Frequently Asked Questions About Dorsal Elongation

Read the answers given by Dr. Mihai Chertif to the most common questions of the patients of the Cosmedica clinic about the Dorsal Stretching procedure.

1. What is the principle of this operation?

– The dorsal elongation procedure involves the release of the internal portion of the corpora cavernosa that is attached to the pubic bone through the suspensory ligament. The root of the corpora cavernosa has the starting point under the pubic bone, through which they then continue their path under the lower edge of the bone and climb in close proximity being connected to the pubic bone through the suspensory ligament. From the deep surface, the fundiform ligament is intercepted, which is the bridge between the aponeurosis of the right abdominal muscle and the Dartos fascia (superficial fascia of the penis) and then it reaches the dome of the pubic bone from where the dissection of the suspensory ligament begins. By disinserting the suspensory ligament, the portion of the corpora cavernosa that was in close connection with the pubic bone will be practically released and thus they will be able to advance. The disinsertion of the suspensory ligament must be done completely both in depth until the deep dorsal vasculonervous bundle can be visualized and in the surface until near the spermatic cord. If this insertion is not complete, the result will be insufficient. After advancing the corpora cavernosa, the surface of the pubic bone from which the suspensory ligament was disinserted requires coating to block its retraction. For this there are 2 techniques: the interposition in that created space of an artificial spacer (usually a testicle implant) or the interposition of own tissue, through a special suture of fat and fascia from the medial portion of the spermatic cord over the bone surface. In this way the suspensory ligament will be blocked and its possibility of reattachment is practically nil.

At Cosmedica we perform the technique by interposing the patient’s own tissue because the risks of infection and reintervention are much lower and at the same time the benefits for the patient are more attractive. Blocking the retraction of the suspensory ligament by the testicle implant involves reintervention and many possible long-term complications – risk of infection, possible compression on the corpora cavernosa which can result in decreased vascularity and, implicitly, impotence.

2. How much can you earn with this operation?

– The gain in length after this procedure is 1-3 cm in a relaxed position and about 40-50% of it can be highlighted in an erectile state. In the erection, the same gain will not be obtained as in the relaxed state due to the curvature that the corpora cavernosa make during the erection and thus lose the visual length. The gain depends very much on the thickness and the depth and surface arrangement of the suspensory ligament. Also, in order to stabilize the result, it is necessary to have a traction exercise regime that will relax the scar deeply and thus will mobilize the corpora cavernosa even more. This procedure involves manipulating existing tissues and will not be able to deliver results at the request of patients.

3. What are the ideal candidates for this procedure?

– The ideal candidates are men who have an erect penis length below 11 cm and have couple problems. They must be in very good health, without chronic diseases for which they need to administer a certain daily treatment such as oral antidiabetics, hypotensive drugs, antiplatelet agents, anticoagulants, cortisone, psychotropic drugs, benzodiazepines, immunosuppressants, etc.

4. What will the scar look like, how big will it be and where will it be placed?

– The scar will have the shape of the letter Y seen from above by the patient, will be placed immediately above the penis and will be 4-6 cm. Healing is an unpredictable process and depends largely on the patient’s tissues. It may change as soon as the traction exercises begin, due to the expansion and stretching of the skin. Depending on how the pubic hair is worn and how the scarring occurs, it can go unnoticed.

5. What anesthesia does this technique require?

– Dorsal elongation can be performed with epidural / spinal anesthesia combined with superficial sedation, deep sedation combined with local anesthesia or general anesthesia. We always try to provide maximum comfort for our patients and that is why we can choose to combine some types of anesthesia: the patient does not want general anesthesia, so a regional anesthesia such as epidural or spinal combined with or without superficial sedation (the patient can interact with the team surgery or can listen to music on headphones) or the patient can opt for “twilight” or general deep sedation anesthesia. All this will be explained during the consultation so that patients understand how each of them is done and what it entails.

6. What preoperative training is required?

– After the consultation in person or online, it is necessary to establish the date of the intervention and then a set of standard analyzes performed about 10-12 days before and the results to be viewed by the attending physician 7 days before. 2-3 days before the operation, we instruct the patients to epilate the entire intimate area and also to use in the shower an antibacterial soap or an antiseptic solution (Betadine, chlorhexidine, etc.) applied and maintained on the intimate area (suprapubic region, penis, scrotum, groin folds etc) for about 5 minutes.

7. How long does the operation take and what is the recovery period?

– The operation of dorsal elongation of the penis takes about 45 minutes – 1 hour. The recovery period involves the patient to lie down for the first 3 days without any effort and then gradually the efforts can be resumed by light walks for up to 3-4 weeks. After a period of 1 month you can resume normal physical activity, sexual activities and also from then on you can start the traction exercises with the vacuum pump.

8. Can impotence occur after this operation?

– Not. If the operation is performed by someone with experience, this condition cannot be discussed. Impotence is related to the vascularization of the corpora cavernosa, which is given by the intracavernous arteries, the deep dorsal artery and the network that connects the two sources. If the disinsertion of the corpora cavernosa is done correctly and the deep dorsal artery is not damaged, there is no risk that this procedure will cause impotence.

9. What complications can occur after dorsal elongation?

– As with any other operation, dorsal elongation can cause general complications: Hematoma – Excess blood accumulation that often requires reoperation, but rarely occurs; Serum- accumulation of excess lymph which in only 20% of cases requires reintervention but rarely occurs; Infection- happens quite rarely; Pathological scarring – depends largely on the patient’s tissues, but rarely occurs; Persistent chronic pain – occurs very rarely or locally: Increased angle between penis and abdomen in erection- the penis will not fall from its initial position, but will slightly lower than the abdomen in erection; Instability of the penis during sexual intercourse – the suspensory ligament is just an extra structure that helps to stabilize the penis, but it does not mean that the interruption will cause a loss of support of the penis during intimate contact, but possibly a slight weakening of the firmness of the axis – this complication has not been reported to us so far by our patients; Initial ligament retraction – occurs only if blockage of the suspensory ligament has not been blocked in the pubic bone – has not been reported to us by our patients, etc.

10. What is the cost of the dorsal elongation operation?

– The cost of the dorsal lengthening procedure starts from 1200 euros with regional anesthesia, with all the facilities included until healing (operation, anesthesia, accommodation 1-3 days, dressings, treatments, services, dressings, etc.)