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

 

 

 Hi Dr. Reed,

Almost 3 years ago i lost a part of my penile skin as a result of car accident.The surgeon who took care for me did something terible to me destroying all my life.He circumcised me because he wanted to use the prepucium to cover my penile shaft.This flap necrotized and after it was removed i had to leave the hospital with a big wound on the right side of my penis.

Since then my life is a real hell.Let me start with the pain-almost three yaers now i have a permanent pain at this place and the skin around and very bad pain in the circumcisison line.  Because of this pain i am not able even to dress myself normaly-for example i can not wear any jeans because they make the pain worse.  The only clothes i can wear are my scrubs(i am working in hospital as cardiac tech)and sport clothes.  When i am  at home i am staying only with boxers.   Because of this i do not have any social life- i am not going out except for job or shopping.  After this surgery i had terible edema of my penile skin that last almost 12 months.   Over the time the wound started to cover itself with something that resemble skin at first sight but it isn’t.In addition it is so short and doesn’t allow any normal erection-any erection is so painfull because of the extreme pulling of this short tissue.In addition this tissue is very painfull itself when i try to touch it.

As yuo can understand i don’t have any possibility for sexual life ,  I can not even masturbate.  Don’t ask me for the cosmetic appereance of my penis -first of all after this circumcision it looks much shorter than before.  It is not facing the floor like normaly,but is facing foreward.Sometimes it causes me voiding problems.   As far as i know the circumcision can cause hidden penis and may be something like this but not comletely happen to me.   Second, on my “health” side i have much more skin compare with the affected side.  It makes the skin ofmy left side excessevly wide and loosed,  and in the same time on the other side is short and tight.  The third thing is the line of circumcision the cicatrix i have is very thick and looks like a railroad and is very painfull.   I realy would like to come to your office for consultation , so you will be able to see the problem and i will be very happy if you are able to help me.   May be i need some kind of grafting or scrotal flap to be rotated in order to cover the shaft of my right side but i think is better if  you take a look.  Thanks God i don’t have problems under the skin -all my structures are in a good condition and functioning normally.   Only the skin is the problem.   I belive with all my heart you can help me to restore my health and to rebuild my life.   Thank you in advance,       

                                               Best regards,   

 Stanislav

Good afternoon Stanislav, 


Thank you for your excellent medical presentation.  There are several options 
that could be proposed.

Please call the office and speak with Anne, our amiable office manager and 
schedule in.

If you are anticipating a visit with surgery to follow, plan on staying at a 
nearby hotel (The Baltic Hotel) and being on strict bed rest for 5 days and 
the day of the procedure. The only exceptions are using the commode and sitting 
up to eat.

Early mobilization is the great enemy of graft of flap or graft  survival.

With kindest regards,

Harold M. Reed, M.D.

305-865-2000

 

Developed Peyronie’s Disease after the 3rd of 3 failed Transurethral Resections in 4 months in 2006. Is this common? What help short of surgery? Use a VED device already–thanks GWJ

 

Good morning George,

This is not common, but certainly I have seen this on a few occasions.  With Peyronie’s there may be also associated loss of length, plaque, waist banding of the circumference, erectile dysfunction and pain.   The treatment options are many and with every one there are some responders.

We have also seen erectile dysfunction following TURP, and of course urinary incontinence.

The vacuum erection device (VED) is a 2 edged sword as pooling of blood in the penis without adequate oxygenation may cause atrophy and injury to your delicate spongy erectile tissue.

I would be pleased to discuss in depth the any options available to you after you initiate a consultation with our office.     

                                                                            

With kindest regards,

Harold M. Reed, M.D.

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.

Hardly a week goes by that we do not receive an inquiry from someone with “get-there-itis”.  Wants length and girth simultaneously. Please understand while some doctors do offer this, many of their practices have been bought out by businessmen who dictate their mode of operations.  Of course, this is a popular sell, but does it work as well as staged surgery?  I think not.  Most patients complain of inadequate length gains, and also some wound healing problems.  The penis does not appreciate too much simultaneous surgery.  If you have simultaneous surgery, you will not be able to apply traction for a good 6 weeks, lest you tear your incision line apart. Better to have lengthening done, if that’s what you require, use traction immediately afterwards to maintain what was accomplished in the operating room, and build upon that until you are satisfied.    Then, go on to  widening with appropriately longer strips of AlloDerm.

If you are result oriented, believe me, this is the proper way.  I have been a phalloplasty surgeon since 1986 with close to 3000 case experience since then.
 

Harold M. Reed, M.D.

Oh yes, by the way please add on peno-scrotal web recession, “I’ve got a turkey neck.”

Phalloplasty has been a preferred term used by phalloplasty surgeons because penis enlargement has been overly worked by the nutriceutical houses such as Enzyte.  It is absolutely amazing how many requests we get almost daily to do everything at once.  “I won’t hold you responsible.”  Guess what? I am responsible and who pays for the revisions and touch ups and prolonged aftercare of a complication when the penis has had too much surgery at one time.   The doctor should know better.  Patients are allowed in the eyes of the law to be impulsive, but a professional is expected to exercise prudent restraint.

Why not simultaneous surgery?  The pubis is the delta which drains the lymphatics of the penis and scrotum.   Genital swelling, which may take 6 weeks to come down, is not an optimal environment for good wound healing.  The tissues are more prone to infection, blood supply is impaired, tension can result in suture line separation.  If you have a fresh circumcision, how are you going to pull on your penis (apply traction) to maintain the added  length I gave you in the operating room and build upon that?   Failure to apply immediate traction within a day or two is a common reason for no length gain.

I’d rather not take that man’s money.  The headaches of aftercare are overwhelming and very time consuming.  Frequent panic calls 24 hours a day; rushes of daily photographs by E-mail.  If the phalloplasty befores and afters on our web-site is what the patient is looking for, let’s do it properly step by step.

Harold M. Reed, M.D.

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