Good feelings after cosmetically Performed Adult Circumcision

From Circumcision Diary…

I had penetrative sex for the first time since I was circumcised (and for the first time ever, actually) a few weeks ago. It was really, really great and there was absolutely no discomfort whatsoever. For me, this was the last step in my healing process, so I’m very excited about it. I’m also very excited about my new relationship, but that’s not what this blog is about.

I don’t have any pictures for you all, but I will try to describe the physical aspects of my healing up to now. The scar has softened a lot and loosened up a bit. It’s still pretty prominent, but the two people who have seen my penis up close since my surgery weren’t able to tell that I hadn’t been circumcised at birth. The inner foreskin that remains has also darkened somewhat and the head has become more purple (especially when I’m erect). Sometimes the scar is itchy, but it’s very minor and doesn’t happen very often. Some of the pinholes from the stitches remain as divots in my skin and probably will forever. However, they are hardly noticeable and I’m pretty sure that I only notice them because I see my penis daily.

In terms of sensitivity, I would say that things have pretty much stabilized. I was concerned with losing sensitivity as a result of circumcision, but I had no reason to worry, really. Things feel different for sure, but just as good. I’ve gotten over the learning curve associated with using lubricant for masturbation (little trick: saliva can make a little bit of lube go a long way) and I’ve even been able to masturbate without lube in a pinch.

The last healing piece (and it’s a pretty minor one) is the fact that I feel a lot more comfortable with my penis on display now. I used to avoid the showers at the gym because I didn’t want people seeing my weird junk, but now I’m completely alright with it. Also, I’ve gotten lots of compliments on how my penis looks. It’s not a huge deal for me, but it does feel nice to be unashamed of such a fundamental part of my body.

There probably won’t be any big reasons for me to update this blog for a while, but I can provide updates on request. Just drop me a comment with questions or whatever and I can try to address them. Of course, I am not a professional, so anything I say is based on personal experience/things I’ve read on the internet. You should always consult a doctor if you’re at all concerned with your junk. It’s your junk, after all.

Peace out for now!

-T

Harold M. Reed, M.D. FICS
Senior Member of the American Urological Association
Member Society of Genito-Urinary Reconstructive Surgeons
Founding Member and Treasurer of American Academy of Phalloplasty Surgeons
Founding Member Sexual Society of North America
305-865-2000

Would penile implant and penis enlargement at same time. Practical?

August 17, 2014

Dear Dr. Reed,

Can you do penile enlargement and put in an implant at the same time?   My internist in Miami suggested I contact you.

Am a type one diabetic in good control.

Randy

August 17, 2014

Good morning Randy,

There are techniques both surgical and non-surgical to make your penis longer and wider.  Please call the office and arrange for a consultation. Also see http://www.penisdoctor.com/prosthesis.htm and http://www.penisdoctor.com/enlargepenis.htm

Look at photographic examples.  Hope you like what you see.

Cordially,

 

Harold M. Reed, M.D. FICS Phalloplasty Services

Senior Member of the American Urological Association Member Society of Genito-Urinary Reconstructive Surgeons Founding Member and Treasurer of American Academy of Phalloplasty Surgeons Founding Member Sexual Society of North America

 

 

Loose and uneven after adult circumcisionj

August 17, 2014

Hi Dr. Reed,

Had an adult circumcision  elsewhere a year ago.  Slightly irregular and too loose.  Can send you some photos?

How soon would you be able to revise?

Carlos

August 17, 2014

Good morning Carlos,

Thank you for your interest in what we do.  We have performed over 8000 cosmetic circumcisions and revisions in the past 35 years and usually do several cases every week.

Your p.nis is one of the most important functional and cosmetic features of your body.  Our patients know that and fly in from all over the world. August is a promotional month.  Please call Anne for special pricing.

We have done sons of physicians, brothers, religious circumcisions, men who have not seen the heads of their penis for 20 years! This is your circumcision and we do it the way you want with respect to 4 parameters.   Please don’t be like the patient who writes: “Dr. Reed I just got circumcised (elsewhere) two days ago, and my result was not what i expected. I was wondering when i recover can i get a consultation with you.” Photos sent and received.  Unspoken comment: “disaster zone.”

