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Caucasians are known for a wide dynamic range, short flaccidity and long erections.

What this means for some is that their skin post circumcision may appear overly loose but if when erect there is lifting of the skin at the peno-pubic junction or triangulation), then the circumcision may be too tight.

If an older man is not sexualy active, we can cater more to his wish of not having skin drape over the glans.   Such was the case of an older Father who presented yesterday in black suit, and was grateful to be “clean once again.”

Hey, I am 19 and have what I am pretty sure is called a skin bridge.  It goes along the top of my penis.  It stops at the edge of the mushroom part, it doesn’t overlap.  I was just wondering the average cost of removing it, and if there is a lot of scarring.  Please get back to me as soon as possible, and thanks,  Steven

Good morning Steven,

Skin bridges are sometimes seen after bell clamp
circumcisions.  Especially if the glans is not
properly separated from the foreskin as there are typically some
adhesions, which if left unattended can form synnechia
or fusion of epithelial surfaces.  The remedy is simple.
First to undermine the bridge and severe the pedicle
at either end flush with the skin and put in some very
fine, fast absorbing sutures.  There may be the slightest
small pin point scar at either end, but with time,
this usually blends in with a very cosmetically acceptable result.

Broad bridges are a great nidus for collection of skin debris,
and of course fly contrary to good hygienic practices.

Our fees are $250 for consultation, and $250 for use of the
operating room, and $250 for minor surgery.

Trusting all this meets with your approval,

Harold M. Reed, M.D.
305-865-2000
Senior Member of the AUA

 

Hi Rolan,

The first 2 weeks after circumcision is not the best time to judge
precisely the outcome of a circumcision. The best time closest to
having a circumcision is when the doctor is near finished and asks
you to look. That’s the way we do 99% of our circumcisions. The
remaining 1% is for patients who insist on general anesthesia,
totally unnecessary. Sure large sutures like hawser (used to moor
ships) and deep tight bites can cause puckering.

There may be some inflammatory fibrosis that could restrict your
length temporarily but this should go away with time. If not you’ve
been overcut and that’s sad.

If you are young possibly with lots of erectile activity some of the
skin will stretch out. Use of Viagra nocturnally (before bed time)
may help.

Once there is no evidence of any bleeding (usually after 2 to 3
weeks), this is no longer a time to suppress erections but to
encourage erections.

Hoping this is of help. Sure wish your condition is just temporary,

Harold M. Reed, M.D.

 Dr. Reed I’m 33yrs old I just had an adult Circumcision on 7/30/08.
The  foreskin kept stretching and tearing during intercourse on several
occasions so I got circumcised. My testes originally swole to about
3  times their normal size, and my penis appears alot smaller, without
the  extra foreskin. The stitches seem to be very ruff looking, and it
started to bleed for about an hour today 08/6/08 while at work
around  the stitches. At night I do seem to get erections frequently which
causes excrutiating pain my Dr. Prescribe valem to help control
them  and relax me . My concern is my Penis Size when I get erections at
night it seems like it does not grow much in size . normally I’m
about  2 inches in lenght when limp, but grow to about 6-7inches while
erect. 

Why does it seem like my penis only grows to about 2 inches in
lenght,  when I’m erect is it because the stitches, or does the extreme
swelling  of my testes affect it. I only see the Corona sitting on the top of
my testes. I don’t even see the shaft whe 
 Rolan

Both were accompanied by their Moms, in each instance 2 classy ladies who were well dressed and very articulate, and one reserved Dad for good measure.  You can believe the best part about doing the circ is walking out to the waiting room and calling Mom and Dad back to join their son in the recovery room.  Smiles and a look of contentment from the patient (”no big thing”) can instantly provide more assurance than ever I could.

Yes, it is a big thing, because each step of the way, we are providing every quality control measure that this operation will go exactly as anticipated with zero pain, and that the patient will have the opportunity to watch work in progress and approve of the final result before the dressing goes on.

