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We read with particular interest the study by Zhang (Zhang CL, Quan Y, Li H, Li Q, Bai WJ, et al. Penile augmentation with injectable hyaluronic acid gel: an alternative choice for small penis syndrome. Asian J Androl 2022; Doi: 10.4103/aja20223.) This Chinese study concerns penis enlargement with hyaluronic acid for patients with Small Penis Syndrome. The use of hyaluronic acid (HA) injections as a dermal filler has become increasingly popular over the past decade for the cheeks, lips, chin especially in women. For patients who have small penis syndrome, a form of dysmorphophobia in which patients believe they have a small penis, injections present a non-invasive option for increasing penis size.

The injection is done in the office after the surgeon has anesthetized the penis with an 18-french injection cannula at the base of the penis between the Darthos and Buck layers. Zhang et al. conducted a study of 38 patients who underwent penile augmentation by HA injection between 2017 and 2020. Follow-up data was collected for 1 year (1 month, 3 months, 6 months and 12 months). The results show an increase in the length and girth of the flaccid and erect penis and improvement in classic psychological criteria such as the Index of Male Genital Image (IMGI), the International Index of Erectile Function (IIEF) and size beliefs. of the penis (BAPS). One-month follow-up showed the most pronounced increases in circumference and length, with a gain of 3.41 ± 0.95 cm for circumference and 1 ± 0.55 cm for length. The absorption of HA in the surrounding tissues is complete after 11 to 18 months post injection HA injections can be a safe and effective treatment for patients with SPS. Positive physical findings, duration of such findings, and mild postoperative complications such as edema and subcutaneous bleeding are consistent with the existing literature. Several other non-invasive techniques are used for aesthetic penis enlargement in the context of small penis syndrome, but none have been able to prove lasting effectiveness 1 hour after DEVICE removal. Compared to other non-surgical treatments, HA injections are often considered more durable and convenient. Compared to surgical penis augmentation procedures, HA injection is a less invasive treatment modality with lower morbidity but lower and less durable outcome. As we are seeing increased demand for penile augmentation aesthetics worldwide, the use of HA injections may be an acceptable temporary medium-term option for men. Data on the medium-term safety and efficacy (one year) of HA injections are now clearly established and published in the scientific literature. The procedure is done in a consulting room with regional anesthesia of the penis by penile boc and anesthetic cream. The procedure lasts 30 minutes. the patient can shower the next day he abstains from intercourses for 8 days. The risks of HA injections are penile oedema, subcutaneous hematoma and the presence of irregularities, granulomas or even partial necrosis of the glans. These last complications are extremely rare.

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