Male intimate surgery: what can be corrected, what we do not offer, and why

Male intimate surgery is probably the area of plastic surgery where the gap is widest between what is advertised and what the medical literature supports. Centimetres, permanence and results are offered that no published series backs up, and part of the real work of a plastic surgery department today consists of resolving the consequences of those promises.

This guide from the Instituto de Cirugía Plástica del Mediterráneo (ICPM), in Valencia, sets out which procedures are performed at the centre, which are not offered and on what clinical grounds, what the available evidence says about each, and in which situations the right approach is not a surgical one.

What male intimate surgery means

That label covers procedures with very different purposes, and it is worth separating them first of all:

• Genital contour procedures: changes to the circumference of the penis or to the shape, size and position of the scrotum.
• Reconstructive procedures: correction of the after-effects of previous surgery, of infection, of trauma or of previously injected fillers.
• Urological procedures: erectile disorders, Peyronie’s disease, implants, phimosis, testicular disease. These belong to urology and are not performed at the centre.

Confusion between the three groups is common in consultations, and it is the first thing sorted out in an assessment.

Which procedures are performed at ICPM

Penile girth enhancement

Increase in circumference using an autologous fat graft or injectable hyaluronic acid. These are two techniques that behave differently — reversibility, permanence, feel, number of sessions — and they are chosen according to each patient’s anatomy and goals, not as a default preference.

This procedure acts on circumference, not on length. It is a distinction worth being clear about from the first consultation, because it determines what result it is reasonable to expect.

Glans augmentation

Injection of hyaluronic acid into the glans. It is a different procedure from the one above, even though it shares the material: a different plane, a different technique and a far smaller volume — of the order of one millilitre, against the tens of millilitres the shaft will take. It is assessed and quoted separately.

Scrotoplasty

Surgical correction of the scrotum when its size, its descent, its excess skin or its junction with the base of the penis causes functional discomfort or a change in shape that the patient identifies as a problem. It is surgery with an anatomical indication: the technique is decided on the individual patient, and there is no single procedure that applies to every case.

Each has its own page, with its technique, its risks and its price:

What is not offered: penile lengthening

ICPM does not perform penile lengthening. This is not a technical limitation, but a clinical decision based on the balance between what these operations achieve and what they cost in risk.

The most complete systematic review on the subject — seventeen studies, 1,192 men, of whom 773 were followed up after a surgical or non-surgical intervention — concludes that the evidence supporting treatment of the small penis in normal men is scarce and of low quality, and that neither injectables nor surgery are appropriate outside a clinical trial. On the surgical lengthening techniques — division of the suspensory ligament, grafts, flaps — the authors describe variable results, frequent complications and no external validation.

The caseload of the units that receive these complications is consistent with that finding. A classic series of twelve men referred to a tertiary centre after a lengthening procedure performed elsewhere describes irregular fat nodules in seven, deformity and skin scarring in four, scrotalisation of the base of the penis in four, wound complications in six, sexual dysfunction in four and reoperation in six. The figure that closes the argument is another one: of the twelve, only one reported having gained length. The authors concluded that the morbidity of these elective procedures is notable and that they should be considered experimental.

A systematic review of 46 articles on penile augmentation techniques sums it up without ornament: these operations can be an option for someone with a genuine concern about genital size, but their risks and their complexity have to be counted in beforehand, and assessing the patient’s psychological state is part of that accounting.

Against that picture, offering lengthening would mean selling an expectation the literature does not support. What we do attend to are the consequences: patients with the after-effects of a previous lengthening procedure are assessed and treated.

Before operating: perceived size and actual size

The most consistent finding of the review by Marra and colleagues is not about surgical techniques but about patients: in the great majority of the published series, the men consulting about small size had a normal size.

The second finding is even more relevant to the consultation: structured counselling proved effective, and most of the men who received it came to understand that their anatomy was normal and wanted no further treatment.

This does not mean the concern is trivial — the distress it causes is real and can be intense — but that the most effective documented intervention for that reason for consulting is information, not the operating theatre. That is why an honest assessment includes measurement and an explanation of the normal ranges before anything is proposed.

When the problem is not surgical

There are three situations in which operating is the worst available decision:

• Genital dysmorphophobia. When the perception of one’s own body is distorted, surgery does not resolve the distress and frequently displaces it. The right approach is psychological or psychiatric.
• Unachievable expectations. When the figure the patient expects is outside what the technique can give, the result will be a disappointment even if the surgery is technically correct.
• A functional problem mistaken for an aesthetic one. Difficulty with erection, pain, progressive curvature or a change in ejaculation are reasons for urological investigation, not for contour surgery.