Is it time for breakfast or lunch?  Claire, ask the patient what he has a yen for..  We have fresh French bread and roast beef in the refrigerator, or hot sausages and eggs with coffee to wash it down.  Don’t forget the OJ and our fancy napkins.

Both patients were seen on Saturday and looked great.

Harold M. Reed, M.D.

I am dissatisfied with the results of the circumcision, in particular the following:
1) I have several stick tunnels, two of which have already become sore and red and excreted discharge in the past months.
2) The circumcision is fairly tight underneath, however there is excess skin on top that I would like removed.
3) There are still remnants of the fraenulum which I would like to have removed or tidied up.
4) Generally the circumcision site is uneven and unsightly.

I am looking for a doctor to perform a re-circumcision and after much research on the Internet, Dr Reed has been highly recommended.  I would like to have the above problems resolved and a tidier and tighter circumcision as a result.

Richard

 

Dear Richard,

We work almost around the clock to put smiling faces back
on “journeyman” circumcisions.  What’s more, we
love work lists, and these are always posted on the
wall in the operating room.  You also find a hand held
mirror nearby because we want you to watch work
in progress to be sure, every detail is corrected to
your satisfaction.

Routinely, we see patients in the morning and you’ll be
gowning up shortly afterwards for revision.   So please
review the informed consent which is posted on our web-site.

We do ask that you stay overnight and be seen the next day
for a dressing check.  Two days of bed rest is better
than one, especially given the nature of what needs
to be done. Unnecessary swelling and bruising is the
great enemy of a good cosmetic result.

A circumcision is perhaps the highest cosmetic
calling given to a urologist. 

 

Harold M. Reed, M.D.

 

 In PROCIRCORG@yahoogroups.com, “steven.t” <steven.t@…> wrote:
>
> Hello Dr. Reed & Everyone,
>
> A while ago I posted my experience with an amateur, clumsily performed
> circ which left me with very little skin (too tight for a full
> erection) and a painful scar.
>
> After the surgery there was very little dark skin left and the pink
> skin stretched to make up the difference. My penis is usually about 2″
>  or less when flaccid and about 6″ when erect. On the underside there
> is about 3/4″ left of dark skin before the scrotum.
>
> Ideally, what I would like would be to restore as much as possible of
> the dark skin perhaps using a stretching method that the restoration
> sites advocate, but I’m worried about scrotal skin being pulled
> forward and ending up with hairy skin on the shaft at the base.
>
> After the restoration, I’d like to be re-cut so that I no longer have
> the ugly scar, much less pink skin and the glans is covered when
> flaccid, but exposed when erect.
>
> My questions are these: are there methods of stretching which won’t
> cause the scrotal skin to be pulled forward? Also, can the tiny amount
> of skin I have left be stretched out enough to work with (I understand
> it can take years)? Are there other options to achieve the same effect?
>
> I understand if a consult is necessary to answer these questions, and
> if so I will make arrangements to come down to see you when I can.
>
> Thanks very much for your kind attention.

Good morning Steven,

Scrotal skin often is seen on the underside of the penis,
in uncircumcised and certainly in many circumcised men.

Scrotal skin varies in thickness, and surprisingly at times,
except for color and some follicular (goose flesh) type of appearance it is quite and acceptably similar.

If you are stretching, then be grateful for whatever skin is
generated.

If you incur some peno-scrotal web-formation, this can be dealt with later on still leaving a fair amount of scrotal skin on the underside. 

Light skin can be medically tattooed.  132 different skin colors
are available.  So really just concentrate on making more skin, and ultimately cleaning up the scar line with a cosmetic adult circumcision revision.
Best wishes,

Harold Reed, M.D.

The fallout seems that 50% of my work is revising the work of other doctors and that is all well and good.

Have to be careful not to cast aspersions, afterall most of what that other urologist does may be excellent.

Two days ago, received a patient from Canada, a college graduate in the science of physical wellness, who
had a circumcision about 6 months ago.  Heavy dense thick scars like pebbles and an irregular suture line, large suture tracts spaced somewhat widely apart, a tough thick frenulum, mis-match of the frenulum and raphe.  But fairly tight circumcision and also low.

