Comments on “Nonsurgical Medical Penile Girth Augmentation: Experience-Based Recommendations”

I am writing to express my concern regarding this article.¹ The authors support the use of hyaluronic acid as an injectable material for penis enlargement. As a plastic surgeon who has been performing procedures for penis enlargement for more than 20 years, I have concerns about this endorsement. Hyaluronic acid dissipates in all cases over time. Its absorption is irregular creating nodules in every case (Figure 1). About half of the patients that I treat have unsatisfactory results from injection of a variety of materials, including hyaluronic acid, polymethylmethacrylate, fat (Figure 2), liquid silicone (Figure 3), and silicone devices (Figure 4). Each of these has unique challenges for surgical removal and each of these patients is very unhappy when they present to me. While there are options for increasing the length and girth of the penis, they are surgically demanding (Figure 5). Unlike hyaluronic acid, or any of the other fillers mentioned, the results are permanent. This is not to say that complications of surgery cannot occur. Complications do occur and as surgeons, we should be prepared to manage them to restore our patients to full function. I think it is incumbent for our members to be aware that the US Food and Drug Administration has not approved any filler for penile injection therapy. These are dermal fillers and there is no significant dermal layer in the penis. Due to the anatomy of the penis, these materials are placed in the superficial fascial layer of the penis. Placement of these materials disrupts the blood supply to the skin of the penis. When removing these materials, the blood supply to the overlying skin is compromised, which can cause skin loss as a subsequent challenge for reconstruction. I would discourage our members from adopting this method of penis enlargement.