Spotting these three situations is part of the work of the first consultation, and its natural consequence is not to operate, or to refer.

When the case belongs to another specialty

We refer on, or work jointly with another specialist, in cases including these:

• Peyronie’s disease, penile curvature or pain with erection → urology / andrology.
• Erectile dysfunction, ejaculatory disorders, infertility → urology / andrology.
• Phimosis, foreskin or testicular disease → urology.
• Genital skin lesions, dermatoses or suspected skin disease → dermatology.
• Persistent distress about body image, anxiety or conflict in the sexual sphere → psychology or clinical sexology.

Contour surgery performed on an undiagnosed functional problem leaves the problem intact and adds a scar.

Permanent fillers: the complication that comes later

A good part of the disease seen in clinic does not come from surgery, but from an injection. Permanent materials — silicones, non-resorbable polymers, products of unknown origin injected outside a healthcare setting — account for the most serious complications described: granuloma, necrosis, infection, lymphoedema and disfiguring inflammation. Treating them usually requires wide excision down to Buck’s fascia and reconstructive strategies with skin grafts or scrotal flaps.

An imaging review of inflammatory complications after penile filler describes a spectrum running from local granuloma to abscess or diffuse cellulitis spreading into the neighbouring tissues; it notes that inflammation is not common, but that when it appears it may force urgent surgery, and that ultrasound and MRI are decisive in assessing it in time.

From that, two practical consequences. First: at ICPM no permanent materials are injected in the genital area, under any circumstances. Second: if something has already been injected and a lump, an induration, a red area, pain or deformity appears, assessment should be early. The same criterion applied in biopolymer removal applies here.

What the assessment involves

The first consultation has an examination part and a conversation part, and both weigh the same:

1. Medical history: past history, medication, previous surgery or injections in the area, habits and general health.
2. Physical examination and measurement: circumference, flaccid and stretched length, skin quality and elasticity, excess skin, penoscrotal junction, testicular descent.
3. The patient’s goal, stated precisely: what exactly is troubling you, in what situation you notice it and what you expect to get.
4. An explanation of what the technique can and cannot give, including risks, recovery and the possible need for a touch-up or a second session.
5. A decision, which may be to operate, not to operate, to refer or to wait.

A procedure is not proposed in the same consultation in which it becomes clear that the indication is not clear.

General risks of this surgery

Each procedure has its own profile, set out on its own page, but there are risks common to surgery of the genital area that are worth knowing beforehand:

• Infection, made more likely by the proximity of the perineal region.
• Haematoma and swelling, usually more striking than in other areas because of the laxity of the tissue.
• Irregularities and asymmetry, especially where a volume has been injected.
• Scars that may widen or become visible.
• Temporary change in sensation.
• An insufficient result or the need for revision.
• An impact on sexual activity during the recovery period, which has to be planned for.

None of these risks is a reason not to operate when the indication is right; all of them are a reason not to operate when it is not.

Prices of the procedures we do perform

Procedure	Price
Girth enhancement with hyaluronic acid, 1 vial of 10 mL	€800
Girth enhancement with hyaluronic acid, 2 vials of 10 mL	€1,400
Glans augmentation, 1 vial of 1 mL	€500
Scrotoplasty	€3,000–4,500
Girth enhancement with an autologous fat graft	after assessment

Two clarifications, because in this field price is often used as bait.

How many vials are needed is not decided by a catalogue, it is decided by anatomy: the starting circumference, the thickness of the skin and the volume the area will take without tension. Nobody can know over the phone whether a case needs one or two.

The fat graft has no fixed price because it is not comparable to an injection in clinic: it means theatre, a donor site and anaesthesia. It is quoted after the assessment.

And what the rest of this page says still stands: there is no price for penile lengthening because it is not performed. If the examination concludes that there is no indication for any of these procedures, that is what we say.

Frequently asked questions

Do you perform penile lengthening?

No. The available evidence on lengthening in men with normal anatomy is scarce and of low quality, the complications described are frequent, and the series of patients referred with after-effects are telling. We do assess and treat the consequences of a lengthening procedure performed at another centre.

Does girth enhancement increase length?

No. It acts on circumference. It may change how the whole is perceived visually, but length is neither the aim of the technique nor something that should be presented as such.

How long does the result last?

It depends on the material. Autologous fat is partly reabsorbed, to an extent that varies from person to person, over the first few months; hyaluronic acid is resorbable by definition, although a randomised trial with eighteen months of follow-up documented that the increase in circumference was maintained at the end of that period. There is no universal figure, and anyone offering one is promising what they cannot know.