My mission was to remove as much underlying scar, (all of it hopefully) freshen up the incision line, remove the frenulum and realign the raphe.  The case took longer than 2 “virginal” circumcisions back to back.   Had to use loupes.

Ultimately the patient had a very acceptable result.  Hand held mirror nearby throughout the case for his review and comment.

Seen at the Whitehouse Inn yesterday and looks great.  Bed rest for 2 more days.  A hematoma or collection of  blood under the skin is a set-up for inflammatory fibrosis which is a great enemy of good cosmetic (soft natural) wound healing.  Even if a patient looks dry on the operating table, simple hydraulics tell us

If a patient is upright, even sitting up, there is a venous column of blood potentially pushing trace oozing out of every ruptured capillary that has yet to seal off.  Simply raise your hand above your heart and the veins on the back collapse.  Less blood, less oozing.

We are careful never to promise perfection, but usually we can greatly improve appearance.

Harold M. Reed, M.D.

Also, I have never found two souses that give up to date rates of
adult or  neonatal circumcision. Any clues?

In general, circumcision in the United States is alive and well.
Hispanics are less inclined but offset by other ethnic and socio-
economic groups who are more inclined. Infant circumcision rates may
be less, but perhaps offset by higher adult circumcision rates which
are less monitored.

There is only so much insurance money available, especially during these
recession times. When adult men (for example) with erectile impairment are
screaming for a penile implant which in itself costs $7,500 to $8,000 (does not
include hospital, anesthetic or surgical fee) where is all this circ money
coming from?)

In my practice, each year our number of adult circumcisions is clearly
increasing, but that certainly could be a “selection” factor.

Anti-circers are perhaps justifiably upset in that with infants and
children, circumcision is performed without the permission of the
patient and is not in most instances immediately medically necessary
and of course, may not be medically necessary at all. Their web-
sites tend to slant and emotionalize the “horrors” of circumcision,
the crying baby. They are very proactive and will not go away, and are
continuously replaced with new legions of anti-circers, who will be here 1
thousand years from now.

Adult circumcision is usually an elective, patient gives consent,
situation. Circumcision is not as we used to say at Bellevue Hospital a “see
one, do one, teach one” type of operation. In fact no operation really is.

The are skills that set apart one doctor from another and, cosmetic
goals, that if never learned are never striven for.

The following information is taken from sites that are either at best
neutral or anti-circ and sustain my belief that circumcision in not
going away anytime soon.

Cordially,

Harold M. Reed, M.D.

Infant (neonatal) circumcision is more common in the United States,
Canada, and the Middle East. It is much less common in Asia, South
America, Central America, and Europe.

According to the 2003 National Hospital Discharge Survey, 55.9% of
all newborn males in the United States were circumcised. This is down
from 64.7% in 1980. However, circumcision rates vary by race and
geographic distribution.

Caucasians have the highest circumcision rate, followed by African
Americans and Hispanics. Geographically, the highest rates are found
in the Midwest, followed by the Northeast, the South, and the West.

Healthcare coverage also has an effect on circumcision rates. Most
insurance plans continue to pay for infant circumcision. However, as
of 2005, 16 states no longer fund routine neonatal circumcisions
through Medicaid, causing a decrease in the number of procedures
performed.

taken from http://www.boystoo.com/history/statistics.htm
(obviously an anticirc site, first words in first paragraph: “Male
Genital Mutilation”)

Table 1: Intact and Circumcised Male Populations
of the USA by Year, 1900 to 2000

Male population (millions)

For 5 year period Commencing with Year

Year
Intact
Circumcised
Total
Circumcised
(%)
Male
Births
(millions)
Newborn
Circumcision
Rate (%)
Newborn
Circumcisions
(millions)
Non-newborn
Circumcision
(millions)

