In short
- It changes circumference by placing volume between the skin and the fascia. It does not change length, the erectile structures or sexual function: the corpora cavernosa are not touched.
- Two materials that behave differently: autologous fat is your own tissue but is partly and unpredictably reabsorbed and requires theatre; hyaluronic acid is temporary, but it can be dissolved with hyaluronidase, and that reversibility turns a complication into a treatable problem.
- The randomised trial with the longest follow-up — 67 men, eighteen months — found a significant increase in circumference with both materials and no significant difference between them, with adverse events of 9.1 % and 5.9 % and none serious.
- Permanent fillers are never used. The reviews describe granuloma, necrosis, infection and lymphoedema for them, with treatment that often requires wide excision and reconstruction.
- No figure in centimetres is promised. The response to the graft, the thickness of the skin and the volume the area will take without tension are individual, and no study allows them to be turned into a promise.
Penile girth enhancement means increasing the circumference of the penis by adding volume beneath the skin, using the patient’s own fat or hyaluronic acid. It is a contained procedure: it changes the contour of the part that has soft tissue and touches neither the erectile structures nor length.
This guide from the Instituto de Cirugía Plástica del Mediterráneo (ICPM), in Valencia, describes what each material does, what evidence actually exists about them — which is less than is usually implied —, what recovery involves, what complications are described and in which cases there is no indication at all.
What this technique changes, and what it does not
What it changes: circumference, through volume placed in the subcutaneous plane, between the skin and the fascia. The effect is one of contour.
What it does not change:
- Length. Neither flaccid nor erect. An increase in circumference can change how the proportions of the whole are perceived, but that is not gaining length and should not be presented as such.
- The erectile structures. The corpora cavernosa are not touched. Neither the rigidity nor the duration of the erection is an aim of this technique.
- Sexual function. It is not a treatment for erectile dysfunction or premature ejaculation. If there is a functional problem, the right route is the urological one.
- The glans. Glans augmentation is performed at the centre, but it is a different procedure: a different technique, a different volume — of the order of one millilitre against the tens of millilitres the shaft will take —, a different literature and a different complication profile. It is assessed and quoted separately, and nothing this page says about volumes, recovery or results applies to it automatically.
The two techniques
Autologous fat graft
Fat is taken from the patient — usually from the abdomen or flanks — by low-volume liposuction, processed, and injected into the subcutaneous plane of the shaft with a cannula, distributed in multiple fine tunnels rather than in a single deposit.
In favour: the material is your own, there is no foreign-body reaction, and part of the graft takes and remains stable.
Against: reabsorption is partial and varies from person to person, so the volume at six months is not the volume on day one; it requires a donor site; and graft that does not take can leave irregularities or palpable nodules. The series of patients referred with complications after fat injection in this area describe exactly that: irregular fat nodules as the commonest reason for referral.
It is a theatre procedure, not a clinic one.
Hyaluronic acid
A high-density cross-linked hyaluronic acid gel is injected into the same plane, with no donor site and no liposuction.
In favour: the procedure is shorter, recovery briefer and — the decisive argument — the material is degradable and, if needed, dissolvable with hyaluronidase. That reversibility is what separates a resorbable filler from a permanent one, and what turns a complication into a treatable problem.
Against: it is temporary by definition, although it lasts longer in practice than is usually assumed; it can migrate, form nodules or produce the Tyndall effect — a bluish discoloration seen through the skin when the product sits too superficially —; and its use in this location, like that of any filler, is not free of inflammatory complications.
What the comparison between materials says
Almost all the available comparative evidence sets hyaluronic acid against polylactic acid, not against autologous fat, so it has to be read with that limitation up front.
A meta-analysis of four studies and 283 patients found that hyaluronic acid achieves a greater increase in diameter than polylactic acid (P=0.01) and better sexual satisfaction at twelve weeks (P=0.0004), with no difference in satisfaction with appearance at four weeks (P=0.79) or in the incidence of pain (P=0.33) or swelling (P=0.98).
A multicentre randomised trial with patient and evaluator blinded, 67 men and eighteen months of follow-up, found something different: both materials increased circumference significantly (p<0.001) and there were no significant differences between them throughout the period. Adverse events were 9.1 % in the hyaluronic acid group and 5.9 % in the polylactic acid group, none of them serious.
The two readings coexist, and the honest conclusion is twofold. First: the increase in circumference with a resorbable filler is measurable and holds for at least eighteen months, which is the longest follow-up published with randomised methodology. Second: the superiority of one material over the other is not established, and anyone who asserts it categorically is running ahead of the data.
On autologous fat in this particular indication, the comparative evidence is appreciably poorer. A systematic review of 46 articles on penile augmentation techniques — including lipoplasty, flaps and fillers — concludes that the risks and complexity of these procedures have to be counted in before they are indicated, and that psychological assessment of the patient is part of that accounting.