Be assured we will show you every courtesy.

All the best,

Harold M. Reed, M.D. FICS Phalloplasty Services

Senior Member of the American Urological Association Member Society of Genito-Urinary Reconstructive Surgeons Founding Member and Treasurer of American Academy of Phalloplasty Surgeons Founding Member Sexual Society of North America

 

Penis enlargement needed sooner rather than later

August 17, 2014

Dear Dr. Reed,

Interested in penile enlargement.  Impressed by http://www.penisdoctor.com/enlargepenis.htmI  I am 25 and slightly below average

in length.  I have always been self-conscious about this and on occasional

can detect some unhappiness with the ladies.

Please send me all pertinent information.  Live in California, but will travel

to do consultation and surgery, if possible during the same visit.

What do you advise?

Matthew

August 17, 2014

Dear Matthew,

Many thanks for your E-mail inquiry and visiting our web-site

http://www.penisdoctor.com/enlargepenis.htm

We hope you can relate to our photo gallery of befores and afters.  Our fees are posted on our web-site.  Patients who have lengthening usually leave for home the next day.  You could probably return to an office environment in 3 days.

Or consultation on Thursday, surgery on Friday.  Monday, back to work.

From surgery anticipate a 3/8″  increase in length and with dedicated use of traction, 8 hours a day in divided sessions, anticipate a 1/8″ gain each month such that after 6 months you’ll have 3/8″ plus 6 x 1/8″ or 9/8″.  We say about an inch longer erection in 6 months.  Flaccid lengths will be correspondingly longer.

Please recognize that American Urological Association policy statement of 2008 remains unaltered?   ?The American Urological Association (AUA) and the Urology Care Foundation consider subcutaneous fat injection for increasing penile girth to be a procedure which has not been shown to be safe or efficacious.   The AUA also considers the division of the suspensory ligament of the penis for increasing penile length in adults to be a procedure which has not been shown to be safe or efficacious.?

Whenever you stop using traction whatever you have gained is permanently yours.   If you continue, more length gains will be accrued.

We do not do simultaneous surgery, such as any combination of length, girth of shaft, girth of glans, circumcision, or pubic liposuction.

Hardly a week goes by when some disillusioned patient done elsewhere calls us for a revision.  And we told you so.  Generally speaking the penis does not appreciate simultaneous surgery with a few exceptions.

With AlloDerm, we can say quite conservatively you can anticipate a 3/4″ gain in circumference if you have not already had penile girth enhancement which is permanent as far as we know having followed patients for 8 years or so who have had AlloDerm.  Most patients will do a lot better than that.

While you do not have to be circumcised for lengthening, you need to be circumcised for girth enhancement.

AlloDerm patients must be on strict bed rest with the exception of getting up to use the commode or eating in their room for 4 days.  Surgery is the zero day, and we certainly recommend you stay at the Daddy O Hotel, one block from the office (305-868-4141) so I can see you daily as your penis will continue to swell for several days, and your dressing will be replaced often to accommodate a larger sized penis.  Mention my name for a discount.  Less expensive is tourist class Whitehouse Inn on the Bay (305-893-8280).

AlloDerm is like particle board, when immersed in body fluids, it swells and swells for several days.  This spreading of the collagen fibers is helpful to permit ingrowth of a capillary bed and new cells of your own making.

Whereas AlloDerm comes from a cadaver, BellaDerm comes from a live donor.  There are many subtle differences which require telephone explanation.  I have not seen any communicable disease emerge with either product.  AlloDerm is packaged dry and swells like particle board.

Early mobilization  is the great enemy of good graft take.   Again plan on staying in your room, stocking up on food or sending out for food.  Good Italian, Greek and Chinese restaurants abound with delivery service only a telephone call away.  I’ve have been known to go shopping for some patients at Publix.  You won’t starve.

If you have AlloDerm surgery on Tuesday, you could be back in an office environment on the following Monday.  If you do manual labor you may wish to wait a good week after surgery and avoid trauma to your genitals.

