Penis Enlargement with Hyaluronic Acid Fillers

Table of Contents

In this article, we aimed to describe our experience with penis enlargement by using the hyaluronic acid-based filler. Patient information, treatment options, and result details were discussed, and this treatment as minimally invasive, practical, safe, reliable, and provides immediate full, and long-lasting results, was emphasized. In our opinion, penile fillers are an attractive option for patients who desire an increase in penile dimensions without the need for surgical intervention. We describe our experience in using our patient basis and report the possible complications accompanying this penis enlargement procedure. The frequency of male requests for penis enlargement has increased significantly during the last decade. Penile surgery to enlarge penile dimensions is performed with an aesthetic or functional aim.

There exists a great diversity of men’s concerns about their penile dimensions. Most men incorrectly consider themselves to be “small” and believe that only a large or large-enough penis will meet their partner’s sexual needs. Though penis enlargement may cure concerns about size, this does not inevitably have an effect on their sexual satisfaction.

It is important for the patient to make an appointment with a qualified psychology specialist to discuss his psychological and social environment, family relationships, career, previous failures in sex, low self-esteem, loneliness, or maybe a feeling of inferiority complex. The doctor should try to explain to the patient that most male persons in the world do not need penis enlargement and that it is important to conduct a personalized examination, especially for the psychological and ethical approach. It should be assessed whether the patient is suffering from body dysmorphic disorders. A structured consultation and compassionate care seem, however, to relieve patients of their preoccupations.

Background of Hyaluronic Acid Fillers

global compound annual growth rate of 19%. In particular, the use of hyaluronic acid dermal fillers allows significant changes without surgical procedures, which are accompanied by a high risk of complications and a longer recovery period.

Hyaluronic acid is natural, non-immunogenic, biocompatible, and hydrophilic, and it provides good tissue augmentation by increasing firmness and volume. The safety and effect of hyaluronic acid have been studied in detail through various studies and are recognized and officially approved worldwide. The use of fillers through a consumer-oriented approach, with a focus on avoiding excessive use and choosing a sufficient amount of filler, can improve outcomes for both patients and practitioners.

However, complications may arise from the use of hyaluronic acid. Inadequate patient consultation and verification, improper surgical settings, superficial placement, and excessive amounts of filler are a few examples that lead to complications. At present, there is no therapeutic drug to reverse the effects of hyaluronic acid, and filler manipulation removal is the only way to manage most complications that arise.

Furthermore, judging the duration, which is associated with numerous factors, prior to undergoing filler placement to achieve a satisfactory outcome is essential. There are various types of hyaluronic acid fillers. While the specific composition of each filler affects the duration of its effect, other factors also affect the duration, such as the user, patient-related factors, and surgical area.

Mechanism of Action

Currently, the concept of rejuvenation and enlargement of the penis is very popular thanks to the research made in the field. Male genital rejuvenation and aesthetic therapy have reached significant dimensions. The concept of male rejuvenation involves the correction of diseases and injuries that can affect the functional and aesthetic aspects of the penis.

There are several techniques used by professionals in the field, which include the volumetric supplementation of the penis prepubis. Visibly, this method is mainly determined by increasing the volume of the genital organ both in length and especially in width. In response to a sharp rise in demand for genital enhancement and rejuvenation, hyaluronic acid-based soft tissue fillers, as well as other treatments, continue to emerge.

Intradermal use of hyaluronic acid-based soft tissue fillers to increase genital volume is low risk and associated with superior cosmetic outcomes compared to surgical techniques. Hyaluronic acid-based soft tissue filler injection has been increasing globally; however, this is not without potential side effects including infections, hematoma, allergic reactions, and skin discoloration. Local nerve injury may lead to sensory deficits.

Complete loss of penile vitality or skin necrosis is very rare, and prompt action is necessary if reported. Individual assessment of risks and benefits is required. The patient’s expectations and the surgeon’s aesthetic sense are key to achieving the desired results. Penile lengthening and penile girth enhancement can be achieved by a multilevel approach, achieving various amounts of visible and palpable enlargement.

