In short
- It corrects excess scrotal skin, excessive descent and the penoscrotal web when they cause a specific problem — not simply when the shape is disliked.
- The indication rests on function: chafing when walking or running, discomfort with sport, interference with intercourse and difficult hygiene. The useful conversation is not «how it looks», it is «what it stops you doing».
- It does not lengthen the penis. Correcting a penoscrotal web can expose a portion that the scrotal skin was hiding, but that is uncovering, not lengthening.
- The evidence is scarce and it is worth knowing that: the most complete review screened 1,430 articles and only eleven met the inclusion criteria. There are no robust figures for outcome or complications in adults, and anyone offering them has not taken them from the literature.
- The technical error that weighs most is removing too much: falling short is corrected with a touch-up, going too far means having to add tissue. That is why assessment is done standing, and marking is done conservatively.
Scrotoplasty is the surgical correction of the shape, size or position of the scrotum. It is an operation little known outside the consulting room and yet it resolves a problem that those who have it describe precisely: excess scrotal skin that chafes when walking, is uncomfortable during sport, interferes with intercourse or gets caught in clothing.
This guide from the Instituto de Cirugía Plástica del Mediterráneo (ICPM), in Valencia, sets out which anatomical situations this surgery corrects, how the technique is decided, what evidence exists — which is scarce, and that is worth saying —, what recovery involves and what complications are described.
What scrotoplasty is
The same name covers procedures with different aims:
- Reduction of excess scrotal skin, when laxity makes the scrotum hang lower than the patient can tolerate.
- Lifting, when the main problem is the descent rather than the excess skin.
- Correction of the penoscrotal junction, when there is a band of skin — the so-called penoscrotal web — running from the scrotum onto the underside of the penis and obliterating the angle between the two.
- Correction of asymmetry and of the after-effects of infection, trauma or previous surgery.
It is not a single standardised procedure, and that is precisely the point: the technique is chosen on the particular anatomy.
When there is an indication
The criterion is not aesthetic in the first instance, but functional. The reference systematic review on the subject defines the picture — the so-called bothersome scrotum — as scrotal laxity causing discomfort when walking, during sport and during intercourse, characterised by the scrotum extending more than one or two centimetres beyond the tip of the penis.
That definition is useful because it shifts the conversation from «how it looks» to «what it stops you doing», which is where the surgical indication holds. In practice, the commonest reasons for consulting are these:
- Chafing and skin abrasion when walking or running.
- Discomfort on a bicycle, on a seat or with particular clothing.
- Mechanical interference during intercourse.
- A sensation of weight or dragging.
- Difficult hygiene, with recurring intertrigo or dermatitis in the fold.
- A change in shape that the patient identifies as a problem, with or without a functional element.
What scrotoplasty is not
It is worth setting this out before going on, because the confusion is common:
- It does not treat testicular disease. Varicocele, hydrocele, epididymal cysts or any disorder of the scrotal contents belong to urology, and investigating them comes before any question of contour.
- It does not increase penile length. Correcting a penoscrotal web can expose a portion of the penis that the scrotal skin was hiding, and so improve visible length, but that is not lengthening: it is uncovering.
- It is not surgery for sexual function. If there is pain, curvature or a problem with erection, the right route is the urological one.
- It does not correct laxity of the skin of the penile shaft, which is a different problem.
What the evidence says, and why there is so little
Honesty is needed here. The most complete systematic review published on aesthetic scrotoplasty screened 1,430 articles and found only eleven that met the inclusion criteria. Its opening conclusion is that scrotal rejuvenation is poorly addressed in the international literature and that most of what is published consists of isolated case reports or descriptions of technique, not series with follow-up.
From that material, the authors propose an algorithm with two main approaches:
- Vertical excision of scrotal skin in the midline, when the problem is excess skin.
- Z-plasty at the penoscrotal junction, when what persists is the band of skin between penis and scrotum.
And they close by asking for what is missing: more published experience in order to reach consensus on nomenclature, diagnostic criteria and treatment protocols.
There is a further nuance worth knowing. A good part of the literature on correcting the penoscrotal web is paediatric and on congenital cases — the largest published series brings together 138 patients with a median age of 9.6 months — so its results do not transfer to adults without qualification. In adults, the published base is appreciably thinner.
None of this makes scrotoplasty experimental surgery: these are well-established skin excision and plasty techniques, with known surgical principles. What it means is that there are no robust published figures for outcome or complications in adults, and that anyone offering them has not taken them from the literature.
How the technique is decided
The examination determines the procedure. We assess:
- How much skin is in excess and how far the scrotum descends when standing.
- The quality and elasticity of the skin, and any dermatitis or lesions in the fold.
- The penoscrotal angle and whether there is a band of skin between penis and scrotum.
- Symmetry and the position of both testicles.
- History: previous surgery, infection, radiotherapy, lymphoedema.
- The patient’s goal, framed in concrete terms of what limits him.
From that comes one of three answers: excision, plasty of the penoscrotal junction, or both. And sometimes, neither.
What the procedure involves
The operation is a day case in most instances. Depending on the extent planned it is done under local anaesthesia, under local anaesthesia with sedation, or under general anaesthesia.
The technical principle is the same in every variant: remove exactly the skin that is in excess — no more — and place the scar where it will be least visible and least troublesome, usually over the median raphe, which is the natural midline of the scrotum, or in the penoscrotal fold.
Closure is done in layers, with particular care over haemostasis: the scrotum is a very vascular, lax tissue, and that combination makes it especially prone to haematoma.
