By the Doctor Stéphane Auroy
Medical penoplasty using hyaluronic acid
Since ancient times, the penis has been a symbol of power, virility, strength and fertility. Japan even dedicates an annual festival to the appendage every April. In addition to being a sex organ, the penis is a major source of anxiety for many men, especially if it does not fulfill his expectations in terms of aesthetics.
We might compare a man’s penis to a women’s breasts which, though not a reproductive organ, are the primary symbol of femininity. Breast implants have become commonplace, and women no longer hesitate about having their breasts done, regardless of their motivations. The large majority of men, perhaps even all men, have wondered how normal their penis is, given that it is a major feature of their virility. Its size and girth are often questioned, and can even become a complex, whether justified or not. However, due to fear, embarrassment or, most often, due to lack of information, very few men dare to talk about this to their doctor and share their feelings and problems.
Medical penoplasty using hyaluronic acid is the current solution for men who want to increase the size of their penis. The procedure is performed in outpatient surgery, under local anaesthetic, and is pain-free, replicable and reversible. It is suitable for all men, once the major counterindications have been ruled out. It enables us to instantly increase the penis’ circumference without surgery (by between 1 and 5cm) and, to a lesser extent, its length (1 to 2cm by projecting it forwards at rest, due to gravity). It fulfills a primary expectation in men: making their penis appear larger at rest and making it thicker when erect to improve feeling during sex (it is much easier to increase the penis’ girth than tighten the vaginal canal, especially after childbirth). In this respect, the studies are unanimous: the girth of the penis has a more important role to play during sex than its length.
The demands are extremely varied: micro penis (rare), locker-room syndrome in sporty men, the pure and simple embellishment of an average-sized penis, recovering lost self-confidence and, as a consequence, enhancing performance. Virtually pain-free, thanks to two injections of local anaesthetic into the head and body of the penis, the procedure takes between 30 and 45 minutes. It nevertheless requires an excellent technique and a certain sense of aesthetics due to the nature of the organ (given that the penis is in constant movement) and requires us to respect the member’s proportions (glans/penis, patient’s corpulence) rather than simply fulfilling inappropriate fantasies.
The penis is injected using a cannula (usually 18G-22G), whose length depends on the size of the penis to be injected. The cannula’s entry point must be positioned so as to minimise the risk of the product descending behind the foreskin. The cleavage plane that enables us to uniformly distribute the product lies in the area of fat cells located between the superficial (dartos) fascia and the deep (buck’s) fascia, so well above the tunica albuginea (brous envelope) and the corpora cavernosa (erectile tissue). At this stage, it is useful to distinguish non-circumcised patients (mark out where the foreskin is to minimise any product migration) and those who are circumcised with a high or low circumcision scar. The number of syringes to be injected should be discussed with the patient, according to their wishes and the model made during the pre-procedure appointment, which is vital for this procedure.
The glans is injected using short 22G needles or cannulas with an anaesthetic injected into the base, enabling us to increase its diameter, smooth it out, reshape its head and even help (somewhat) with premature ejaculation, which affects 1/3 of men (by acting upon the glans’ hyper-sensitivity as opposed to the other causes of premature ejaculation).
The choice of hyaluronic acid is essential. Currently, there is no one official product, but the one that best fulfills the specifications that this indication requires (even distribution, consistency without lasting too long, homogenous resorbability, little or no migration) is the one from VIVA- CY® laboratories. VIVACY® have already obtained the CE standard for Désirial ® (hyaluronic acid for intimate use in women) and are currently carrying out studies to obtain the CE standard for a specific product for penoplasty. Complications are rare in medical penoplasty, providing the correct injection protocol is used and the post-surgery instructions are adhered to (dressings, massages, no water sports, no sexual activity for 8 days) but they do exist: product distributed badly, incorrect technique or use of a product that is not suitable for this area, migration into the testicles due to excess unsticking of the cleavage plane, swelling of the foreskin, temporary hypersensitivity). Erectile function is not affected in any way. The immediate after-effects are mild (bruising, nodules that require massage, swelling). Over the long term, the product is gradually resorbed at a rate of 30 to 60% over the first year, but if injections are carried out repeatedly, this could lead to brosis which makes the results last longer.
Plan for two injection sessions in the first year to achieve extra girth/length and longer-lasting results, then a smaller quantity can be injected every 12-24 months according to the patient’s wishes, to maintain the results achieved.
Dr. Stéphane Auroy 
Specialist in dermatology and venereology. Master of Advanced Studies in skin biology and pharmacology. Former consultant for the Paris Hospitals, specialising in aesthetic dermatology for the last 20 years. Tutor at the Paris V faculty, teaching the university diploma in “Evaluation and control of injection and volume-enhancing techniques”. Speaker at aesthetics conferences. Runs training courses in injection techniques and investigates clinical study protocols.
