 0.4%, when PMMA nodules had to be surgically removed in three of the 24% of patients who had a non-circumcised penis.
Conclusion: After 5 years of development, penile augmentation with PMMA microspheres appears to be a natural, safe, and permanently effective method. The only complication of nodule formation and other irregularities can be overcome by an improved injection technique and better postimplantation care.
Long-term effects of glans penis augmentation using injectable hyaluronic acid gel for premature ejaculation
T I Kwak 1 , M H Jin, J J Kim, D G Moon
Int J Impot Res. 2008 Jul-Aug;20(4):425-8. doi: 10.1038/ijir.2008.26. Epub 2008 Jun 12.
Abstract
The authors created the glans penis augmentation by injectable hyaluronic acid gel and reported the 6-month result for premature ejaculation. In a total of 38 patients, long-term effects of 5 years were compared to those of 6 months in terms of residual volume of implants and efficacy on premature ejaculation. Maximal glandular circumference measured by tapeline significantly decreased by 15% (P<0.05) but mean patient’s visual estimation (Gr 0-Gr 4) did not decrease (3.60 vs 3.56, P>0.05). Compared to 6-month follow-up, intravaginal ejaculatory latency time and vibratory threshold decreased at 5 years (P<0.05), but still well increased considering those of preaugmentation. Hence, 76% of patients and 63% of partners were still satisfied. There was no serious adverse reaction. In the 5-year long-term follow-up of glans penis augmentation by filler, the implants were well maintained and effective for glans penis hypersensitivity in premature ejaculation patient
Nonsurgical Medical Penile Girth Augmentation: A Retrospective Study of Psychological and Psychosexual Outcomes
Aesthetic Surgery Journal 2018, 1–11
Gemma Sharp, PhD; and Jayson Oates, FRACS
ABSTRACT
Background: Although interest in penile augmentation procedures is increasing, there is a significant lack of research into the psychological and psychosexual outcomes of these procedures.
Objectives: To investigate the psychological and psychosexual outcomes of nonsurgical medical penile girth augmentation.
Methods: This retrospective study involved a mixed method approach. Twenty-five men who had undergone a nonsurgical medical penile girth augmentation between 1 and 12 months prior (mean, 6.6 months) completed an online questionnaire containing measures of procedure motivation,
procedure satisfaction, genital self-image, penile-focused body dysmorphic disorder symptoms, self-esteem, and sexual relationship satisfaction. Six of these men elected to complete in-depth one-to-one semi-structured phone interviews to further explore the psychological impacts of the procedure.
Results: In the online questionnaire, most men were satisfied with their penile size, appearance, and function after penile girth augmentation. The men also reported statistically significant improvements in their genital self-image (P < 0.001) and self-esteem (P = 0.008), and a reduction in penile-focused body dysmorphic disorder symptoms (P = 0.002) at the time of completing the questionnaire compared to recalled pre-procedural levels. The in-depth interviews yielded 3 themes surrounding penile augmentation outcomes: (1) high satisfaction with increased penis girth; (2) increased self-confidence, particularly in situations in which the penis would be seen, such as a locker room; and (3) increased sexual confidence, but some mixed impacts on sexual relationships.
Conclusions: Most men appear to be satisfied with their nonsurgical medical penile girth augmentation results, and they also seem to experience improvements in their overall self-esteem.
Effects of glans penis augmentation using hyaluronic acid gel for premature ejaculation
J J Kim, T I Kwak, B G Jeon, J Cheon, D G Moon
Int J Impot Res. 2004 Dec;16(6):547-51. doi: 10.1038/sj.ijir.3901226.
