PENİS UZATMA

The goal of this surgery is to lengthen the penis. Lower abdominal liposuction, penoscrotal skin plasty and glans (head of the penis) filling procedures can be added to this surgery. Penis thickening can be done with fat grafting technique together with penis lengthening surgery. Most patients prefer to have penis lengthening and thickening surgeries done together.

Details of the surgery:

1) Cutting the suspensory ligament of the penis and inverting-anti-retraction stitches

The suspensory ligament of the penis is a connective tissue that connects the part of the penis that is deep inside the body to the pelvic bone. Approximately half of the penis is located deep inside the body, and when the suspensory ligament is cut, this deep part slides out of the body. As a result, the outer part, the visible part, will be longer. The degree of penis lengthening is related to the condition and volume of this suspensory ligament. The better developed the ligament is, the greater the success in penis lengthening. Unfortunately, it is not possible to measure the actual size of this ligament, which is located quite deep and which the surgeon cannot examine manually, before surgery. In ultrasound examination, only the superficial part can be viewed due to the blocking of sound waves by the pelvic bone. There are differences in the volume and consistency of this ligament between men, and this determines the lengthening that will be achieved in the penis. In other words, it is impossible to predict exactly how much length will be gained before surgery. The generally accepted view is that if the ligament is cut with the appropriate surgical technique and skin plasty is added to provide sufficient lengthening, a lengthening of 2 to 5 cm can be achieved. This lengthening will be 2-5 cm in the flaccid state of the penis, while in the erect state it will be limited to half the gain. The erect (rigid) penis length can be further extended with the penis stretching or vacuuming device that we recommend using from the 6th week after surgery until the 6th month.

By measuring the superficial part of the suspensory ligament, it is possible to evaluate the patient's suitability for penis lengthening surgery to a certain extent. In cases where the distance between the bone and the penis is good, the results are satisfactory.

Technically, the cutting of the suspensory ligament of the penis is an easy surgery. However, when working in a deep area, care should be taken due to the proximity to the dorsal neurovascular structures of the penis. In order to ensure the clarity of the incision and to cause minimal thermal damage to the surrounding tissue, we use the latest version of the computerized CO2 LASER, the most advanced incision method in the world, in our suitable patients at this stage of the surgery. The advantages of LASER include less bleeding, clear incision, less thermal damage to the surrounding tissue, less pain and superiority in recovery. While the incision is made with LASER, bleeding of the vessels is also prevented. In summary, there may be positive contributions to the results and benefits in post-surgical recovery with the use of LASER. However, the use of LASER brings additional costs to the surgery and it is not necessarily used in every patient.

The lengthening achieved by cutting the ligament is often partial, because scar retraction of the ligament occurs. Scar retraction is a condition that can be seen in other surgeries in the body and is the spontaneous closure and filling of the surgically cut body part days after the surgery. In this case, the results are zero and even shortening of the penis is possible. The ligament can reattach to the pelvic bone by pulling. This problem has been detected in problematic cases that have been reoperated.

The most important tool to prevent this problem is the use of penis EXTENDERS-TENSIONERS, which have become more important in recent years. These are mechanical devices that can stretch the penis in a controlled and increasing manner. You can see advertisements on the internet all the time about these systems that extend the length of the penis, but the success that can be achieved without penis lengthening surgery is minimal. However, they have many benefits in preventing post-operative scar retraction (pulling). They are not used in the early period after surgery due to their potential to enlarge the wound. At least 30 days should pass for the use of extenders-tensioners after surgery. In our clinic, we recommend regular use starting 6-8 weeks after surgery. It is very important for a man who decides to have penis lengthening surgery to know that he will need to use some kind of tensioning device after surgery and to be ready for this.

Since we cannot use tension devices in the early days after surgery, a tissue must be used between the cut ligament and the bone. For this purpose, a special suture is used that separates and fills the space between the cut ligament and the pelvic bone. In this technique, called periosteal fascial inverting suture, the fascia tissues on the surface are fixed to the membrane of the pelvic bone with a special suture material.

The results obtained with this technique have become apparent and permanent. The problems reported by some surgeons, such as the decrease in the pubopubic angle and the drooping of the penis during erection, are negligible with this technique.

When penis lengthening surgery is performed alone, it takes 1 hour (60 minutes). It can be performed under general or spinal anesthesia. The type of anesthesia is determined by the other procedures to be performed and the patient or physician's preference. The patient can be discharged the same day.

2) Supra-pubic cutaneous advancement

With this plastic surgery technique, the skin required for the lengthened penis is advanced towards the penis. If this technique is not added, the result may be problematic as there will not be enough skin to cover the penis that has slipped out of the body and has lengthened. The method we use classically is a V-Y plasty. Here, the inverted V-shaped incision created at the beginning of the surgery is closed in the form of an inverted Y at the end of the surgery. LASER energy can also be used for skin and subcutaneous incisions at this stage of the surgery.

