as im going to be flying in from the UK. im going to be limited on how long i can stay in america for i was just wondering how long do you thing i should wait between having the two stages of surgery ie 4 weeks 6 weeks or longer? im eager to get as much done in one sitting as im going to be traveling a long way to have the procedures im intrested in…. and then  if the wait is only 4 weeks between surgerys…i could stay in the states in stead of flying home and then back???????
 
scrotal altreation (turkey neck pushed back?)
left testical enlargement
head glans enlargement
lengthening
and widening
and may be some pubic fat removal?
 
i know these can not all be perforemed at the one sitting (surgery) so i just wanted to know how much you think we could do at one go  and then how long before i can have the otheres completed??
 
ie stage 1 = glans enlargement,lengthening,widening and scrotol pushing back under the shaft?             then       stage 2 = fat pad lipo,testicular enlargemnt
 
im not looking for monster girth only a very modest increase of say 1″ all over,thanks again good doctor  Brian

Good morning Brian,

Lengthening, insertion of left testicular implant, and perhaps release of penile scrotal web, could be done at the same time.  Girth enhancement and glans enhancement need to be done separately as insertion of AlloDerm  works like a fixative to reduce length gains produced by traction.

Pubic liposuction could be done with either of these procedures, but is not advised as the transient lymphatic injury impacts on wound healing of the penis and scrotum. To do a proper job think of the pubic fat pad as an inverted U which extends down into the scrotum along side the penis.   This needs to go also. Tenderness for a few weeks in  that area, may cause you to procrastinate on use of traction,  which ideally should be done within a few days after surgery to maintain exteriorization of the penis.

Please understand the results in length are 35% me (with surgery) and 65% you (with traction).  To gain  an inch in erect length you would need to apply traction for am minimum of 6 months. 

Don’t rush to have the second stage done as you will obviate the potential gains with length enhancement.

You are spending a lot of hard earned money and we wish to have  as many assurances in place you will have a gratifying result.

Cheers,

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

 

 

About  two (2) years ago I had thickening 8 months after lenghtening. I was at 8 inches length. The thickening cost me -2 to -2 1/2 inches. I want my length back. A simple release of the adhesions would allow the “gtip ” to restore my original length.  This is my second inquiry and the first doctor said it was not a difficult procedure. I am older and in good health. I will diligently use traction once the release is made. Can you use a transcrotal incision?     Jimmy

Hi Jimmy,

Truly sorry for your loss.  There is so much I would like to say, that will be revealed after you become an established patient.   The attached file is enclosed only as it may be of interest. 

A transscrtoal incision is perhaps not the best apporoach as we need to be right over the scar tissue and adhesions when surgery is being done.  May I propose an infrapubic incision which (being on the lower pubis) avoids the shaft of the penis itself.   If the scarring is very involved a supplmental incision along the dorsal coronal sulcus may also be required.

Our office has become a clearing house for correction of these problems.  You are invited to call our amiable office manager Anne, perhaps tomorrow, and set up an appointment for consultation.

With every best wish for a speedy resolution,

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

 

 

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

 

 

QUESTIONS:i have dermal grafts and fat transfer,but the dermal graft is almost gone and the fat transfer is very insignificant, due to very low body fat.i would like to have the fat takin from my buttock area moved to my penise. how much would that be?  thank you…  Benson

Good morning Benson,

Thank you for your interest in what we do.

This is a story we are all to familiar with.  I could talk for almost 30 minutes about liposuctioned fat survival and the need for dermal fat grafts to secure excellent vascularization to survive.  (Been there, done that)  Most likely you not only have atrophy of the graft but perhaps a fibrous tether as well with some loss of penile length.

We are always responsive to patient requests, but we do make recommendations based upon 35 years of medical experience and common sense.

Please consider initiating a consultation with our office, could start out on the phone, as you do not want to continue to revisit your penis with one surgical procedure on top of another.

Our one time charge for consultation fee is 250.  If you do start with a phone consult there is no further consult fee once you come to our office, or any additional charge for followup questions.

Have a restful Sunday,

Harold M. Reed, M.D.

Phalloplasty Surgeon
305-865-2000

At 06:44 PM 2/14/2009, you wrote:

_________________________________________________

SURGERY:Penile Enlargement
OTHER_SURG:

Received a call last week from a patient who was unhappy with the contour of his penis post AlloDerm and also started to noted some hardness and some discomort, and wanted it removed.  Yesterday, call updated, leakage of fluid noted.  Patient will be seen ASAP this Monday and hopefully will have drainage of abscess and possible removal of an infected graft.  Every so often we see the occasional very affluent patient who says, “money is no object, put is as many AlloDerm pieces as you can.”