Abstract
The main limitation of medical treatment for premature ejaculation is recurrence after withdrawal of medication. We evaluated the effect of glans penis augmentation using injectable hyaluronic acid (HA) gel for the treatment of premature ejaculation via blocking accessibility of tactile stimuli to nerve receptors. In 139 patients of premature ejaculation, dorsal neurectomy (Group I, n=25), dorsal neurectomy with glandular augmentation (Group II, n=49) and glandular augmentation (Group III, n=65) were carried out, respectively. Two branches of dorsal nerve preserving that of midline were cut at 2 cm proximal to coronal sulcus. For glandular augmentation, 2 cc of HA was injected into the glans penis, subcutaneously. At 6 months after each procedure, changes of glandular circumference were measured by tapeline in Groups II and III. In each groups, ejaculation time, patient’s satisfaction and partner’s satisfaction were also assessed. There was no significant difference in preoperative ejaculation time among three groups. Preoperative ejaculation times were 89.2+/-40.29, 101.54+/-59.42 and 96.5+/-52.32 s in Groups I, II and III, respectively. Postoperative ejaculation times were significantly increased to 235.6+/-58.6, 324.24+/-107.58 and 281.9+/-93.2 s in Groups I, II and III, respectively (P<0.01). The percentage of postoperative satisfaction in both patient and his partner was 68% (17/25) and 44% (7/16) in Group I, 80% (39/49) and 66% (25/38) in Group II and 75% (49/65) and 62% (32/52) in Group III, respectively. Maximal glandular girth was significantly increased from 9.16+/-0.59 to 10.95+/-0.4 cm in Group II and 8.95+/-0.54 to 11.67+/-0.71 cm in Group III, respectively. These results suggest that glandular augmentation with injectable HA gel is a safe and effective modality to reduce sensory of glans penis. Long-term follow-up for residual volume and efficacy should be requested to establish its precise therapeutic potentials in premature ejaculation.
Tolerability and efficacy of newly developed penile injection of cross-linked dextran and polymethylmethacrylate mixture on penile enhancement: 6 months follow-up
Int J Impot Res. 2013 May;25(3):99-103. doi: 10.1038/ijir.2012.41. Epub 2012 Nov 22.
Abstract
Cross-linked dextran and polymethylmethacrylate mixture (Lipen-10) is newly developed tissue filler. The purpose of this study was to evaluate tolerability and efficacy of Lipen-10 on penile enhancement. Twenty adult males were included in this study. Lipen-10 was injected into the subcutaneous tissue of the penile shaft. The penile girth and length were measured in the flaccid state, before and 1, 3 and 6 months after the injection. The circumference increased by 3.7±1.2 cm (50.8%, P<0.0001) at penile base, 4.2±0.9 cm (59.0%, P<0.001) at mid-shaft, and 3.8±1.0 cm (53.2%, P<0.0001) at distal shaft and the length increased by 2.3±1.4 cm (63.2%, P<0.001). There was, however, no significant difference between 3 and 6 months post-treatment in girth and length (P-values: 0.796, 0.498, 0.600 and 0.084 for penile base, mid- and distal-shaft and length, respectively). The complications were only one mild asymmetry of penile shape and one 5-mm-sized nodule in the injected site. There were no clinically significant adverse events in all subjects. Penile injection of Lipen-10 led to a significant increase in penile size, showed a good durability and was well-tolerated, without serious adverse events. These results suggest that penile injection of Lipen-10 may be a new effective method for penile enhancement.
Penile girth enhancement procedures for aesthetic purposes
Int J Impot Res. 2022 May;34(4):337-342. doi: 10.1038/s41443-021-00459-y. Epub 2021 Jul 13.
