Fat Grafting to the Penis

Why Did You Decide to Do This Technique?

Penis enlargement is becoming more popular every day and thousands of male individuals are seeking some help to satisfy their desire.

Our community, however, is generally skeptical of performing penile enlargements because of the uncertain results and bad reputation, mostly produced by non-board-certified plastic surgeon physicians or unprepared medical professionals and commercial agencies, who reproduce and imitate the penis enlargement surgical procedure. Many individuals have ended up dissatisfied, with severe complications, because they have been offered paramedical, practical, surgical, or nonsurgical therapies and have been cheated with treatment options without a doubt are not in the armamentarium of any ethical plastic surgeon or even respectful physician.

We never put any pressure on an individual to proceed with this operation. It is his sovereign decision whether to proceed or not. We should never promise results that surpass the capability of our technique. Patients with unrealistic expectations, who request results superior to those explained, or who feel entitled to obtain the maximum penile increase based on ideas and perceptions coming from adult videos, should be excluded.

But before we start analyzing the plastic surgery methods that enhance penis enlargement, we need to review the physiological function and size of the penis, the history, anatomy, and histology for this operation.

When Did You Learn It? Historically, What Is Your Contribution?

In 1982, a French plastic surgeon, Yve Gerard Ylouz, was probably the first to liporecycle fat microparticles (lipoaspirates), for cosmetic purposes. That was performed on a young actress, a close friend of Ylouz, by aspirating the fat cells of a lipoma on her back, using a very small liposuction cannula and transferring the lipoaspirate as it was, to the deep nasolabial folds. I was present as an assistant young plastic surgeon at this historical procedure and at many more to follow, evaluating and developing the lipotransfer technique. We used the term liporecycling, interpreted from the Greek Λίπο ανακύκλωση (leapo anakeekclossi) , meaning literally recycling the fat. In 1983, at the BAAPS course in London, together with Bryan Mayou, we presented officially ( ISAPS Newsletter, September–December 2012, 27–29), maybe the first in the UK, the new technique of liposuction and a few years later, lipotransfer of lipoaspirates. After that year, liporecycling became maybe the most wanted, frequent, and popular plastic surgery procedure and ever since, plastic surgeons all over the world have reliably used fat grafting as a way to improve and enhance cosmetic appearance or augment many anatomical areas. Either as a core procedure or an adjunct to several other plastic reconstructive or cosmetic surgery procedures on breast, face, scalp, feet, hands, hips, buttocks, and endless other anatomical sites, today liporecycling remains within the top five plastic surgery procedures.

Two major disappointment in those early years was that the transplanted fat was short surviving and that the fat could not be preserved for later second-time use. Over the last 15–20 years, plastic surgeons started, and then clinicians followed, to document in several publications the therapeutic benefits of fat grafting with or without added platelet-rich plasma (PRP) and adipose tissue-derived stem cells (ATSCs, which are present of course in the stromal vascular fraction, [SVF]).

Given today’s answers and knowledge, during that time of the late ’70s and early ’80s, fat recycling was the subject of extended studies and strong discussions, and considered the hot topic for congresses and scientific panels. As well, at the same time, as plastic surgeons, we received vast amounts of ironic comments and dispute, unfortunately not only from other physicians, but sadly from conservative or skeptical members of our own society.

Nowadays, many other non-plastic surgery specialties are using liporecycling to assist their procedures and enhance their therapeutic results. Gynecology, orthopedics, urology, ophthalmic surgery, ENT, dermatology, and of course, general surgery are among those specialties using fat in addition to the most commonly done plastic surgries.

In fat-grafting history, we see the names of Gustav Neuber (1850–1932 German plastic surgeon) and Dr. Viktor Czerny, a German Bohemian surgeon, who at the beginning of the early 20th century used lipografting not as harvested fat micro lipoaspirates, but as an entire lipoma or a fat-piece transfer. In fact, fat grafting at the beginning indeed had trouble gaining acceptance, mainly for its poor results, as modern liposuction techniques had not yet been developed or standardized, and there was a lack of experience and knowledge.

Fat grafting should be performed in a hospital or outpatient surgery center, and when done in private consultation facilities, only as where they are accredited. Facility accreditation is important as it guarantees that the specific facility is inspected at regular intervals by the public health authorities or ministry, ensuring patient safety, best practices, and that operations are performed by certified plastic surgeons.

Can This Technique Be Compared To Others and Why?

Surgical penis enlargement and elongation methods include various types of penile augmentation and suspensory ligament release. Penile augmentation involves injecting mostly fat cells or other types of injectables into the penis, or grafting dermofat pieces. Injecting fat cells into the penis is the most common technique.

When done by inexperienced physicians, fat transfer, fillers injection, and placing dermo-fat grafts into the penis (usually to the dorsum) can cause severe deformity and functional issues, which, in some instances, are long-lasting or unrepairable. Suspensory ligament surgery produces a high rate of functional issues. All those surgeries leave scarring at the operation and donor site and the results in size may disappear over a short time, leaving calcified tissue. For the recipient individual, this is a most uncomfortable and unpleasant situation that demands extrusion and correction, which sometimes is not very successful.

Suspensory ligament release increases flaccid penis length, but does not increase by any means the length of an erect penis and usually because of the instability that this operation produces, creates firmness problems with sexual dysfunction. The suspensory ligament is the remainder in mankind of the erectile bone in canids (dogs, wolves, and many more carnivores, household or wild). Functionally, the suspensory ligament supports and maintains the base of the penis attached to the pubis. It is the main point of support and straightening for the erect penis, keeping it in an upright and stable position during sexual intercourse.

Expert Approach: Fat Grafting to the Penis

• Theodore Vodoukis

• Plastic Surgeon

• Athens, Greece