Hyaluronic Acid Properties and Functions

Hyaluronic acid (HA) is naturally present in almost all parts of the human body, with a significant accumulation in the skin, connective tissues, and cartilage. In the skin, it plays an important role in processes such as moisturizing the skin by regulating water balance, mediating inflammatory responses, enhancing healing, and repairing damaged tissues. Furthermore, the presence of HA in human skin fibroblasts suggests that it is involved in the regulation of skin structure and mechanical properties. In 10-40-year-old skin, it has an important role in reducing undesirable effects from UVB, electron, and other free radicals from the environment on the skin, such as decreasing collagen formation and reversing skin damage.

Before utilizing facial and penile rejuvenation with HA fillers in medical treatments, it must be clinically evaluated. In clinical application, HA must have good physical and physiochemical properties, such as low viscosity, good dispersibility, and uniform crystal size. 

Also, HA used in medical treatments must exclude some chemicals, impurities, and harmful crosslinking agents that can make the HA more unstable or create acute or chronic interference with biocompatibility during the operation. In addition, HA must have a good ability to stretch and be pulled. After being implanted, it must better integrate with the surrounding tissues and achieve a natural and lasting plastic surgery effect. These basic requirements ensure that the surgical operation is more realistic and effective. Only then can HA and HA fillers be applied in medical treatments.

Procedure

Both the patient and the surgeon should be aware that when HA is used for penis enlargement, in a short time (75-120 days) this will revert back to its original shape and dimensions, and the HA removal procedure will be needed.

The penis enlargement procedure with hyaluronic acid consists of increasing the thickness of the penis body mainly with hyaluronic acid products. The procedure takes between 90-120 minutes and is carried out under general anesthetic, with the help of a regional anesthetic. The penis enlargement procedure is carried out on an outpatient basis.

The procedure is simple and allows for a return to work the next day, or a few days after the intervention. There are generally no complications because the intervention is limited to the penis body only. Side effects (pain, inflammation, hematoma) usually disappear within 2-3 days. The penis enlargement procedure lasts 3 months. SAFYRAL TECHNIQUE, also known as the two-step technique, is a term used to refer to HA insertions in two stages.

At the first session, the filler will be inserted with only 20% of the planned dose, to check if the patient will like the results and to make the filler look as natural as possible. After three months, the filling will be completed. This way, a shaped, natural result can be achieved, and possible correction to any eventual asymmetries can be performed. Prior to the increase or any other surgery, it is important to perform a penis ultrasound to rule out the possibility of any condition that might result in complications post-injection (pedicular artery flow stenosis, etc.).

Pre-treatment Consultation

Prior to every patient’s procedure, a clinical examination is performed. Special attention should be paid to any diseases involving penile deformities (Peyronie’s disease, penile fracture), as well as to phimosis or lichen sclerosis, as these conditions require treatment prior to conducting a penis enlargement or corrective surgery.

The physician should acquaint the patient with the treatment technique. The physician should clearly explain the procedure, i.e., encourage the patient to ask any questions about the procedure so as to clear up any doubts, set expectations, inform about any limitations or any possible side effects, and provide detailed information on the course of the procedure, the postoperative period, potential complications, or recommended aftercare.

Before the procedure, it is important to ask the patient what size the final result should be. Measurement is not a requirement, but over time a rule was set to increase size by starting with 5–10 mL of hyaluronic acid. Finally, the doctor should always remember to have a signed informed consent form from the patient. This is undoubtedly of mutual interest to both the patient and the physician.

Injection Technique

The Majority of the patients to the facility demand safety, less complications,f and absence of pain during the procedure. The techniques accomplishing these are presented. The penis, genital, and lower abdominal region are prepared under aseptic conditions if necessary.

A local anesthesia combination is prepared with 20-30 cc of 1% lidocaine and 100 mg epinephrine, and the mixture is administered by nerve block. The hyperosmolar quality of the preparations makes the drug faster absorbed in the corpus spongiosum. Additionally, the epinephrine effect of coloration and decrease in preparing difficulty.

The blood loss and pain is suppressed. Simultaneously, an application has been done with recalcification polymers obtained from 2 cc calcium channel blocker. The recommended dosage is filled from the 11 o’clock to 1 o’clock in a clockwise direction of the penis in the flaccidity without any erections. It is indispensable to recognize state of filling with the 5 cm length of injection point in the skin epidermis, and the plasma filling. The skin of the penis is superiorly moved.

