A penile block was induced by injecting 2 ml of 0.2% lidocaine into the penis root. In addition, 0.2% lidocaine was injected underneath the coronal sulcus. After the anesthesia had taken effect, CD gel was injected into the subcutaneous tissue (lamina propria layer) of the glans penis by the fanning technique through a 24‑gauge needle. The injection of highly cohesiveness hyaluronic acid (Voluma or contour XL) is done in the subcutaneous tissue (lamina propria layer) of the glans penis.
For this technique, the injection needle was indwelled at the 1 and 11 o’clock positions on the corona of the glans to avoid dorsal pedicle injury. Thereafter, the needle was directed posteriorly and laterally, parallel, or tangential to the glans penis, distributing the material as uniformly as possible by a continuous back and forth movement, while constantly pressing the syringe plunger. If necessary, the injection needle was indwelled between the 1 and 5 o’clock positions or between the 7 and 11 o’clock positions (multiple puncture technique).
To avoid urethral compression or injury, the injected material did not cover the ventral part of the glans penis or around the urethral meatus. The mean procedure time and injected volume were about 30 min and 6.6 cm2, 0.9 ml (range: 4.9–8.8 ml), respectively. After the procedure, the injected surface was thoroughly massaged, to redistribute the gel as uniformly as possible
Yang et coll published in 2018 ((Asian Journal of Andrology (2018) 20, 80–84; doi: 10.4103/aja.aja) ) A case series of 18 individuals ; two of them were lost to follow‑up. The mean procedure time and injected volume were about 30 min and 6.6 Å} 0.9 ml,respectively. The mean surface areas of the glans at baseline and 24 weeks were 20.0 cm2} 3.5 cm2 and 33.6 } 5.4 cm2, respectively, representing a mean increase of 68.7% } 14.0% (P < 0.001). Sixteen individuals (88.9%) were satisfied with the outcomes, and none were dissatisfied. There were no serious adverse events during the study.