In the last part of the surgery, absorbable aesthetic stitches are used. In other words, the skin is closed with stitches that dissolve and fall off on their own after 15-20 days without the need for stitch removal.

3) Supra-pubic lipo-shaping surgery

In people with significant and abundant fat tissue at the base of the penis and just above it, a second abdomen image forms just below the abdomen. This area is called pannulus in medicine and is the most important problem that can mask the lengthening achieved in penis lengthening surgery. This problem is not always observed in overweight people and the penis can be buried in normal weight people. It is a phenomenon that can be explained by the distribution characteristics of fat accumulation areas and can be encountered even in thin people.

The procedure we prefer in these cases is “supra-pubic lipo-shaping”. It is a procedure in which pubic fat tissues are cleaned from the body with the help of gentle suction cannulas, accompanied by a vibration mechanism. The fat tissue, which is first released with vibration, is then aspirated. The fat tissue absorbed from this area is not of the quality preferred primarily in the penis thickening procedure.

Since male fat tissue is firmer than female fat, it may be more effective to use vibratory suckers. This procedure flattens the pubic fat pad, the pannulus, and results in a visual improvement in the perception of penis length. It is not a standard part of classical surgery and can be performed alone or in combination with other methods in patients deemed necessary.

Technically, with the help of a cannula advanced through small incisions made on both sides of the area, excess fat tissue is melted and suctioned. The duration of the surgery is determined by the amount of fat to be removed, and it takes an average of 40 minutes. A pressure bandage is applied at the end of the surgery. Even if additional procedures are performed, the patient can be discharged on the same day.

4) Peno-scrotal cutaneous laser-plasty

In some men, the junction of the penis and scrotum (sack) is abnormal. The skin of the sack is attached to the middle of the penis and creates the appearance called a turkey neck or bat wing. This excess skin under the penis causes the penis to be perceived as short visually.

There are two techniques that can be used to correct this situation. The first is a type of plastic surgery called Z plasty. The other is a technique popularized by Dr. Carrion. After the excess skin is corrected, it is closed with absorbable aesthetic stitches. These stitches will also fall off on their own in 15-20 days.

This method can be applied alone or in addition to the methods we have described above. The aesthetic results are very visible and satisfactory.

PENIS THICKENING

Fat tissue transfer and penis shaping

After the fat tissue taken from the patient's abdomen or inner thigh (leg) is processed and purified, it is ready to fill the desired body area. These fat cells will struggle to hold on and survive in the new body area to which they will be transferred and will ultimately create a permanent solution in the area where fullness is desired. In our technique, the deep plane where the transfer will be made is reached with small incisions made on both sides of the penis root. Annoying cosmetic problems and accumulations have been observed as a result of inexperienced physicians applying the filler material to the very surface, just below the skin. It is important that the fat is applied homogeneously between the Dartos tissue and the penis body. The fat is injected into the back and sides of the penis with a special cannula with a non-piercing (blunt) tip using radial movements. It is not applied to the lower part where the urinary tract is. In this injection and penis shaping, the physician must have experience as well as an aesthetic sense. Just like making a sculpture, while adding volume and size to the penis, symmetry and aesthetics should not be neglected. The most important thing our patients need to know about fat injection is that there will be a 30-50% loss in the injected fat within a few months. This procedure is repeated in patients who wish to undergo it after 6 months.

Penis lengthening and penis thickening surgeries can be performed together as a single surgery. In fact, 80% of patients prefer this. The desire for a global penis enlargement or concerns that a penis that only gains length or thickens will look strange and unnatural explain this tendency. The treatment fees requested for penis lengthening and penis thickening surgeries are more economical when the two surgeries are performed in a single session (due to reduced operating room, medical, nursing and consumable costs).

Since there is no significant surgical wound after the penis enlargement procedure, it is possible to be discharged hours after the surgery. Daily activities can be resumed the next day. The only exception is sexual activity. Sexual activity, including masturbation, can lead to an undesirable result such as the transfer of fat to certain areas and is prohibited for 45 days after the procedure. Smoking is the greatest enemy of wound healing and graft adhesion. It is strongly recommended to quit 2 weeks before the surgery and not to start for at least 30 days after the surgery. Unfortunately, our chances of smoking are not the same as those of circumcised Turks. Many of our patients continue to smoke despite our explicit warnings, thus jeopardizing our cosmetic results.

PENIS HEAD ENLARGEMENT AND PREMATURE EJACULATION TREATMENT

Enlargement of the glans penis with fillers containing hyaluronic acid is an effective application for patients who are not satisfied with the size of this area. The application takes approximately 10-20 minutes under local or topical anesthesia. The applied substance is the laboratory-produced form of hyaluronic acid, which is naturally found in the body, and theoretically, the possibility of side effects is very low, of course, here it is necessary to use purified forms of the filler produced by appropriate manufacturers.

Studies have shown that the application also provides improvement in approximately 3/4 of patients suffering from premature ejaculation, and that this effect continues after 5 years, although the effect may decrease.