Most likely you will have many questions and we are available for consultation only, if that suits your purposes.

Candidates who wish to schedule surgery with our facility are required to have phone

consultation with a favorable response to questions of concern.  Assuming this, you will be given the nod to send in a 50% deposit which is non-refundable.

All patents will require these blood tests: a recent CBC,  platelet count, PT and PTT.  This can be done at our office the day before surgery or in your home town. These tests run about $100.

If you are over 40 or are on medications, please call the office before scheduling surgery, as a letter of medical clearance may be required.

If you are a smoker, you must stop completely for 2 months before surgery (girth enhancement especially) and please never again.

Smoking causes vaso-spasm, impairs wound healing, produces excessive scarring, tissue necrosis, irritates and inflames pulmonary membranes and enhances anesthetic risk.  However, most of our penile surgery is done under local anesthesia with IV sedation.

This goes also for any products containing nicotine or nicotine like agents including nicorette gum, nicotine patches, Nicotrol inhalers, and second hand smoke.

Again not for 8 weeks before and not for 8 weeks afterwards. Hopefully never again.

Please no aspirin or aspirin products, no anti-inflammatory drugs such as Motrin, Advil, Alleve, or Cox 2 inhibitors such as Celebrex or Vioxx for a week before surgery. No Vitamin E or excessive alcohol or spices for a week before surgery as this may promote bruising. Bruising can be reduced (many believe) with Bromelain 500 mg 1 twice

a day, Arnica montana (Boiron brand) dose 30C (take 4 small tablets sublingually, 4 times a day), vitamin C 500 mg (3 times a day) starting 1 week before surgery. Do take these medications unless there are specific reasons why you choose not to and let’s discuss it beforehand.

Boiron brand is available at Whole Foods and on the web at http://www.vitaminshoppe.com for “pennies” and we do notice a difference.  You will need 2 vials.

Again, for  the only 2 motels on our preferred list (where rounds are made daily) we recommend Daddy O Hotel, 3 star.  Daddy O  is located at 9660 E. Bay Harbor Dr, Bay Harbor Islands, FL 33154, one block from our office  (305-868-4141).   Ask for Courtney.  Please make reservations as soon as you obtain a surgical date and specify a room on the ground floor.    Some discount is usually given to our patients.  Less expensive is tourist class motel? Whitehouse Inn on the Bay at 2305 NE 123rd St, North Miami, FL 33181 (305) 893-8280.

We hope to have the pleasure of serving  you whenever your travel plans include the South Florida area.

With regards,

Harold M. Reed, M.D. FICS

Phalloplasty Services

Senior Member of the American Urological Association
Member Society of Genito-Urinary Reconstructive Surgeons
Founding Member and Treasurer of American Academy of Phalloplasty Surgeons
Founding Member Sexual Society of North America

Circumcision: Why the foreskin increases infection risk

Circumcision – Why the Foreskin Increases Infection Risk

As a prelude to this, one needs to first understand the anatomy. The foreskin is composed of an outer layer that is keratinized (as is skin generally), and an inner lining that is a mucosal surface. The inner lining thus resembles other mucosal epithelia such as constitute the cervix, nasal passages and rectum. It had been suggested that the foreskin protected the glans from drying out and becoming keratinized. However, histological examination has shown the same amount of keratin in the skin of the head of the penis irrespective of circumcision status. Interestingly, whereas most consider the inner foreskin to be thinner, one study has reported there is no difference between the keratinization of the inner and outer foreskin. This study was, however, flawed because  the foreskins studied were from men circumcised for a medical indication, where balanitis, infections and phimosis could have made the keratin layer of the inner foreskin thicker, and  the authors do not indicate what part of the foreskin they studied, where inner foreskin is thinner close to the base at the coronal sulcus than at the distal end.

The inner layer of the foreskin lines a ‘preputial sac’, which becomes a repository for shed cells, secretions, and urinary residue that accumulates. It is also a hospitable environment for the growth of bacteria and other microorganisms.

During an erection the head and shaft of the penis extend so that the inner layer becomes exteriorized along the distal half of the shaft. This exposes it to infectious agents during sexual intercourse.