Recovery
The exact timings are given in writing before the procedure. The usual pattern:
- First 48–72 hours: swelling and bruising, frequently striking. Relative rest, local cooling as instructed and elevation of the scrotum with a support or firm supportive underwear.
- First week: specific hygiene of the wound and the area, clothing that does not rub, avoiding effort and heat.
- Support: this is the measure that most influences progress. An unsupported scrotum accumulates swelling by gravity.
- Sexual activity and sport: suspended for the period indicated and reintroduced gradually. Cycling and anything involving direct pressure come back last.
- The scar: it matures over months. Its final appearance is not judged before then.
Risks and complications
- Haematoma. This is the complication that most conditions this surgery, because of the laxity and the blood supply of the tissue. Compression and post-operative support exist to prevent it.
- Infection, made more likely by the proximity of the perineal region and by the moisture of the fold.
- Dehiscence, or partial separation of the wound edges.
- A widened, hypertrophic or painful scar.
- Prolonged swelling.
- Asymmetry or insufficient correction, which may require a touch-up.
- Temporary change in sensation.
- Recurrence of the excess skin over time, especially with significant weight change.
Warning signs
These need to be seen immediately:
- A rapid increase in scrotal volume, especially if it is asymmetrical.
- Pain that increases rather than decreases.
- Fever, spreading redness or local heat.
- Discharge from the wound.
- An area of pale, dark or purplish skin.
The technical error that weighs most: removing too much
It deserves a section of its own because it is the difference between a good result and a problem that is hard to put right.
Removing too little leaves the problem half-solved and can be corrected with a touch-up. Removing too much, by contrast, creates tension, traction on the scrotal contents and an uncomfortable situation whose solution requires adding tissue, not taking it away. Correcting a defect caused by over-excision is always more complex than correcting one caused by under-excision, and that is why the reasonable approach is conservative: mark short, check, and adjust.
It is also the reason this surgery must be planned with the patient assessed standing and not only on the couch: scrotal skin behaves very differently depending on position.
Price
Scrotoplasty costs between €3,000 and €4,500.
The range is not a commercial margin: it reflects the fact that not every scrotoplasty is the same operation. A contour correction with measured excision and a reconstruction that requires adding tissue share neither operating time, nor complexity, nor type of anaesthesia. Where each case falls within that range is decided at the examination — standing, not only on the couch — and with the technique already chosen.
The quote is given in writing after the in-person assessment, with the specific technique stated. No fixed figures are given without having examined you, and if the examination concludes that there is no surgical indication, that is what we say.
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Frequently asked questions
Is it aesthetic surgery or functional surgery?
Frequently both at once. The indication holds better when there is a specific limitation — chafing, discomfort with sport, interference with intercourse, difficult hygiene — and it is that functional element that defines the picture in the literature.
Will the scar show?
The scar is usually placed over the median raphe or in the penoscrotal fold, lines where scrotal skin conceals it well. It is a real scar and it may be visible; that it should be discreet is the aim, not a guarantee.
Does it affect fertility or the testicles?
The operation acts on the skin, not on the scrotal contents. It is not surgery of the testicle or the epididymis. Any disorder of the contents must be investigated by urology first.
How much time off work is needed?
It depends on the extent of the excision and on the type of work. Sedentary work allows an early return; physical work, prolonged driving and cycling need longer. It is set out in writing before surgery.
Can it be done together with another procedure?
It can be considered when both indications exist. Combining lengthens the recovery and adds up the risks, so it is a decision made in the consultation and not an offer made up front.
Is the result permanent?
The skin removed does not come back, but the tissue goes on ageing and significant weight changes can create new laxity. Weight stability is the factor that most influences how long the result lasts.
What if the problem is the band of skin between the penis and the scrotum?
That is a different situation, corrected with a plasty at the penoscrotal junction, typically a Z-plasty, and not with excision of scrotal skin. It can improve the visible length of the penis by no longer hiding it, which should not be confused with lengthening.
Is there a non-surgical alternative?
For established excess skin, no. Conservative measures — supportive underwear, hygiene, treating intertrigo — relieve the symptoms of chafing, but they do not change the amount of skin.
How much does scrotoplasty cost in Valencia?
It depends on the extent, the technique and the type of anaesthesia. The quote is given in writing after the in-person assessment.
Sources
- 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. Systematic review: 1,430 articles screened, 11 included; proposes vertical midline excision and Z-plasty at the penoscrotal junction. https://pubmed.ncbi.nlm.nih.gov/33057830/
- 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 that includes scrotoplasty among the techniques assessed. https://pubmed.ncbi.nlm.nih.gov/38792941/
- McLeod DJ, Alpert SA. Double-V scrotoplasty for repair of congenital penoscrotal webbing: a hidden scar technique. J Pediatr Urol. 2014;10(5):810-814. Series of 138 patients, median age 9.6 months; illustrates the largely paediatric character of the literature on the penoscrotal web. https://pubmed.ncbi.nlm.nih.gov/24572216/
- Pignanelli M, Williams JM, Fernandez Crespo RE, et al. Complications and management of penile enhancement procedures. Transl Androl Urol. 2025. Describes the use of scrotal and dartos flaps in reconstruction of the genital area. https://pubmed.ncbi.nlm.nih.gov/41230130/
Book your consultation
If excess scrotal skin limits your activity, chafes, is uncomfortable during sport or interferes with intercourse, an in-person assessment is what makes it possible to know whether there is a surgical indication and which technique applies. The examination is also carried out standing, because that is the position in which the problem shows itself. The consultation produces an explanation of the result you can expect 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.
Registration no. 46/4624077
