penisdoctor.com

I am Randall from Australia and have monitored yahoo groups for some time now. I am interested in coming over for circumcision. I also have a second little one on the way thus am also interested in a future reversable vasectomey however only 26 years old. Can these two procedures both be combined into a days surgery keeping in mind I have to travel the globe. Can I simply refer yself to you for this surgery or do I need to see a doctor and if so do I need referals for both ocedures or just one. I am very interested in seeing if having both these in a day is possible and wouldn’t be too much trauma for the area. I am also interested in having the frenulum completely carved out for smooth underside and excessive scrotum webbing removed and tidied up also. I am after a tight circumcision that leaves about 1.5cm of inner skin.
 
What sort of prices would I be looking at and how far ahead do I need to book?
 
Many thanks,
Randall

 

Hi Randall,

We would be delighted to do simultaneous cosmetic circumcision and bilateral vasectomy.  If you are married we would  appreciate a note from your wife saying she agrees.

Given that you are 26 years old, with good height weight conformation, and in good health (not on any medications), you do not need a referral.We would be glad to evaluate you for penile scrotal web, a phenomenon which is seen more frequently on circumcised men owing to excessive pulling or removal of tissue on the under side of the penis.

A tight circumcision is no problem and you will be given a hand held mirror to evaluate work in progress.

You may exercise some caution regarding the remnant of only 1.5 cm of inner skin in that when a small circle has to be worked into a larger circle them may be a tendency for puckers, but there are techniques to avoid this such as taking out a V-dart on the underside of your pigmented (outer) skin.

We are seeing quite a few Australians here every year. Anticipate that we will show you every courtesy.

All the best ,

Harold M. Reed, M.D.
305-865-2000

 

 

 

The reason being usually a loose circumcision.  The doctor cannot see what is going on underneath the clamp.  Following surgery, if no attempt is made to separate the overlying skin, adhesions or synechia will develop and this ultimately leads to a skin bridge.   Most skin bridges will not bleed but underneath there is often accumulation of smegma which is not healthy.   Here is a typical letter from a patient with skin bridges.

I am an 18 year old with two thin skin bridges– well, I used to have two! My girlfriend and I are both very prude as we are committed to being abstinent until marriage, but it proved to be a bad thing in this case. We were kissing and grinding last night, clothes on, when I suddenly felt a sharp pain “down there.” Not wanting to ruin the moment, I dismissed it and went on my merry way. It didn’t occur to me to check it out until things had calmed down and I noticed some discomfort.

If you have any more information that you think would be beneficial to me, I would be very appreciative for it.

Thank you for your help!

“mypantsaresofancy”

Hi Fancy Pants,

Fortunately the bleeding was episodic and now you have an area of opened skin which like any superficial cut, should heal fine, as long as you keep it clean.  you may wish to apply an antibacterial ointment.

Yes, removal of skin bridges should be covered by insurance especially given your recent history.  Not to worry.

Harold M. Reed, M.D.

Question for Dr. Reed:

I have lost 42Lbs., from 260 down to 218, on the way to 175. There is absolutely no increase in apparent length. The glans was the only part visible, and it still is. It appears that the fat pad has just sagged and replaced some of the original blubber with sagging skin and flabbier blubber. I presume this will not improve as the rest of the weight comes off, because it appears to actually be just a little worse now than when I started.

 I suppose plastic surgery could correct this. Do you do this in your office, what does it cost, and would Medicare cover it?

Hi “Headout”

Congratulations on your weight loss. As we age we lose lower abdominal and pubic skin elasticity. So there is often a blousing effect of the skin which doesn’t help your perceived outward length. The sheer weight of the fat that had existed also drags skin downwards. Providing more skin at the base of the penis tends to translate into at times an uncircumcised state.   This is best seen when we are standing in front of a full length mirror. Also remember, pubic fat is called “privileged fat” and is often the last to “melt” when you diet.

To check on the benefit that dermatolipectomy might offer, take both hands and lift your lower abdominal and pubic skin with any contiguous fat mass. See if you like that look.  The other alternative to regain a circumcised look is simply to redo your circumcision but the dermatolipectopmy is certainly cosmetically more appropriate in my opinion.

If you do the lift, this would give you some idea of how you may fare with a dermatolipectomy (removal of skin and underlying fat).

Headout, your many contributions to our message board are fully appreciated.

Harold M. Reed, M.D.

I’m curious if you use only one “sheet” of alloderm per procedure, or if they can be doubled up?…if so, how does that effect pricing? I am hoping to gain at least an inch in girth, if possible. Thanks..  Steven

Hi Steven,

May 26, 2009

Good morning Steven,

Thank you for your interest in what we do and visiting our web-site penisdoctor.com  Hope you can relate to some of the photos.