It has been speculated that the foreskin is a source of secretions, pheromones, etc, but given the dubious authorship of these reports and the absence of any research support, such suggestions should be regarded as fanciful. In fact, for references that cite evidence to the contrary see.

It has been suggested that the increased risk of infection in the uncircumcised may be a consequence of the following:

• The foreskin presents the penis with a larger surface area.

• It has been suggested that the moist inner lining of the foreskin represents a thinner epidermal barrier than the more cornified outer surface of the foreskin and the rest of the penis, including the glans. It should be noted that the glans of a circumcised and an uncircumcised penis have the same amount of keratin (i.e., similar skin thickness and protection from invasion of microorganisms). Although the keratin thickness of the inner and outer foreskin was suggested to be similar, the samples used were from men with pathology that could have increased keratin thickness, and could have been from the thicker distal end of the foreskin. The thin, moist inner lining may be a potential entry point into the body for viruses and bacteria, but more information is needed on how this occurs.  (A photograph of a histological section that illustrates the much thinner inner than outer foreskin can be found later, in the section on the AIDS virus.)

• The presence of a prepuce is likely to result in greater microtrauma during sexual intercourse, thereby permitting an entry point into the bloodstream for infectious agents.

• The warm, moist mucosal environment under the foreskin favours growth of micro-organisms (discussed in detail later). The preputial sac has even been referred to by Dr Gerald Weiss, an American surgeon, as a ‘cesspool for infection’, as its unfortunate anatomy wrapped around the end of the penis results in the accumulation of secretions, excretions (urine), dead cells and growths of bacteria as referred to above. Parents are told not to retract the foreskin of male infants, which makes cleaning difficult. Even if optimal cleansing is performed there is no evidence that it confers protection. Rather, the foreskin tends to trap and transmit micro-organisms, both to the man himself, and his sexual partners.

Mens Health: Facts you didnt know about your penis

Facts You Didn’t Know About Your Penis

By: Mike Zimmerman

Penis Fact #1

Smoking can shorten your penis by as much as a centimeter. Erections are all about good bloodflow, and lighting up calcifies blood vessels, stifling erectile circulation. So even if you don’t care all that much about your lungs or dying young, spare the li’l guy.

Penis Fact #2

Doctors can now grow skin for burn victims using the foreskins of circumcised infants. One foreskin can produce 23,000 square meters, which would be enough to tarp every Major League infield with human flesh

Penis Fact #3

An enlarged prostate gland can cause both erectile dysfunction and premature ejaculation. If you have an unexplained case of either, your doctor’s looking forward to checking your prostate. Even if you’re not.

Penis Fact #4

The average male orgasm lasts 6 seconds. Women get 23 seconds. Which means if women were really interested in equality, they’d make sure we have four orgasms for every one of theirs.

Penis Fact #5

The oldest known species with a penis is a hard-shelled sea creature called Colymbosathon ecplecticos. That’s Greek for “amazing swimmer with large penis.”

Penis Fact #6

There are two types of penises. One kind expands and lengthens when becoming erect (a grower). The other appears big most of the time, but doesn’t get much bigger after achieving erection (a shower).


Penis Fact #7

An international Men’s Health survey reports that 79 percent of men have growers, 21 percent have showers

Penis Fact #8

German researchers say the average intercourse lasts 2 minutes, 50 seconds, yet women perceive it as lasting 5 minutes, 30 seconds. Are we that good or that bad?

Penis Fact #9

Turns out size does matter: The longer your penis, the better “semen displacement” you’ll achieve when having sex with a woman flush with competing sperm. That’s according to researchers at the State University of New York, who used artificial phalluses (ahem) to test the “scooping” mechanism of the penis’s coronal ridge.

Penis Fact #10

The penis that’s been enjoyed by the most women could be that of King Fatefehi of Tonga, who supposedly deflowered 37,800 women between the years 1770 and 1784—that’s about seven virgins a day. Go ahead, say it: It’s good to be king

 

 

 

Mens Health article ‘Does your penis smell?’

Does Your Penis Smell?

