penisdoctor.com

Dear Dr Reed,

First, thank you for getting back to me.  I was circumcised at birth. I have developed some scars underneath my corona that I would like to have removed. Additionally, I would like a tighter cut, maybe with my frenulum removed. Second, I don’t have any real problems with my penis or circumcision. I just want some cosmetic changes. Third, I have a few questions, if you don’t mind and have the time.

1. What are the “four parameters” you respect?
2. “Photos sent and received (unspoken comment ‘disaster zone’)” You mean, the pictures of the penises that you circumcised were ‘disaster zones’ before you circumcised them?
3. I’d never heard of a Japanese circumcision until I opened that document. What is it? What are the benefits?

Thank you,
Steve

November 21, 2010

Good morning Steve,

Thank you for your thoughtful questions which are answered in the order
posed…

1. What are the “four parameters” you respect? 

Firstly, I confer with the patient to find out exactly what type of result he is looking for: tight or loose, high or low, removal of the frenulum or preservation of the frenulum, and whether the cut be parallel to the corona (oblique) or perpendicular the shaft.  Secondly, only fine plastic surgery suture is used to create perfect alignment.  The patient has access to a hand held mirror in the operating room  to be sure the circumcision is being done according to his specifications.

2. “Photos sent and received (unspoken comment ‘disaster zone’)” You mean, the pictures of the penises that you circumcised were ‘disaster zones’ before you circumcised them?  

Thank you, as this is a little unclear and could even be construed that I was initially the operating surgeon.   This a letter from a patient who had been circumcised elsewhere and wasn’t happy with the result.  He sent me photos and later had a revision with me.

3. I’d never heard of a Japanese circumcision until I opened that document.  What is it? What are the benefits?

Please avoid this as the cut is made towards the base of the pubis and all of the foreskin is saved.  Problem is this results in a lot of swelling of the shaft which may take months to resolve.    I am not saying that this is the way all circumcisions are performed in Japan, but this is the appelation was given to me by the patient which is also described on the web.

Have a restful Sunday,

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

I apologize for my bad English. I want to if anyone has experience with circumcision, which is wound up at the base of the penis? Or with very high and tight circumcision. Is it possible to do these types of circumcision, or even in childhood and in adulthood? Please mail the information to barca.mala@…

Hello Barca,

The Japanese circumcision looks good on paper but if you have any significant tightening of the distal foreskin (phimotic ring), dragging that up as high as possible will constrict the base of the shaft and cause lots of distal edema which may only go away with revision surgery. If this is what you want, best to have the front side and back side done at 2 different times, or something still high, but less extreme. Also remember a dragged inner skin is a distal based flap, in other words getting its blood supply from the end of the penis, then taking a U-turn to go back to the pubis. The blood supply is therefore attenuated. This can result in unsightly scarring.

Another suggestion, and I am not trying to be cute, is to go to Japan to be under the care of a doctor who does this frequently with minimal complications.

Also please keep in mind the inner skin which you wish to preserve is the portal for many sexually transmitted diseases, even HIV.

Why leave the door open? Take good care of little and big Barca.

Harold M. Reed, M.D.

— In PROCIRCORG@yahoogroups.com, “barca.mala” <barca.mala@…> wrote:
>
>                                                                         Hi,
>

Potential problems that could develop are: A. Skin septa (connective tissue strands) even if released may still may cause the inner skin to wrinkle slightly as the tension applied that seems to completely stretch the foreskin is often applied at the mid shaft by the patient to get some idea of what to expect. Applying the traction further away at the base requires more force and if so greater potential for incisional breakdown.
B. Lymphedema or persistent swelling of the entire penile skin.

For illustrations see
http://www.penisdoctor.com/photo-circumcision.htm
 
Harold M. Reed, M.D.

Re: Very High/Very Tight–what are the practical limits?

Hi Dr. Reed…

I recognize that everyone’s penis is different and the same thing can’t be
done for everyone, so my questions may be unduly vague… But I was wondering,
given your “average” customer asking for a very high/very tight circ, where does
the inner/outer scar line tend to be on the shaft when erect? 1/8 of the way
down, 1/4, 3/8, 1/2, etc.? Does the removal of the frenulum allow for a lower
scar line? Does a revision (on an infant circ) offer a lower line than one
being done for the first time on an un-circ’d male?

Obviously, you know what’s best in not making it too tight. The general
consensus is that it shouldn’t be too tight (which makes sense) but someone else
mentioned (in message 2769) that a slight pull on the abdomen skin can be a good
thing as it helped pull the sulcus. Do you agree? Also, what defines an
“extreme” high/tight circ (that you wouldn’t do)–one that is more likely to
cause an undesirable outcome–and an unhappy patient?

Thanks!

Good afternoon Will,

Taking your thoughtful questions in the order posed…

1. Some foreskins are longer than others, and some have a tight preputial ring which has to be discarded, lest a waist banding occurs. Assuming the skin is typical, high could be close to half way up. Of course, this will give you more post operative swelling which could take a few months to resolve and less protection against communicable disease including penile warts, papilloma virus, HIV, etc.

My bias is that if on erection the penile pubic junction is triangulated or lifted, the circumcision is overly tight, and this is difficult to correct. There is nothing magical about high and tight, nor has any study ever shown such patients enjoy sex more than those with a normal circumcision.

Lastly, some patients who request adult circumcision have had years of chronic sin inflammation and the typical loose septa which relate to skin mobility are overly tight, so even if the foreskin is pulled up by its bootstraps so to speak, this will not translate into a pleasing result unless the doctor actually undermines the skin and “resets” it like a skin graft.

Lots of things to consider.

2. The removal of the frenulum usually allows for the skin on the underside to be pulled with the same tension as that on top, but does not especially relate to being able to do low or high better.

3. Lastly I was involved as an expert witness for a patient who almost had a buried penis from an overzealous circumcision, and he was not at all happy.

For me, moderation always makes the most sense.

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

— In PROCIRCORG@yahoogroups.com, “Will Smith” wrote:

Please see

http://penisdoctor.com/photo-circumcision.htm

for Japanese styled very high cut adult circumcision

A NEW METHOD FOR THE RELIEF OF ADULT PHIMOSIS

HIROYUKI OHJIMI, KOSUKE OGATA AND TOSHIHIDE OHJIMI

From the Division of Plastic and Reconstructive Surgery, Department