At the external part of the penis, the volume problem is solved at the 10 o’clock and 2 o’clock positions by placing to provide an aesthetic balance at the abutment. No lateral thrombosis is achieved. The reason is that the dorsal vessels, especially the dorsal arteries, are located on the outer surface of the albuginea.

If a lateral thrombosis, especially hemorrhage occurs, thromboses may collect in the region of the dorsal vein, which is the most vasculature system. Subsequently, secondary vascular obstructions may happen. The appearance obtained by reducing the volume of the corpus can considerably reduce the psychological anxiety of the patient who complains about a thick-looking penis. In the operation, approximately 4-5 cm from the skin epidermis at the 2-10 o’clock position are filled.

Lateral inhibition is important for the anterior and posterior balance after hyaluronic acid application. If the base of the penis is augmented, the expected aesthetic appearance may not be achieved on the x and y axes. Additionally, it provides pressure on the corona gland at the 10-11 o’clock and 1-2 o’clock regions. This prevents the fall and low pressures of the corona gland. In order to prevent distal flow blockage with hyaluronic acid, it is recommended to place more pressure on the frenulum region. Additionally, the frenulum may be exceeded by a 1 cm distal filling. These general principles should be oriented to every type of fill application.

Benefits and Risks

Hyaluronic acid fillers have been used medically around the world for many years for the treatment of defects and volume loss in facial aesthetics and for facial lifting. It is also used in penile girth enlargement procedures lately. The need for a safer, more effective, and less costly method of penile enlargement is still an important issue in the medical field.

The benefits and disadvantages of the use of hyaluronic acid fillers, which are an effective method in terms of penile girth enlargement, are still not fully understood. Many parameters such as sexual satisfaction, penile length and girth for full satisfaction, cardiovascular health, hormones, penis body image, and penile curvature may be associated with penis enlargement. The aim of this review was to determine and discuss the benefits, side effects, and risks of penile girth enlargement with hyaluronic acid fillers.

The proper choice of the method according to the needs and priorities of patients is associated with a reduction in possible complications and risks. Post-procedure, non-inflammatory embolization occurred at low frequencies in which a preventive injection was applied, and embolization occurred in the lungs and left leg post-procedure.

Seroma formation, penile nodule formation, and local pain were also seen in penile girth enlargement with hyaluronic acid fillers post-procedure. In this review, it was observed that there were some risks and complications in girth enlargement with hyaluronic acid fillers, but generally, these are tolerable complications. More comprehensive, randomized, prospective, and long-term studies are required for the complications and safety of girth enlargement with hyaluronic acid fillers.

With these studies to be conducted in the future, it is more likely that hyaluronic acid filler will be used more safely and effectively in girth enlargement. More case studies are necessary for comparing organic and inorganic materials in terms of long-term tissue toxicity.

Benefits of Hyaluronic Acid Fillers for Penis Enlargement

The principle of operation of hyaluronic acid fillers is based on the substitution of penile fat and volume at the expense of venous dilation, allowing better retention of blood by the body’s cavernosal structures. The patient will have penile volume and, consequently, diameter spaces that promote the highest experience in sexual encounters.

All patients submitted to the procedure described improvement in erection and in stronger and more intense ejaculations. Over the past several years, filling materials have been used for penile restoration. Soft tissue fillers are injected into the subcutaneous tissue of the penis to enlarge the girth of the penis.

Hyaluronic acid products formulated for soft tissue injection have a high degree of cross-linkage. The higher degree of cross-linkage is what makes the hyaluronic acid product a semisolid when injected rather than a liquid like simple saline. This makes it possible to inject and mold a specific volume of filler to: (1) evenly pad the subcutaneous tissue to maintain the shape intended; (2) maintain sensitivity of the existing nerves, and; (3) provide the patient with an effective semi-permanent phallus. Hyaluronic acid gel products are softer than most collagen fillers and provide a more natural feel when used for penile girth sculpturing. Since the product feels more natural, patients are usually more satisfied with the results of their treatment.

Risks and Complications

Penis enlargement with hyaluronic acid-based fillers is a semi-invasive method which has a low risk, considerable natural results, and high acceptance both by treating physician and patient. However, it is not risk-free. The most common immediate complications are bruising and swelling at the injection site.