Having done AlloDerm for about 12 years, we have learned not only from our experience, but also attending the complications of others, that multiple layers is a blueprint for disaster.

AlloDerm works best when a capillary bed grows into the graft and this in turn is followed with an ingrowth of cells of your own making.  Afterall, AlloDerm is a dermal matrix.   In other words a scaffold designed to receive in growth of tissues.  When the strips are multiple, this never occurs on the inside.  This often a good hiding place for bacteria which may ultimately make their presence known clinically.

We are using “extra thick implantable” and beyond that requesting the largest in their inventory.  Just like every egg in an extra large box may not be precisely equal, one could be larger than others.

We can also extend the strip laterally to provide more girth if that is what you desire.  But you must have a larger than average penis.

We have learned the primrose lane to complications starts out when a patient says “money is no object, put as much AlloDerm in as possible.”  This also causes compression of  your blood supply and in turn results in many wound healing problems.

There is some much more information we would be delighted to put out to you after you initiate a consultation with our office.

Hope you had a restful weekend,

Harold M. Reed, M.D.

Phalloplasty Surgeon
305-865-2000

 

 

The penis is innervated (supplied by nerves) which enter both from the top and underside. A ring of anesthesia could be placed around the base of the penis and ultimately the penis would become anesthetized for 3 to 4 hours if long acting agents are used (which is what we do). Please understand distal nerves are always in the center of the nerve bundle, so when injecting they are the last to become anesthetized. This could take up to 20 minutes as patients don’t want to feel anything.

Our injection technique uses the “advancing wheal” principle. A wheal is a swelling like you could get from an insect bite.

In that we are always pushing anesthetic in with our syringe in advance of the needle, ideally you should only feel one needle stick.

However, waiting for a ring of anesthesia at the base to take effect distally could take 20 minutes, if we inject anesthesia both at the base and more distally in the circumcision area, we achieve total anesthesia in about 10 minutes. Anesthesia costs virtually nothing, so this is what we do staying within the limits of safety.

For those who do not wish to feel even a needle stick, EMLA or Betacaine cream can be applied to the skin and after 20 minutes, the skin is numb.

Most of our patients are quite manly and tolerate a little needle stick or pinch without making a big to do over this.

When I see the dentist I say “no anesthesia” whatsoever unless he really insists.

I only wish you could talk to over 5000 patients we have done here and you would hear a resounding reassurance, “this is not at all painful.”

My assistant Anne and I once traveled 2500 miles to Nevada to hear a doctor lecture on ambulatory surgery and he said rule number one is never to hurt your patients. And we looked at each other and said, “do you mean we came 2500 miles to hear someone tell us this no brainer.” But you know, this was the best advice we could have ever received.

Harold M. Reed, M.D.

— In PROCIRCORG@yahoogroups.com, “Ms. VG”  wrote:
I’m curious to know with local injections, to which part of the penis or pubic area is injected? Also how many injections are there?

 if there is more than one, does the doctor wait at least until the first injection takes effect? How many injections total?

Thanks.

 VJ

May 22, 2009

Good afternoon Ron,

How timely you should write.  A paper was presented
in April saying that circumcision is not necessary with
Peyronie’s surgery.

There is probably more to it beside that and certainly we
can review your records and offer some suggestions.

Our consultation fee is 250.

This could be initiated over the phone.

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

At 03:05 PM 5/21/2009, you wrote:

quests: I had a circumcision done and at the same time my doctor recomended that I have a curve fixed at the same time. (Peyronies). I consented but am now very unhappy, I have lost half ot the length I had when fully erect. Can anything be done to give me bay some of the length. I now have a hard time getting and keeping pentrated while making love with my wife? The circumcision is not pleasant to look at either.
contact:

May 23, 2009

Good afternoon Miguel,

Thank you for your interest in what we do.

Yes, of course ideally the original incision line should
be re-opened.  We recommend you consider Baltic Hotel
where we typically have many patients staying there
at any one time. 

Your courtesy and respect of hotel linen is appreciated. 
If you wish, at a local pharmacy (CVS, 3 blocks away)
you could purchase a wrap of underpads.