Please keep in mind overpacking the penis can lead to vascular compression and without blood flow, the patient is more likely to have an infection.   Moderation is always a good idea with elective surgery.

Avoid too much surgery on the penis at one time.  Can interfere with vascularization, so important for wound healing and lymphatic drainage.

Harold Reed, M.D.

Harold M. Reed, M.D.

Peyronies, penile curvature affects 3% of sexually active men, and perhaps more who could care less.

Some are very creative with sexual positioning and can work around some very mind-boggling angulations.  Peyronie’s curvature which is caused by a deposition of scar tissue or plaque is also associated with erectile impairment, but not always.  For most patients there are many ways to approach Peyronie’s including medication, traction, suture plication of the larger curvature side, and insertion of a graft on the lesser involved side.

In severe cases where Peyronie’s results in severe loss of length, then many urologists would certainly consider the option of an inflatable implant, with or without insertion of graft.  As a rule of thumb, if over a 35% lysis in circumference is required to relax the tension and straighten the penis, then a graft such as Tutoplast should be employed.  Otherwise leaving an open defect may not provide enough integrity to the casing or tunica albuginea to provide sufficient axial rigidity.

Releasing plaque of course restores the lesser curvature back to the length of the uninvolved greater curvature.  For men who insist on a closer approximation of their length of yesteryear, the LGX cylinder of AMS (American Medical Systems) may be considered.  The LGX, different from its Ultrex predecessor, expands more uniformly and is not considered as prone to aneurysm formation.  Using a table top model as a demonstrator, easily a 3/8″ increase in length is obtained, but the manufacturer says could be at least twice that in some applications.

Grafting as the sole remedy for Peyronie’s has yielded a disappointing successful length restoration result rate.  Only 30% of patients, despite correction of angulation have some restoration. .  Perhaps for Peyronie’s patients, we should be thinking more of implants.  For a patient to opt for an implant is an important decision, because he will forsake forever being able to have a natural erection.  Although some tumescence does occur with implants, it is never enough should the implant be removed to provide sufficient intromission.  The patient must also accept occasional replacement as part of the deal and the 2 to 8% incidence of infection (all comers having implant surgery).  However, for most with implants, happiness is being able to never have to say “I’m sorry.”

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

AlloDerm has by far and away become the most popular way to enhance penile girth.  Sure we lived through the liposuctioned fat transfer years with the lumps and bumps and reabsorption and inevitable touch ups. and then dermal-fat strips for phalloplasty with the harvesting scars, our were neater than most have seen, especially those 1/2 inch wide violacious bands of Zoro on the lower mid back which fortunately the patient doesn’t have to see everyday.  “Dr. Reed, please mail me a copy of the photo you just took, I want to show it to my doctor.”

With AlloDerm you don’t have to worry about atrophy and fibrosis, as long as you don’t stack it, it’s already dead.  It is a sterile dermal matrix.  Cells of your own making will grow into it.  If a dermal-fat graft doesn’t get an optimal vascular hookup within the first five days, the final result can be anywhere from necrosis in an extreme example to length contracture with palpable tethers (fibrosis)  to fat atrophy.  I started out with a 6 1/2 penis and now have only 5 inches?

Oh, we’ll put some AlloDerm, over that.   Not such a good idea.   If there is a poor blood supply, the AlloDerm will not work.  AlloDerm always works best when it is supported on both sides by a rich vascular bed.

That is the key to tissue ingrowth.   That is the difference between a reach for the moon operation on the penis and phalloplasty performed by a phalloplasty surgeon.  Our phalloplasty pictures are available on our web-site, befores and afters.  Please be sure to click Next Photos (below each photo) for the whole gallery.

Harold M. Reed, M.D. FICS

305-865-2000

Dear Dr. Reed,

Interested in penile lengthening. What are expected erect gains? Can you perform a vasectomy as well?

Mike

Hi Mike,

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 phalloplasty before and after photo gallery. I am a phalloplasty surgeon.

Our phalloplasty cost are posted on our web-site.

Yes, we can perform simultaneous vasectomy at a discount.

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 corresponding longer.

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 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. 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 Baltic Hotel (877 622 5842) 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.

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.

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.

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.

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.

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
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