1900
30
7
37
18
5.1
30
1.5
0.3

1905
33
8
41
20
5.6
35
2.0
0.3

1910
35
10
45
22
6.6
42
2.8
0.4

1915
37
12
49
25
7.0
50
3.5
0.4

1920
37
15
52
29
8.0
52
4.2
0.4

1925
38
19
56
33
6.2
55
3.4
0.5

1930
38
21
60
36
6.3
58
3.7
0.5

1935
38
24
62
39
6.5
60
3.9
0.5

1940
37
27
64
42
7.5
65
4.9
0.5

1945
37
31
68
46
8.7
70
6.1
0.5

1950
37
37
74
50
9.9
72
7.1
0.6

1955
38
43
81
53
11.1
75
8.3
0.6

1960
38
50
88
57
10.7
78
8.4
0.6

1965
38
57
95
60
9.3
80
7.4
0.6

1970
37
63
100
63
8.7
82
7.1
0.6

1975
37
68
105
65
8.5
85
7.2
0.6

1980
36
74
111
67
9.8
80
7.8
0.7

1985
36
80
116
69
9.9
74
7.3
0.8

1990
36
85
122
70
10.4
68
7.1
1.0

1995
38
90
128
70
10.0
63
6.3
1.1

2000
39
94
133
70

Totals
165.8
66
110.0
11.4

Sources:
Population data: U.S. Bureau of the Census
Circumcision data: Wallerstein

1. 70% of the current male population of the US have been
circumcised.

2. 110 of the 166 million males (66%) born during the century
underwent circumcision in the newborn period.

3. The annual number of circumcisions was highest between 1955 and
1965. During that decade, 1.8 million males were circumcised every
year — almost 5,000 every day.

4. Between 1915 and 1995 the intact male population remained in a
very narrow band between 36 and 38 million, while the circumcised
male population soared from 12 million to 90 million.

5. A male born during the century who remained intact in the newborn
period had on average about a one in five chance of being circumcised
after the newborn period, or a four in five probability of dying
intact. That probability fell steadily during the course of the
century so that, if the current post-newborn circumcision rate
remains constant in the future, a male born at the end of the century
who escaped circumcision in the newborn period nevertheless has less
than a two in three chance of dying intact.

6. The model used to produce these figures takes into account non-
newborn circumcision rates, the rate of immigration and the
circumcision status of immigrants, and the circumcision status of
deaths and emigrants, all important factors in arriving at the
percentage of living males who have been circumcised.

Table 2: Number and Percentage of Living Males in USA in 2000
who have been Circumcised, by Age and Place of Birth

Sources:
Population data: U.S. Bureau of the Census
Circumcision data: Wallerstein

NC = Circumcised in the newborn period (neonatal circumcision)
LC = Circumcised after the newborn period (later circumcision)
AC = Circumcised prior to arrival in the USA
PC = Circumcised after arrival in the USA

1. Table 2 also shows that 70% of the current male population of the
US have been circumcised.

2. The figure for every age group below the age of 90 is over 50%.
Only the (very small and rapidly diminishing number of) males born
before 1910 have a better than even chance of having retained their
foreskins.

3. 87% of all 20-24yo males born in US have been circumcised. From
the differences in circumcision rates by race, one can infer that
over 90% of all 20-24yo white males born in US have been circumcised.

—

When is a circumcision cosmetically performed.  Well for one the detail and match up has to be right on. We don’t want to see puckers when large suture, like howser for mooring a ship, are used every 3rd to 4th space when smaller sutures could have been used.  Surely, we don’t want to see residual pin hopes and ghost lines, which are tell tale signs of an adult circumcision.  The skin should be not so loose it is draping over the rim of the penis or so tight it is tenting the pubic skin during erection or causing a penile scrotal web (turkey neck).

That part’s not supposed to go in the vagina and of course detracts from perceived length.  Is you doctor attentive to you precise requests and giving you good eye contact and pre-marking you with your approval and allowing you to watch work in progress with a hand held mirror to be absolutely sure, it is being done your way.

Harold M. Reed, M.D.