What is never used: permanent fillers
Liquid silicone, non-resorbable polymers and any product of unknown composition injected outside a healthcare setting are ruled out without exception. This is not a matter of school preference: it is the direct reading of what they produce.
Reviews of complications describe granuloma, necrosis, infection, lymphoedema and disfiguring inflammation for these materials, with treatment that often requires wide excision down to Buck’s fascia and reconstruction with skin grafts or scrotal flaps. A specific imaging review of inflammatory complications after penile filler describes the full spectrum, from local granuloma to abscess and diffuse cellulitis, and stresses that ultrasound and MRI are decisive in assessing them in time.
Against that, hyaluronic acid shows lower complication rates than polylactic acid, silicone or self-injected materials, provided standardised protocols and low volumes are applied.
At ICPM no permanent materials are injected in the genital area under any circumstances. Patients who arrive with complications from a previous permanent filler are assessed and treated, on the same criterion that governs biopolymer removal.
Who is a good candidate
The indication exists when these conditions come together:
- Anatomy with no associated disease, confirmed on examination.
- Skin and subcutaneous tissue able to accommodate volume without tension.
- A goal framed in terms of contour, not length.
- An expectation proportionate to what the technique gives.
- No active infection, no skin disease in the area and no uninvestigated urological condition.
- In the case of fat, a sufficient donor site available.
Who is not
- Anyone looking to gain length. This technique does not give it.
- Anyone with an uninvestigated functional problem — erection, pain, curvature. That belongs to urology and andrology.
- Anyone with a distorted perception of their own anatomy. The reference systematic review on men with normal size who consult about small size documents that the great majority had a normal size and that structured counselling was effective: most understood that their anatomy was normal and wanted no further treatment. Operating there does not resolve the real reason for the consultation.
- Anyone with a previous permanent filler in the area who has not resolved that situation first.
- Anyone who cannot or will not follow the post-operative activity restrictions.
What the procedure involves
With hyaluronic acid: injection under local or block anaesthesia, as a day-case. There is no incision, only entry points. The product is distributed evenly and moulded by hand at the end.
With autologous fat: liposuction of the donor site, processing of the graft and injection in multiple fine passes. It is carried out in theatre, under local anaesthesia with sedation, or general anaesthesia, depending on the case and the volume planned.
In both cases the volume is distributed and checked during the procedure; moulding is not an incidental step but the one that determines whether the result is even.
Recovery
The specific timings are given in writing before the procedure, because they depend on the technique, the volume and individual progress. The general pattern is this:
- First hours and days: swelling and bruising, more striking in this area than in others because of the laxity of the tissue. Controlled with oral painkillers and the measures advised.
- First week: specific hygiene, supportive underwear, avoiding physical effort and local heat.
- Sexual activity: suspended for the period indicated. Resuming it too early is one of the avoidable causes of the material shifting and of a poor result.
- Sport and exertion: gradual reintroduction as instructed.
- Final result: with hyaluronic acid, once the swelling has settled. With fat, not before reabsorption has stabilised, which happens over the first few months.
Any fixed number of days offered without having examined the patient is advertising, not medicine.
Risks and complications
The complications described differ according to the material.
With a fat graft: swelling, haematoma, infection — the organisms most frequently described are Staphylococcus aureus and Escherichia coli —, necrosis, contour deformity and, rarely, fat embolism. Management ranges from compression and local debridement to staged reconstruction.
With hyaluronic acid: migration of the product, nodules, Tyndall effect, phimosis and infection. The management described includes early massage and moulding, warm compresses, judicious use of hyaluronidase where the material is confirmed hyaluronic acid, antibiotics with drainage if there is an abscess, and selective surgical excision of nodules that do not respond.
Common to both: asymmetry, irregularity to the touch, an insufficient result, the need for a touch-up or a second session, temporary change in sensation, and a scar at the donor site when fat is used.
Warning signs
These need to be seen immediately, without waiting for the scheduled review:
- Pain that increases rather than decreases.
- Spreading redness, local heat or fever.
- A pale, mottled or purplish area.
- Discharge from an entry point.
- A painful nodule appearing, or an induration that is growing.
- Difficulty retracting the foreskin that was not there before.
Results: what it is reasonable to expect
Three statements that can be sustained, and one that cannot.
Sustainable: the increase in circumference with a resorbable filler is measurable and holds for at least eighteen months according to the randomised trial with the longest published follow-up; satisfaction with appearance improves significantly in the available studies; and adverse events in those same studies were infrequent and none serious.
Not sustainable: promising a specific figure in centimetres, a defined permanence, or an identical result for two different patients. The response to the graft, the thickness of the skin, the elasticity of the tissue and the volume the area will take without tension are individual, and no study allows them to be turned into a promise.