With kindest regards,

Harold M. Reed, M.D.
305-865-2000

At 01:25 PM 5/22/2009, you wrote:

 
Questions:  I had cut as an adult, with a very low cut style. I would like to get it tighter (as tight as possible), and the cut as lowest as possible, it could be done (currently my scar line is almost at the sulcus). As I am living in Dominican Republic, how long I will need to stay for the procedure? any concern about blood spot on bed’s linen at the hotel? Thanks Miguel
contact:

May 24, 2009

Good afternoon Will,

Yes, sutures need to be removed by a person with some skills and training.

Three ingredients are needed: a bright overhead light, delicate plastic surgery instruments such as would be used for removing eyelid sutures, and, loupes (eye glasses that magnify like jewelers use).

It is entirely improper to dig down under the skin to left up the suture, rather the tail should be lifted and the stitch cut underneath.

One of many technical things that a cosmetically oriented urologist could tell you.  It takes about 2 to 3 weeks to train a nurse who has not done this before to fully understand all aspects based upon post op patients coming back to our office and we see usually a few a day.

Any urgent care center or “quiet” ER could do this, or at any plastic surgeon’s office perhaps one of his nurses could do this.  Most importantly is not to let anyone talk you out removing them, saying “they will dissolve.”

Sincerely,

Harold M. Reed, M.D.
305-865-2000

At 05:16 PM 5/24/2009, you wrote:

Thanks for your quick reply!

I’m a bit confused… When you say “the sutures should be removed on the 12th post-operative day”, do you mean that they need to be removed PROFESSIONALLY (i.e.. by a doctor/nurse) or is it something that I would have to do personally (to which I have no objections…)?  I get the impression that it’s the latter but I just wanted to be sure…

Thanks for a very informative site and hope you have a great Memorial Day as well!

— On Sat, 5/23/09, Harold M. Reed, M.D. <admin@srsMiami.com> wrote:

From: Harold M. Reed, M.D. <admin@srsMiami.com>

Subject: Hi Will from Dr. Reed!!! Re: Cosmetically Performed Adult Cir

To: myxtrash1@yahoo.com

Date: Saturday, May 23, 2009, 4:26 PM

May 23, 2009

Good afternoon Will,

Thank you for your interest in what we do.

Yes, you could have an elective meatotomy

at the time of your circumcision revision..

Allow an additional 250.

Please present a detailed work list of what you

would like done.  Our policy is to offer our patients

a hand held mirror so you can approve of work

in progress.

We use an expensive suture called Vicryl Rapide

which does dissolve faster than most, but even so,

if you wish to avoid ghost lines and pin holes, the sutures

should be removed on the 12th post-operative day.

Have a restful and safe Memorial Day weekend,

Harold M. Reed, M.D…

305-865-2000

At 02:47 PM 5/22/2009, you wrote:

> Hi Dr. Reed…

>

> I was circumcised when I was a baby.  The circumcision is somewhat tight on top and VERY loose on the underside with a LOT of skin.  This skin sometimes covers the underside of the glans when not erect.  This skin just “gets in the way” sexually, is a magnet for fuzzies, was commented on by others, etc. I was looking at getting a very high & tight circ (within reason) and have the frenulum removed.  On the top-side of my penis, the scar line is just over 1cm from the head when flaccid.  Obviously, this would be elective…

>

> But I was also wondering, since we’d be doing a bunch of “gardening” in the neighborhood, if it’s also possible to get an (elective) meatotomy?  If so, I’d like to know what my options are in what the final result looks like–i.e. I’d want one that looks “open”…  (I found a picture online of what my “perfect” meatotomy would look like).  I recognize & accept the “side-effects”–i.e. difficulty urinating.  Let me know if you’d do this and whether it can be done at the same time as a circ…

>

> Finally, do you use self-dissolving sutures?  Can’t really tell from your pictures.  I’m not from the Miami area and I’m not looking to go to a doctor 2x (or worse, 2 different doctors)… Thanks.

>

> –”Will Smith”

> (sorry for the fake name but I haven’t made a decision yet…)

My circumcison needs to be re-done due to scarring and lop-sidedness done by the previous urologist 1 yr ago. However that operation has produced lichen sclerosis of the glans which still exists today and has closed my urethra by 50%. Which of these issues can you help with? and do you know of someone who uses laser to treat/cure LS? thanks.  Geoffrey

 

Good afternoon Geoffrey,

Invasive lichen sclerosis is known but rare.   I doubt if it is deep inside the urethra, laser will cure it,       as only more scar may be laid down. Please review  this reference http://emedicine.medscape.com/article/1074054-overview   If your urethra is involved, you may need a buccal graft to replace  the involved urethra. That we can do and may require 2 stages.

This entity is often referred to as balanitis xerotica obliterans.  