Abstract
The present study aimed to describe and critically discuss the current evidence regarding the penile girth enhancement procedures for aesthetic purposes. We designed a narrative review of the literature. A comprehensive search in the MEDLINE database was performed. Original articles in English-language, published until March 2021, were selected. A total of 29 studies were included (3 reporting non-invasive approaches, 11 injection therapies, and 15 surgical procedures). The vast majority of articles (26, 89.7%) were not randomized controlled trials, with overall low quality and limited level of evidence. Only 1 (33.3%) paper regarding non-invasive approaches reported a minimal (+0.03 cm) but a significant increase of penile girth (p = 0.034). A low rate (11.2-14.4%) of mild, temporary adverse events and poor-to-moderate patient satisfaction were found. Eight (72.7%) articles concerning injection therapies showed a significant increase in penile girth (p < 0.05). A low rate of mild complications, generally at the injection site, and a high patient satisfaction rate (75-100%) were highlighted. Nine (60%) papers on surgical treatments found a significant increase in penile girth (p < 0.05), while the other 6 (40%) studies reported a generic improvement in penile circumference. Skin necrosis or ulcers, wound infections, or need for reoperation were reported in 8 (53.3%) studies. A high patient satisfaction rate (60-100%) was reported. Our review highlighted the overall positive results of injection procedures, the poor outcomes associated with non-invasive techniques, and the good efficacy and satisfaction with a non-negligible risk of complications in patients undergoing surgical treatments. However, the adverse events are probably largely under-reported and these procedures should still be considered under investigation due to the limited evidence available and the lack of guidelines.
‘Use of Macrolane VRF 30 [Hyaluronic Acid] in emicircumferential penis enlargement’
Sito, Giuseppe; Marlino, Sergio; Santorelli, Adriano
Aesthetic Surgery Journal / The American Society for Aesthetic Plastic Surgery 33.2 (Feb 2013): 258-64
ABSTRACT
Background. Penis enlargement is increasingly in demand. Methods for penis enlargement can be classified into surgical, nonsurgical (filling), and mechanical. Each method has shown only relatively successful results. A new formulation of injectable, stabilized, hyaluronic acid (HA)-based, nonanimal gel is available that may have applications for this use.
Objectives. The authors propose a new technique for emicircumferential-injection filling of the penis and assess the safety and efficacy of this procedure compared with lipofilling [fat grafting, fat injection].
Methods. The authors retrospectively reviewed the charts of 83 patients who underwent penis enlargement with either their HA-injection technique or lipofilling between December 2007 and July 2011. Safety, efficacy, and patient satisfaction were assessed.
Results. The circumferential enlargement obtained from both techniques ranged from 3.2 to 4.5 cm, with a decrement during erection. In all patients, the increase in penis length ranged from 1.8 to 3.6 cm.
No complications were seen in patients treated with HA [Hyaluronic Acid], whereas 8 patients treated with lipofilling [fat grafting, fat injection] developed granuloma, and another experienced fat necrosis.
The vast majority (n = 72) of patients reported being “very satisfied” with the results.
Conclusions. The ideal technique for penis enlargement should be nonsurgical, with a satisfactory and predictable result, a low rate of complications, and long-term stability. Emicircumferential enlargement with HA [Hyaluronic Acid] filler meets these requirements. However, results have been durable but not definitive, and repeated treatment (with associated costs) is necessary.
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Afterwards, and before we can scheduling the exact date for your first procedure, our surgeon will need to conduct a brief urologic examination. The majority of men complete this step using the same safe HIPPA-protected Telehealth platform that we use to treat urologic clinical patients.
Remember, there are some men not well suited for a non-surgical enlargement
- Patients must be circumcised. Adding girth to an uncircumcised penis almost always causes issues with the natural function of foreskin retraction during an erection, resulting in phimosis, infections, and a number of problematic urologic disorders. We provide non-surgical cosmetic circumcisions for $3,900 that leave extra skin for men wanting to create an extra thick penis. At least three months must pass after a new circumcision has been performed before a non-surgical penile enlargement can be performed.
- Men with enlarged suprapubic fat pads above the base of their penis are not good candidates for starting with a non-surgical girth enlargement. This enhancement will almost always make them appear smaller than they were originally. These men shoulder consider a surgical option where the fat pad is removed, the stomach contoured, and the penis lengthened in a singular procedure.
- Patients with a micropenis usually don’t get fulfilling results starting with a non-surgical girth They should first start with either non-surgical or surgical lengthening. Adding thickness to a shorter penis doesn’t create a positive outcome and will almost always cause the penis to appear smaller.