Lipopenosculpture for Thickening and Lengthening in Montreal
The demand for penile augmentation has been steadily increasing for many years. In order to meet this demand, it was important to devise a global strategy that takes into consideration the desires of patients as well as technical limitations.
The perception of the size of one’s penis often varies significantly from one patient to the other, depending on his age and socioeconomic milieu. However, embarrassment can be so great that it can turn into a complex and then an inhibition, to the point where it becomes a real hindrance to social and intimate interactions.
The size of the shaft varies greatly from one patient to another. When flaccid, the average shaft is 10 cm long and 9 cm around. When erect, it is on average 15 cm long and 12 cm around. The shaft is composed of four erectile structures and four sheaths. The erectile organs include two corpus cavernosa, which extend from the pubic bone to the gland; the corpus spongiosum, through which the urethra passes throughout its length; and the gland.
The four sheaths of the shaft, from the outside in, are as follows:
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The skin, thin and very mobile
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The dartos, a sub-cutaneous muscular layer
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A highly vascularised cellular layer
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A fibroelastic envelope, or fascia, that contains the corpus cavernosa and the corpus spongiosum
The shaft is connected to the abdominal wall, the pubic symphysis and the pubis thorough the suspensory ligament. It consists of three bodies – one medial and two lateral.
Penoplasty Lenghtening Augmentation
Penile augmentation, also known as phalloplasty, is a surgical procedure aimed at increasing the size or girth of the penis in men. This procedure may involve various techniques, such as fat injection, the use of tissue grafts, or the implantation of synthetic materials, depending on the patient's needs and goals.
Penile surgery consists of two components that can be easily combined: thickening and lengthening.
LIPOPENOSCULPTURE - LENGTHENING PENILE SURGERY (LPS)
LENGTHENING PENILE SURGERY
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Penile lengthening emerged later, around the 1980s, and is the result of detaching the corpora cavernosa from their pubic bone attachments by cutting the suspensory ligament. The practice of these procedures has allowed for the standardization and reliability of the techniques.
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The surgical lengthening procedure involves a partial section of the suspensory ligament of the penis, dissection and incision of the superficial parts of the medial and lateral ligament bundles, and a skin plasty.
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After marking the width of the penis at its base, two vertical lines are drawn upward at both ends by one centimeter and then connected by a horizontal line. The skin is incised along these lines, and the incisions are extended downward by one centimeter on each side. Two horizontal incisions are made at the level of the natural peno-pubic folds. Once the skin is incised, the two lateral counter-incisions open, allowing an initial downward tilt of the penis. Dissection is performed between the spermatic cords, which must be preserved, to reach the bundles of the suspensory ligament, which are then cut while maintaining contact with the pubic bone.
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After determining the maximum detachment in the created space, this empty space between the bone and the corpora cavernosa is filled by bringing together the funicular fat to create a cushion that will prevent any secondary attachment between the bone and the corpora cavernosa. The skin is closed by suturing the lateral angles of the initial incision to the outer ends of the lateral counter-incisions.
This skin plasty phase is essential to ensure the permanence of the downward tilt of the initial incision. In the end, the scar will consist of a central vertical branch and two lateral branches at the level of the penis body.
LIPOPENOSCULPTURE - THICKENING PENILE SURGERY (LPS)
THICKENING PENILE SURGERY (LPS)
For decades, liquid silicone and other filler substances were used for penile thickening. These methods were ineffective and often harmful due to the formation of granulomas or the migration of the product.
Today, the autologous fat graft, which is effective and non-harmful, has proven to be the most reliable and least dangerous method.
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EXTRACTION OF ADIPOCYTES (Fat)
Fat is extracted from the pubic area, the inner and outer thighs, the abdomen, or sometimes the buttocks. These sites are rich in adipocytes with a2 receptors, which are less sensitive to diet and weight fluctuations compared to adipocytes with b1 receptors (arms, chest), allowing for better long-term maintenance of the graft.
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GRAFT PLACEMENT
We use a cannula with a 1.2 mm diameter. The cannula is mounted on a 10 ml syringe, placed in a specially designed device, similar to a gun, where the ratchets of the barrel allow for gentle and even pressure, ensuring a harmonious and uniform distribution of the graft and good control of its contours.
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The two entry points are located on the ventral and distal parts of the penis, in the preputial skin or the balanopreputial groove. We choose the entry points in the balanopreputial groove, just below the glans, as this is the natural anatomical plane, and the procedure is easier than with a peno-pubic approach. The graft is placed up to the base of the penis, at its pubic angle; it must be deposited in parallel layers in each histological layer, between the skin and the tunica albuginea, while preserving the integrity of the dartos and Buck's fascia.
The deposition involves seeding subcutaneous fat islands, in equal amounts, averaging 0.5 cm³, placed in overlapping layers along a flaccid penis, ensuring the integrity of these envelopes. It is important not to inject too large quantities of fat at once to limit the occurrence of cytosteatonecrosis, which could have an unsightly and uncomfortable effect for the patient. The usual amount grafted is 50 to 70 cm³. In subsequent sessions, 70% of the previous graft is used. It is also crucial not to place the fat too superficially to avoid any risk of necrosis.
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POSSIBLE COMPLICATIONS
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Irregularities in the insertion of the graft
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Cosmetic problems related to these irregularities
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Rejection of the fat graft
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Frequent swelling (27 % of cases) with no ensuing problems. Uncircumcised patients must be informed of the possibility that swelling could prevent them from easily moving the foreskin for three to five weeks.
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Separation of the scar tissue (10 % of cases) that heals in a few days
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Cutaneous necrosis, extremely rare
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Infections where the patient suffers no adverse consequences
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Fibrosis, calcification, or fatty cysts
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Granulomas caused by cytosteatonecrosis
Before/After Results of Penoplasty - Lengthening and/or Thickening of the Penis
It is important to note that the examples of surgery performed by Dr. Alain Danino are provided for informational and educational purposes only. These illustrative cases are intended to offer information about the surgical procedures performed but should not be considered as a guarantee or assurance of the surgical outcomes that potential patients may achieve.
