(307) 6 S TECHNIQUE: A NEW APPROACH TO PENILE GIRTH AUGMENTATION WITH HYALURONIC ACID
Authors: Barbosa Garofo Stábile Moura D , Camargos Cunha Ribeiro G , Boeira Lopes R , Souza Carneiro MP , Maria Silveira Sigrist R , Matos Lourenço L , Henrique De Souza J , Rocha Chavez Zambrana D , Brandão Vasco M , Nardozza Junior A 
Published: December 2024

Abstract

Introduction
The penis is often seen as a symbol of masculinity and sexual prowess, making its size important for many men. The belief that a larger penis is better can lead to dissatisfaction, affecting self-esteem and sexual function. Positive body image, which involves accepting and respecting one’s body, is crucial for mental health. Various techniques for penis augmentation exist, but most lack medical approval, raising ethical issues. The demand for safe, minimally invasive procedures has made tissue filler injections popular for penile augmentation. Hyaluronic acid (HA) has been widely used since 2003. HA, a natural substance in mammalian cells, offers benefits like anti-inflammatory and antioxidative properties and maintains tissue hydration and turgidity. It is used in various medical fields due to its favorable biomechanical properties and hypoallergenic nature. Men seeking penile girth augmentation usually have normal-sized penises but feel dissatisfied, a condition known as “small penis syndrome” (SPS). SPS, influenced by sociocultural factors like pornography, can lead to anxiety about genital size. Some men with SPS may also have body dysmorphic disorder (BDD), characterized by a preoccupation with perceived physical flaws, causing significant distress. This study describes a technique using HA filler for penile girth augmentation in men dissatisfied with their penis size.

Objective
The aim of this study is to describe a new approach to penile filling with hyaluronic acid through a series of cases.

Methods
This is a case series of men who underwent penile filling with hyaluronic acid. Men dissatisfied with their penis size and seeking treatment at the andrology outpatient underwent psychological evaluations to exclude reality judgment disorders before the procedure. Measurements of flaccid penis length and girth were taken before, immediately after, and 30 days post-procedure. Satisfaction levels were assessed 45 days post-procedure using a 0-10 scale. The procedure starts with local asepsis using 2% aqueous chlorhexidine and an anesthetic block with 2% lidocaine solution. The penis is marked with longitudinal lines around the urethra and six equidistant segments on the dorsolateral aspect (Fig. 1). A canula injects HA filler in small boluses, totaling 9 mL (fig. 2). The filled area is shaped with a sterile syringe and compressive massage, and any irregularities are corrected with additional filler. A bandage is applied for seven days, with instructions for post-procedure care. Patients perform massage techniques and replace the bandage twice daily. After 30 days, patients are reassessed for potential corrections.

Results
Between October 2023 and January 2024, eight men, aged 20-59 years, underwent the procedure. The average stretched flaccid penis length was 13.5 cm, and the pre-procedure girth averaged 8.86 cm. The penis girth increased by 1.0–2.5 cm, with a mean value of 1.76 cm, immediately after the procedure. After 30 days, the mean penile girth increase was maintained at 1.45 cm. Four patients did not require retouching, while three needed minor corrections (Fig. 3). No major complications were reported, and the mean satisfaction score was 8.4.

Conclusions
The presented penile girth augmentation technique utilizing HA filler demonstrated reproducibility, yielding high satisfaction rates among patients without significant adverse effects.

Disclosure
No.