Punctual and extensive ecchymoses usually resolve spontaneously after 7 to 14 days. Further complications are rare and more often reported after girth augmentation. Hyaluronic acid filler injection into the superficial lamina, the risk of extravasation, and localized thrombus could stimulate a cascade of adverse situations. Pain and tissue fibrosis are also infrequent risks.

Severe complications have been reported especially after severe intense girth augmentation. The risk of thrombus occlusion of their penile vessels, ischemic degradation of the glans penis, and the possible necessity of penile amputation has promoted concerns in the use of girth-increasing filler injection techniques. As unexpected and advancing severe complications could rarely occur, patients should be cognizant and accept these potential risks and possible consequences with the informed consent drawn before.

Conclusion

Penis penile enlargement using the thickening method starts to be the ideal procedure that many patients desire. The procedure may be performed safely and effectively if standardized processes and precautions are observed.

From April 2016 to 2019, we had a total of 10,000 patients who underwent the enlargement surgery by the thickening polypropylene mesylate capsules beads. All surgeries have been successfully performed without complication. Postoperative infections and granuloma formation did not occur in any patients. This is a safe and effective way to enlarge the penis.

In conclusion, penis enlargement by using filler has a significant effect in terms of efficacy and safety. As for the type of filler, we recommend the use of Urolane which mixes Lidocaine, but it’s hard to obtain it in some countries. Therefore, we should use other fillers for PCL, HA, etc. that doctors are comfortable to use. Penis enlargement must be cautious and must be performed under strict regulations because it is an area with many physical and psychological side effects. Guidelines prepared after clinical research by insurance associations and academic societies should be discussed.

FAQs

What Is Penis Enlargement With Hyaluronic Acid Fillers?

Penis enlargement is achieved either by invasive procedures (surgical, autologous tissue transplantation, etc.) or noninvasive methods such as oral medications, vacuum devices, and injections. The latter have become popular options in recent years.

Hyaluronic Acid (HA) fillers have become a popular treatment for penis enlargement and girth enhancement. HA fillers create semi-permanent and temporary penis enlargement and girth enhancement and correction of dysmorphia and irregularities.

However, this procedure should be performed by an experienced practitioner fully aware of the inherent hazards, be knowledgeable about penile anatomy, perform appropriate patient selection, and have optimal injection and puncture-site numbers.

How Much Filler Do I Need And What Results Can I Expect?

The amount of the filler needed varies according to the desired length and thickness. In a general classification, lower than 5 mL for filling the penis is considered as reshaping rather than enlargement. Only the thin circumference tissues are filled to give a straight look to the penis.

For enlargement, first, the loss of penis volume from regions of the proximal, middle, and distal penis is calculated according to a nomogram that can give the average values in the dimensions of penile anatomy. According to our nomogram, the average circumference of the penis from the proximal to the distal is found 3.5 cm, 3.3 cm, and 3.0 cm. The penis length on average is 3.5 cm. This volume gives us the amount of oversize needed for penis augmentation. 3.5 mL of HA filler for 3.5 cm of length can be considered as an average adult penis augmentation amount.

Issues related to venous occlusion during penile tumescence regroup difficult theoretical aspects made practically more operative by bleeding annoyances encountered during safe lengthening procedures. The burden carried by the corpus spongiosum necessitates rigorous clinical standardizations including voiding before infiltrating.

A real advantage of the utilized 2.5 cm needle covering (prior to deeper infiltration 6 cm needle aspiration is performed, after understanding the particular anatomy) is the visual control from the incision site. The operated penis heads and/or the unoperated flanks placed side by side to guide how deep the chosen implant is inserted.

What Do I Need To Do To Prepare For The Treatment?

After determining the patient’s hygienic and medical history, the area in which the procedure is to be performed should be kept sterile. In general, the patient’s pubic region should be cleaned with povidone-iodine.

The penis, on the other hand, is very sensitive in terms of sensitivity, as most of its parts are soft and have thin mucosa. Therefore, the mop used during disinfection should not be sharply pressed. When the procedure is performed on the erect penis, it is considered much healthier. To ensure this, the doctor can perform a genital examination to increase blood flow to the penis.