 

Eliminate the odors lurking down below—for your partner’s sake

By Markham Heid, July 14, 2014

Your groin is the perfect incubator for unpleasant smells: It’s hot, humid, and tucked beneath layers of stink-trapping clothing.

“Sweat and moisture mix with the natural bacteria on your skin to cause body odor,” explains Kelley Pagliai Redbord, M.D., a dermatologist at George Washington University. Specifically, your groin contains a number of apocrine glands that release secretions which, when mixed with sweat, can lead to some alarming scents, she adds.

Even if you’ve never caught a whiff of something nasty—or heard complaints from female companions—chances are good there are unsightly smells lurking underneath your underwear. Along with turning her off from oral sex, one smelly encounter could earn you a bad reputation with your partner and her pals.

Here, Redbord and other experts offer tips to remove and prevent those unwanted aromas:

Consider a new haircut. Pubic hair traps dampness and odors, and also makes it difficult for the underlying skin to stay cool and dry, Redbord says. You don’t have to shave yourself bare. But pruning your hedges with a beard trimmer can help keep gross odors at bay, she says.

Wash like you mean it. You’ve already lost the war if you fail to clean out the bad-smelling gunk that accumulates in the many folds and clefts that comprise your groin area, says Tobias Köhler, M.D., a urologist at Southern Illinois University. He says elbow grease and attention to detail are the most important parts of washing. “Don’t just wipe some soap on the area,” he warns. “Use some pressure and get into all those crevices.” An antibacterial soap could also help if all else fails, Redbord says. And if you’re uncircumcised, be sure to clean below your foreskin, she stresses.

Dry out. “Reduce moisture, and you’ll reduce body odor,” Redbord promises. To do that, she says it’s necessary to fully dry out your junk before dressing—especially during the summer when you’re hot all the time. “Consider using a blow dryer to get the area completely dry,” she suggests. (Now you’ll get to be that guy at the gym.) Damp towels or washcloths also accumulate bacteria, so they could contribute to your problem, Redbord adds. Make sure you’re using clean, dry linens every time you step out of the shower.

Put on the finishing touches. Cotton is breathable, and so sporting cotton briefs and clothing can help keep your package stink-free, Redbord says. In the middle of the summer when the temps and humidity skyrocket, a swipe of underarm deodorant on the underside of your scrotum can also help target the area of your worst odor, she adds.

CDC Research: Male circumcision reduces HIV transmission

CDC.govCDC.gov                    

Summary

  • Male circumcision reduces the risk that a man will  acquire HIV from an infected female partner, and also lowers the risk of other STDs  , penile cancer, and infant urinary tract infection.
  • For female partners, male circumcision  reduces the risk of cervical cancer, genital  ulceration, bacterial vaginosis, trichomoniasis, and HPV. Although male circumcision has risks including  pain, bleeding, and infection, more serious complications are rare.

Young mother looking at newborn baby in her arms

What is Male Circumcision?

Male circumcision is the surgical removal of some or all of the foreskin (or prepuce) from the penis.1

Male Circumcision and Risk for HIV Acquisition by Heterosexual Men

Several types of research have documented that male circumcision significantly reduces the risk of men contracting HIV through penile-vaginal sex.

Biologic Plausibility

Compared with the dry external skin surface of the glans penis and penile shaft, the inner mucosa of the foreskin has less keratinization (deposition of fibrous protein) and a higher density of target cells for HIV infection.2 Some laboratory studies have shown the foreskin is more susceptible to HIV infection than other penile tissue,3 although others have failed to show any difference in the ability of HIV to penetrate inner compared with outer foreskin surface.4 The foreskin may also have greater susceptibility to traumatic epithelial disruptions (tears) during intercourse, providing a portal of entry for pathogens, including HIV.5 In addition, the microenvironment in the preputial sac between the unretracted foreskin and the glans penis may be conducive to viral survival.3 Finally, the presence of other sexually transmitted diseases (STDs), which independently may be more common in uncircumcised men, increase the risk for HIV acquisition.6-11

International Observational Studies for Prevention of HIV Acquisition by Heterosexual Men

Young Asian man in consulataion with doctor

A systematic review and meta-analysis that focused on male circumcision and heterosexual transmission of HIV in Africa was published in 2000.12 It included 19 cross-sectional studies, 5 case-control studies, 3 cohort studies, and 1 partner study. A substantial protective effect of male circumcision on risk for HIV infection was noted, along with a reduced risk for genital ulcer disease. After adjustment for confounding factors in the population-based studies, the relative risk for HIV infection was 44% lower in circumcised men. The strongest association was seen in men at high risk, such as patients at STD clinics, for whom the adjusted relative risk was 71% lower for circumcised men.