Prices
The figures below correspond to girth enhancement with hyaluronic acid, which is the one done in clinic and the one that allows a fixed price per product:
| Procedure | Price |
|---|---|
| Shaft, 1 vial of 10 mL | €800 |
| Shaft, 2 vials of 10 mL | €1,400 |
| Glans, 1 vial of 1 mL | €500 |
How many vials are needed is not decided by a catalogue. It depends on the starting circumference, the thickness of the skin and the volume the area will take without tension, which is an anatomical limit and not a preference: injecting beyond what the tissue accepts is one of the described routes to irregularity and nodules. That is why the figure is settled after examining, not before.
The autologous fat graft does not appear in this table because it is not comparable: it is a theatre procedure, with a donor site, processing of the graft and anaesthesia. Its quote is given in writing after the assessment.
No price is made conditional on booking on the spot.
Book an appointment
You can book your own appointment. Pick the day and time from the free slots in the diary, in a panel that opens right here, without leaving this page.
Frequently asked questions
How much circumference is gained?
It depends on the volume the anatomy will take without compromising the skin or the evenness of the result, and that is determined at the examination. The studies document significant, sustained increases, but no published figure transfers directly to an individual patient. Any number promised before examining is marketing.
Fat or hyaluronic acid?
There is no universal winner. Hyaluronic acid offers reversibility — it can be dissolved — and a shorter recovery; fat avoids a foreign material and the portion that takes remains stable, at the cost of variable reabsorption and a donor site. The choice is made on the anatomy and on what the patient prioritises.
How long does it last?
The randomised trial with eighteen months of follow-up documented that the increase was maintained at the end of that period. Beyond that, there is no data of comparable quality. With fat, what remains is the fraction that takes, and that fraction varies between patients.
Does it hurt?
The procedure is performed under anaesthesia. Recovery is usually managed with oral painkillers; the dominant nuisance is not usually pain but swelling and a temporary restriction of activity.
Can it be felt to the touch?
The technical aim is that it cannot. Distribution in multiple fine passes and moulding during the procedure exist precisely to avoid irregularity. Even so, palpable irregularity is among the complications described and must be stated in the consent.
Does it affect erection or sensation?
The technique is performed in the subcutaneous plane and does not act on the erectile structures. There may be a temporary change in sensation during recovery. A persistent change is not expected and should be assessed.
Can it be removed if I do not like it?
Hyaluronic acid is degradable and can be dissolved with hyaluronidase; that is its main advantage. Integrated fat is not removed as easily and its correction, when needed, is surgical.
How many sessions do you need?
More than one may be considered, especially with fat, where partial reabsorption is expected. It is assessed once the result of the first has stabilised, not before.
I was injected with silicone years ago. Can it be treated?
That is a different and more complex situation than a primary girth enhancement. It requires specific assessment and, frequently, imaging; treating permanent materials is surgical and may need reconstruction. You should seek advice without delay if there is a nodule, an induration, pain or inflammation.
How much does penile girth enhancement cost in Valencia?
It depends on the technique chosen, the volume and the type of anaesthesia. The quote is given in writing after the in-person assessment, with no fixed figures beforehand.
Sources
- Kusumaputra A, Setiawan MR, Soebadi MA, Wirjopranoto S. Efficacy and complications of hyaluronic acid and polylactic acid for penile augmentation: a systematic review and meta-analysis. Ann Med Surg (Lond). 2023;85(9):4477-4483. Four studies, 283 patients. https://pubmed.ncbi.nlm.nih.gov/37663705/
- 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 in Men Reporting a Small Penis: A Multicenter, Patient-Blinded/Evaluator-Blinded, Non-Inferiority, Randomized Comparative Trial with 18 Months of Follow-up. J Clin Med. 2020;9(4):1024. 67 men; adverse events 9.1 % and 5.9 %, none serious. https://pubmed.ncbi.nlm.nih.gov/32260508/
- Pignanelli M, Williams JM, Fernandez Crespo RE, Britt J, Parker J, Carrion R. Complications and management of penile enhancement procedures. Transl Androl Urol. 2025. Complications and 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/
- 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/
- 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. https://pubmed.ncbi.nlm.nih.gov/31027932/
- Wessells H, Lue TF, McAninch JW. Complications of penile lengthening and augmentation seen at 1 referral center. J Urol. 1996;155(5):1617-1620. Twelve patients referred; irregular fat nodules in seven. https://pubmed.ncbi.nlm.nih.gov/8627836/
Book your consultation
The choice between fat and hyaluronic acid, and before that the decision as to whether there is an indication at all, are made on your particular anatomy. At the in-person assessment we examine, measure, explain what real margin exists and give you a written quote. If the examination concludes that there is no indication, that is what we say.
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, and Dr Sandra Lucas Hernández, specialist in Family and Community Medicine with an MSc in Aesthetic Medicine, registered under number 46/4623351. Last medical review: 2 August 2026. This information is for general guidance and does not replace an individual medical assessment in consultation.
Registration no. 46/4624077
Registration no. 46/4623351