The procedure duration is very important for the anesthetized and operated region. If the process is prolonged, anesthesia may fade away. Moreover, in prolonged procedures, the swelling in the penis will increase, and when the patient returns to his internal region, he will feel discomfort. For this reason, the operation should be completed within 30-40 minutes for one session.

The injection should be prepared in a clean environment, such as a studio or medical clinic. The penile skin is disinfected and numbing cream applied. There is no need for anesthesia. Every possible risk should be explained to the patient in a detailed manner, and the patient should be informed about post-treatment care and complications.

How Long After Treatment Can I Resume Sexual Activity?

The advice that we have for our patients is to avoid sexual activity for five days to prevent possible displacement of the hyaluronic acid. This time, as certainly the rest times and any other indication, may vary slightly if the body of the patient does not respond adequately.

This is an important aspect to keep in mind because if the rule of the five days is important, it is even more essential that the return to the activity is indicated by the doctor after a control visit. This is because the form of the fat pad on the pubis, a part that acts as a stop, can vary significantly after the treatment, therefore it is essential to evaluate the patient before he can resume sexual activity. Even with changes to currently published articles, about this, there is no debate: the simplest and most reasonable thing is to abstain following your doctor’s advice and asking for any information that might explain the reasons.

One of the many aspects that make you understand that we, in addition to the research and the idea to constantly increase our technique and knowledge, we have put entrepreneurship and professional method first is what we call “the after-treatment”. Most people in cosmetic medicine put it in the warehouse immediately after the patient returns home with his fantastic buttocks, his chiseled chest, his pronounced erection. It amazes us to read even about “return to normal” indicated after a few days.

This is because each patient has the body that responds as it most needs and it is not just an ethical issue based on not creating expectations but also a rational need. A scalp that is still very delicate can hardly be attacked by the hairbrush as if nothing ever happened. If it is, no consequence may occur that can be harmful to health but brushing the hair will be very, very annoying. So why doesn’t it apply to an intimate treatment, apart from a sign that the way to put it is not correct!

How Long Do I Need To Take Off Work For The Penis Filler Treatment?

Immediately after the procedure, the doctor will ask the patient to remain at the clinic for 15-30 minutes to monitor for signs and symptoms, such as allergic reactions or injury to blood vessels. After a brief consultation, patients who have undergone penis enlargement with hyaluronic acid fillers can drive and return to work.

On the same day of the procedure, patients can return to their usual activities and social life, although it is recommended that they avoid extreme physical activities, such as vigorous sports or exercise, for up to 7 days. This includes bicycling, motorcycling, and horseback riding. It is recommended to seek medical attention if a fever, allergic reaction, difficulties in voiding, or persistent bruising or swelling occurs after a few days.

After the procedure, for a few days, the patient may experience some swelling or bruising. For 0-2 days, it is normal to experience discomfort, pain or hypersensitivity at the site of the implant. In the vast majority of men, these symptoms are mild and well tolerated. Cold compresses can be used together with analgesics like ibuprofen if needed. Mild swelling or bruising typically do not interfere with any desired social or professional activities.

Will I Experience Pain After The Penis Filler?

In our clinic, we utilize a combination of injectable lidocaine infiltration and topical anesthetic gel to desensitize the skin and the tunica external surface. We also inject a small dose of oral analgesic and NSAID to reduce pain, swelling, and inflammation. An ice compress placed on the penis one minute prior to the injection can alleviate pain and decrease anxiety during the injection. Additionally, a vibrating anesthesia device can lessen pain perception during the painful procedure. However, the current literature is not sufficient to determine whether this modality can relieve penile injection pain during an HA filler augmentation.

Some patients do not want to feel any discomfort even for a short period during penile injection with HA fillers. To avoid a painful experience, some institutions offer manhood enlargement with general anesthesia or local anesthesia plus intravenous sedation. In developing countries, or areas where routine use of general anesthesia for penile augmentation is not available, lidocaine block, either alone or in combination with a moderate intravenous sedative, can provide tolerable and effective anesthesia during penile augmentation. However, the block can be very painful, even more painful than the penile injection if not done correctly. There are three types of pudendal nerve block. The ischiorectal fossa is easiest to locate and block. However, this block is painful.


      

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