With every best wish for a restful weekend,
 
Harold M. Reed, M.D.
305-865-2000

Thank you for your quick reply Dr. Reed,

I appreciate it. I should have been more clear and said that my BXO has caused meatal stenosis and it’s my urethral opening that has closed by 50% not the urethra itself. I don’t know if you can reverse the stenosis at the same time you perform the reconstuctive circumcision, and at what additional cost? And would you prefer for me to get the BXO lasered off before I see you or after?

Many thanks for your time.

Geoffrey from Ontario Canada

May 26, 2009

Hi George,

Ideally if you know of a physician who reports very successful treatment of meatal stenosis with laser, than have that done first and be sure a suitable period of time has passed without recurrence.

Otherwise we would be delighted to perform a conventional meatotomy with of course removal of any scarified tissue.  If you have a process in evolution, there is no guarantee that it will be reform. Otherwise plan on your being left after surgery with a sufficient aperture.

All the best,

Harold M. Reed, M.D.
305-865-2000

Hi Dr. Reed,

 I got circumsized at age 30 and i still feel whether i did right thing or not.  Recently i heard of Preputioplasty.  Is this a safer bet for people suffering  with phimosis?

 I cannot do much now but just want to suggest anyone of this in case if  they have problems.

Thanks,

Ramon

Conservative Surgical Alternatives:

Preputioplasty is the medical term for plastic surgery of the prepuce or foreskin. It is a more conservative alternative to the traditional circumcision or dorsal slit for the treatment of preputial stenosis or phimosis. Many doctors have proposed surgical alternatives to circumcision because of the many problems, risk, complications, and disadvantages inherent in circumcision.

Advantages claimed for preputioplasty are more rapid, less painful recovery, significantly less morbidity, and preservation of the foreskin and its various protective, erogenous, and sexual physiologic functions.

There are a number of articles is the medical literature describing various preputioplasty techniques. CIRP presents below a bibliography of articles known to us (there may be others.) The articles are listed in the approximate order of their appearance.

Some of the procedures such as Y- and V- plasties are complex and require a skilled surgeon to perform properly. Consequently, they have not won favor.

Many doctors recommend the “dorsal slit with transverse closure” procedure described by Cuckow, Rix, and Mouriquand. The American Academy of Pediatrics now recommends the Cuckow procedure in its 1999 Circumcision Policy Statement. The procedure is relatively simple to perform and gives good results. The newer lateral procedure described by Lane et al., however, may offer a cosmetic improvement over the Cuckow procedure. It moves the “slit with tranverse closure” from the top to the sides.

May 26,  2009

Good afternoon  Ramon,

I still tell my patients in most instances a full circumcision is not medically necessary, but confers several advantages relating to maintenance of hygiene, reducing acquisition of sexually transmitted disease and reducing the incidence of your giving your lady friend cervical cancer.

Preputioplasty would not really confer these benefits, and while perhaps safer for a neonate has the potential for many problems in an adult male.

Sincerely,

Harold M. Reed, M.D.
305-865-2000

At 01:36 PM 5/26/2009, you wrote:

Hi Dr. Reed,

 I got circumsized at age 30 and i still feel whether i did right thing or not.
 Recently i heard of Preputioplasty. Is this a safer bet for people suffering
 with phimosis?

 I cannot do much now but just want to suggest anyone of this in case if
 they have problems.

Thanks,
Rama

Conservative Surgical Alternatives:

Preputioplasty is the medical term for plastic surgery of the prepuce or foreskin. It is a more conservative alternative to the traditional circumcision or dorsal slit for the treatment of preputial stenosis or phimosis. Many doctors have proposed surgical alternatives to circumcision because of the many problems, risk, complications, and disadvantages inherent in circumcision.

Advantages claimed for preputioplasty are more rapid, less painful recovery, significantly less morbidity, and preservation of the foreskin and its various protective, erogenous, and sexual physiologic functions.

There are a number of articles is the medical literature describing various preputioplasty techniques. CIRP presents below a bibliography of articles known to us (there may be others.) The articles are listed in the approximate order of their appearance.

Some of the procedures such as Y- and V- plasties are complex and require a skilled surgeon to perform properly. Consequently, they have not won favor.

Many doctors recommend the “dorsal slit with transverse closure” procedure described by Cuckow, Rix, and Mouriquand. The American Academy of Pediatrics now recommends the Cuckow procedure in its 1999 Circumcision Policy Statement. The procedure is relatively simple to perform and gives good results. The newer lateral procedure described by Lane et al., however, may offer a cosmetic improvement over the Cuckow procedure. It moves the “slit with tranverse closure” from the top to the sides.