Your first discussion with a surgeon should clearly set out your expectations and whether the operation can give you the results you desire.
Careful discussions regarding the reasons for wanting penile surgery and your suitability for this type of surgery are very important at this stage. Make sure that you obtain as much information as is necessary to enable you to make a fully informed choice and make sure you receive satisfactory answers to all your questions.
A medical history should also be taken to make sure that there are no reasons why you shouldn’t have this operation. You would normally be asked to sign a consent form which means that you have understood the potential benefits and risks associated with penile surgery.
Photographs will also be taken by the practitioner as a "before and after" comparison at a later date.
The surgeon may also wish to write to your G.P. giving details of the operation so that if there are any problems associated with surgery in the short or long-term your doctor is aware of the procedure and can help you to recover.
Penile surgery is usually performed under local anaesthetic with IV sedation, meaning that you are conscious but in a reduced state of awareness and will feel no pain, but it can also be carried out under a general anaesthetic.
Please take into account that a general anaesthetic carries more potential risks – this should be clearly explained by the surgeon before you make any decisions about the anaesthetic. Types of anaesthesia available should always be discussed with your surgeon.
If you make a decision to go ahead with penile surgery, the actual procedure may take place in an outpatient surgical clinic where you can go home the same day.
The penoplasty operation(s) usually takes about 1 – 2 hours, depending on whether you have the lengthening or enlargement procedures on their own or both.
The genital area will also require shaving prior to any of the procedures.
It may be necessary to have a circumcision performed at the same time as the lengthening and/or enlargement procedures, as this avoids swelling of the foreskin, which can last for several weeks.
In a lengthening procedure a small incision is made above the base of the penis, and the ligament which suspends it, running from the pubic bone to the top of the penis is cut. This causes the penis to drop forward, thereby lengthening its appearance from the outside by 1 – 2 inches (20 – 50%), although the actual gain will depend from person to person. The ligament is then reattached lower down and a flap of skin, taken from the pubic bone area, is used to cover the new extension, created from bringing the “inner” penis forward. Often dissolvable stitches are used, both internally and on the external cuts, but some surgeons do use normal stitches as well, which will need to be removed after a couple of weeks.
This lengthening operation only affects the non-erect (flaccid) length of the penis, any post-operative erection will remain the same size but the angle of it may be slightly lower than it was prior to surgery.
To enlarge or increase the girth of the penis, a small liposuction procedure is required first to obtain fat from the abdomen or thighs which can be transferred to the penis by injection. As the fat is injected into the penis, it avoids incision scars and reduces the recovery time required.
The penis can usually be increased in girth or circumference by 1 – 2 inches (30 – 50%). The enlargement will be visible in both flaccid and erect states.
With the enlargement procedure there is a risk that the body will reabsorb some of the fat injected into the penis, in fact as much as 30% of the injected fat can be reabsorbed in the first few months. For this reason, surgeons will overfill a little at the point of transfer so that the shaft is just slightly wider than the tip.
If required, top-up fat procedures can be carried out after 6 months. Final results can be long lasting.