Is it painful surgery?

Post-operative pain from girth enhancement and from scrotoplasty is usually controlled with oral painkillers. The most constant nuisance is not pain but swelling and restricted activity during the recovery.

How long without sexual activity?

It is an individual instruction, set out in writing before the procedure, according to technique and progress. Resuming too early is one of the avoidable causes of a poor result, especially where a volume has been injected.

Will the scar show?

In scrotoplasty the scar sits in the midline or at the penoscrotal junction, areas where the skin conceals it well, but it is a real scar and it may be visible. In girth enhancement by injection there is no incision, only entry points.

I was injected with something years ago and now I have a lump. What should I do?

See someone without waiting. A lump, an induration, a reddened area, pain or deformity after a previous filler needs early assessment and, frequently, imaging. It should not be handled or treated on your own.

Can girth enhancement be combined with scrotoplasty?

It can be considered when both indications exist and the anatomy allows it, but it is a decision taken in the consultation and not an offer made up front. Combining procedures lengthens the recovery and adds up the risks.

What if I am not happy with the result?

It is reviewed. Part of the work of the prior assessment consists of setting down in writing what margin of improvement is reasonable and what options exist if the result falls short, including the possibility of a second session in the techniques that allow one.

How much does it cost?

Girth enhancement with hyaluronic acid runs from €800 to €1,400 depending on the volume, and scrotoplasty from €3,000 to €4,500 depending on the complexity of the technique. The figures are broken down above. The final quote is given in writing after the in-person assessment: no fixed figures are given without having examined you.

Sources

• Marra G, Drury A, Tran L, Veale D, Muir GH. Systematic Review of Surgical and Nonsurgical Interventions in Normal Men Complaining of Small Penis Size. Sex Med Rev. 2020;8(1):158-180. Seventeen studies, 1,192 men; scarce, low-quality evidence, effective counselling. https://pubmed.ncbi.nlm.nih.gov/31027932/
• Falagario UG, Piramide F, Pang KH, et al. Techniques for Penile Augmentation Surgery: A Systematic Review of Surgical Outcomes, Complications, and Quality of Life. Medicina (Kaunas). 2024;60(5):813. Systematic review of 46 articles. https://pubmed.ncbi.nlm.nih.gov/38792941/
• Wessells H, Lue TF, McAninch JW. Complications of penile lengthening and augmentation seen at 1 referral center. J Urol. 1996;155(5):1617-1620. Series of patients referred with after-effects. https://pubmed.ncbi.nlm.nih.gov/8627836/
• Pignanelli M, Williams JM, Fernandez Crespo RE, et al. Complications and management of penile enhancement procedures. Transl Androl Urol. 2025. Review of complications and their management by material type. https://pubmed.ncbi.nlm.nih.gov/41230130/
• Abo-Hedibah SA, Badawi AN, Aly SA, Ismail SRM, Elmokadem AH. Penile girth augmentation by injectable fillers: a comprehensive review of imaging features and inflammatory complications. Abdom Radiol (NY). 2021;46(4):1725-1739. https://pubmed.ncbi.nlm.nih.gov/33040174/
• Yang DY, Jeong HC, Ko K, Lee SH, Lee YG, Lee WK. Comparison of Clinical Outcomes between Hyaluronic and Polylactic Acid Filler Injections for Penile Augmentation… with 18 Months of Follow-up. J Clin Med. 2020;9(4):1024. Multicentre randomised trial, 67 men. https://pubmed.ncbi.nlm.nih.gov/32260508/
• Thomas C, Navia A. Aesthetic Scrotoplasty: Systematic Review and a Proposed Treatment Algorithm for the Management of Bothersome Scrotum in Adults. Aesthetic Plast Surg. 2021;45(2):769-778. https://pubmed.ncbi.nlm.nih.gov/33057830/

Book your consultation

If you have a specific concern about genital contour, discomfort from excess scrotal skin or the after-effects of a previous procedure, an in-person assessment is what makes it possible to know whether there is a surgical indication, whether there is one in another specialty, or whether there is none at all. That consultation produces an explanation of what the technique can give and a written quote.

Clinical confirmation by the surgeon

Clinical review: Dr Enrique Salmerón González, specialist in Plastic, Aesthetic and Reconstructive Surgery, registered with the Medical Council of Valencia under number 46/4624077. Last medical review: 2 August 2026. This information is for general guidance and does not replace an individual medical assessment in consultation.