Another review that included stringent assessment of 10 potential confounding factors and that was stratified by study type or study population was published in 2003.13 Most of the studies were from Africa. Of the 35 observational studies in the review, the 16 in the general population had inconsistent results. The one large prospective cohort study in this group showed a significant protective effect: The odds of infection were 42% lower for circumcised men.14 The remaining 19 studies were conducted in populations at high risk. These studies found a consistent, substantial protective effect, which increased with adjustment for confounding. Each of the four cohort studies included in the review demonstrated a protective effect, and two were statistically significant.

Smiling young Hispanic couple with newborn baby

Ecologic studies also indicate a strong association between lack of male circumcision and HIV infection at the population level. Although links among circumcision, culture, religion, and risk behavior may account for some of the differences in HIV infection prevalence, the countries in Africa and Asia with prevalence of male circumcision of less than 20% have HIV infection prevalences several times higher than those in countries in these regions where more than 80% of men are circumcised.15

International Clinical Trials for Prevention of HIV Acquisition by Heterosexual Men

Three randomized controlled clinical trials (RCTs) were conducted in Africa to determine whether circumcision of adult males reduces their risk for HIV infection. The controlled follow-up period in all three studies was stopped early, and the control group offered circumcision when interim analyses found that medical circumcision significantly reduced male participants’ HIV infection risk. The controlled follow-up period in the study in South Africa16 was stopped in 2005, and the controlled follow-up periods for the studies in Kenya17 and Uganda18 were stopped in 2006.

In these studies, men who had been randomly assigned to the circumcision group had a 60% (South Africa), 53% (Kenya), and 51% (Uganda) lower incidence of HIV infection compared with men assigned to the wait-list group to be circumcised at the end of the study. In all three studies, a small number of men who had been assigned to be circumcised did not undergo the procedure; likewise, a small number of men assigned to the control groups did undergo circumcision. When the data were reanalyzed to account for these occurrences, men who had been circumcised had a 76% (South Africa), 60% (Kenya), and 55% (Uganda) reduction in risk for HIV infection compared with those who were not circumcised.

A 2008 meta-analysis, which examined data from the three RCTs, as well as from cohort and case-control studies, found that HIV risk was reduced 58% in circumcised men (overall risk ratio [RR], 0.42; 95% confidence interval [CI], 0.33-0.53). The authors concluded that the studies provided enough evidence to conclude that circumcision causes a reduction in transmission of HIV-1 infection

Penile girth enhancement: FAQ

Hi Doctor Reed,

I have a few questions about improving the girth of my penis.  I have always been self conscious about it, I’m also newly single and would like to step back into the dating world with more confidence.  Can you give me some general information about girth enhancement? I am also curious as to what material  is used to improve the girth?

Thanks in advance,

Bryan

 

August 12, 2014

Good morning Bryan,

I am happy to provide you with information regarding penile girth enhancement, please see the following:

Penile girth enhancement can be performed by one of three techniques: A. placement of dermal-fat grafts which are harvested from the lower abdomen or buttocks area (actually upper thigh just below the crease), B. insertion of  acellular dermal matrix strips such as AlloDerm® or   BellaDerm™,  or C. insertion of liposuctioned fat.

