Penile lengthening is carried out through the division of the suspensory ligament, in order to allow the forward movement of the corpora; while the most common technique for penile girth enhancement consists of autologous fat transfer, whereby adipose tissue harvested from areas such as the hips is grafted into the dartos fascia of the penis, with no involvement of the erectile tissues.
The main advantage of autologous fat grafting is the use of the patient’s own adipose tissue; on the other hand materials such as non-absorbable fillers, porcine dermis, or alloderm have shown such a high rate of complications, and results so poor as to discourage their use.
Severing the fundiform and suspensory ligaments
The fundiform ligament is an inferior attachment to the pubis of the Scarpa’s fascia. It exceeds to the superficial tissues of the pubis tot the lateral sides, like a sling. This is superficial to the suspensory ligament.
The suspensory ligament is a fascio-aponeurotic structure which is responsible of maintaining in a relativ elevated position the erectile penis because of its connection with the pubic bone. It’s more robust than the latter.
By severing of the suspensory ligament the penis will remain attached to the pubic bone by its lateral connections and it’s internal portion will be advanced , gaining in this way, 1 to 3 cm in flaccid state and 1 cm in erectile state. These dimensions are relative because of every patient’s anatomy, because the suspensory ligament can be sometimes very thin and sometimes very thick and disposed well on the lateral sides. The lengthening procedure depends very much on these aspects.
The procedure is done with deep sedation combined with local ligament anaesthesia or epidural anaesthesia combined with superficial sedation for the most comfortable state for the patient, and with the use of the
Radiofrequency Laser Ellman 4.0MHz wich seems to produce no swelling and pain after surgery.
After 2 months after the lengthening procedure, the patient can increase more the penile length by
conducting some traction exercises with a special device of traction or a special device of vacuum.
Penoscrotal webbing/penoscrotal Z-plasty
This procedure can deepen the scrotum and by this, it can reveal the radix of the ventral cavernosum bodies. In this way the 2-3 cm of cavernosum bodies can be used during sexual intercourse.
Complications: infection, seroma formation, haematoma formation bad scarring
Laser phalloplasty is the term used to describe surgical penile lengthening. The suspensory ligament is a deep-seated anatomical structure located between the corpora and the pubic bone; its severing allows the forward movement of the corpora thereby increasing the visibile portion of the penis. The result largely depends on the consistency of the ligament itself: the thicker the ligament, the greater the gain in terms of length. Results typically vary between +1 ÷ +3 cm and are visibile in rest condition (100%) and in the erect state (40%).
The thickness of the suspensory ligament varies among men and cannot be fully appreciated at ultrasound or clinical exam because as we said it is a deep-seated structure, partially hidden by the pubic bone.