I treat any circumcision procedure with an equal concern for the attention to detail with the surgical technique. The principal features of technique that impact the quality of cosmetic outcomes are: length of foreskin removed, symmetry of the incision lines, gentleness of handling of the skin and the Dartos fascia layer which lies beneath the skin careful attention to control of bleeding arteries and veins, careful attention to aligning the skin edges for wound closure, delicate handling of the suturing (stitching) process so that suture scarring ("railroad track" scarring) does not result, suture technique which is performed to prevent suture tunnels (These are NOT the result of stitches remaining in too long but are entirely the result to the surgeon's technique.) proper postoperative dressing (bandage) application to minimize swelling and stretching of the healing tissues. For adult circumcision, I use the sleeve resection technique in which the foreskin is removed as a single ring of tissue utilizing a scalpel. In my opinion, this gives a symmetrical, fine incision line. In addition to a refined scar line, this technique allows the final result to be customized to the patient's specifications if he has a particular outcome in mind.