Dermal-fat strips are associated with graft contracture, which may result in palpable fibrous cords and penile shortening.  Liposuctioned fat (or autologous fat transfer, AFT) despite mention of new handling techniques can undergo either zonal or complete reabsorption in some patients, or may form palpable lumps called fibro-fatty nodules.  In my practice, AFT is used only for small touch ups.  Lack of girth enhancement at the base is often seen as once the “test tube” is filled up, fat tends to spill into planes of least tissue resistance, i.e. the pubis or scrotum.  The use of liquid silicone is mentioned as an abhorrent, high incidence of complications procedure

AlloDerm® is an acellular cadaveric dermal matrix product and is capable of stimulating an ingrown of connective tissue with blood supply if one does not overly pack the penis with “stacked” dermal-matrix..  It eliminates the need for taking donor fat or dermis from one part of the body to another.  Patient oriented information for AlloDerm® may be accessed via the LifeCell Corporation web site at http://www.lifecell.com.

BellaDerm™ is equally available and is also an acellular dermal product.  Their web-site is http://www.belladerm.org/   BellaDerm is packaged moist and does not have to be refrigerated.  It comes from live donors, especially those who have tummy tucks with large surfaces of skin removed.

Our office has had good experience with both products.  The selection decision is a patient choice.  Regardless of which product you select, fees and post-operative instructions are the same.

All patients considering girth enhancement must be circumcised as there will be post operative swelling which may impede retraction of your foreskin for daily hygiene.  Under these circumstances there could be disruption of your suture line  which would definitely predispose to a BellaDerm or AlloDerm wound infection.  While some doctors may do both simultaneously, your incision and dermal-matrix  placement will heal better if incisions are kept to a minimum.  Following circumcision please allow a healing period of 3 months before scheduling AlloDerm surgery.    If you desire a cosmetic circumcision, ideally you should allow us to do this for you.  If we are asked to do an extensive revision of a circumcision done elsewhere and insert AlloDerm we may be back to square one.

Any patients considering AlloDerm/BellaDerm must be prepared to stay for 4 additional days (surgery is the zero day) at a nearby motel, either Daddy O’s or White House Inn so I can see you daily as necessary.

You will be requested to be on bed rest (flat or on your side) except for using the rest room and sitting up to eat.  Early mobility is the great enemy of graft survival.

Having done all these techniques, I have drawn certain conclusions. When length and girth enhancement are requested, these procedures should be staged to get the best results from both. The use of penile traction postoperatively makes for appreciable length gains beyond what surgery alone can produce. A longer penis deserves a longer graft or AlloDerm® product. To stretch these products from the “git-go” of lengthening is to give the penis and you an unnecessary work assignment. The simultaneous transfer of fat with lengthening will cause “thumbprints” or impressions in the newly injected fat when traction is applied. Again, these procedures must be staged.

Patients who are thin, or who undergo austere dieting programs do not hold on to fat well, and for this reason fat grafts may not be appropriate.  If you are at least of normal weight, anticipate a gain of about 3/4 to 1 inch increase in circumference with dermal fat grafts and about 3/4 inch increase with AlloDerm®.

I hope I have provided you with enough information.  Please do not hesitate to contact our office for more information or to set up a consultation visit.

Best regards,

Harold Reed, M.D.

305-865-2000

Please review advantages, disadvantages of a low cut

August 10, 2014

Dear Dr. Reed,

Plan to be with you this September.

Advantages and disadvantages of a low circ?  Don’t like to make last minute decisions.

Ken from Kennebunkport, Me

August 10, 2014

Good morning Ken (how can I forget),

Inner skin is the portal through which HIV virus gets into the penis.  So the less of that left behind the better.  However, the circumference of the shaft just in back of the head is quite a bit smaller than mid-shaft.

The problem we face is trying to”marry” 2 circles one larger into one smaller.  There is a tendency to leave some puckers in the upper larger circle, which could be reduced with another incision.  My bias is to stay away from extremely low circ.  True for more pigmented men there will be a two-tone appearance to the shaft but hey, this is normal as a women’s areola having darker pigment than the rest of the breast.

Go have fun, see if I care.  Safe sex of course.

Sincerely,

Harold M. Reed, M.D. FICS
Senior Member of the American Urological Association
Member Society of Genito-Urinary Reconstructive Surgeons
Founding Member and Treasurer of American Academy of Phalloplasty Surgeons
Founding Member Sexual Society of North America

305-865-2000