I believe I have some infertility problems associated with a varicose vein on my scrotum. I was also interested in lengthening at the same time. Do you perform this operation?  Can you do both at the same time? And what are the prices and payment options?   Thank you.

Donald

Good afternoon Donald,

A varicose vein on your scrotum would not produce infertility but a varicocele, (similar to many varicose veins) surrounding your spermatic cord could.

Please review the attached on phalloplasty and penile enlargement, length and girth.

In that a well performed varicocelectomy may result in some discomfort after surgery and lead you to procrastinate on early use of traction, I would suggest you have the more important operation for you done first.

Best wishes,

Harold M. Reed, M.D.

Just a quick question regarding traction following surgery.  What would be the minimum period of time that you would reccommend using traction in order to avoid retraction.  I would be happy with the immediate gains but would not want to loose them!.  I know that you suggest 8 hrs per day.  If this was done for a month for example would this period of time be sufficent to hang onto surgery gains?

Doug

October 14, 2009

Good morning Doug,

Right on.  Yes, I would think if you apply traction as we recommend for 4 to 6 weeks, you will certainly maintain what was accomplished in the operating room.  An incision does not regain full tensile strength for 6 weeks.

But for 3/8″, and never to use traction again, is it worth it?

Once that is accomplished, you could resume full time traction whenever you wish, and you will not have lost anything.

All the best,

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

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

 

 

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

 

 

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

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

Dr.Reed,

My name is Stan. I am a 55 years old and very fit.  Approx 10 years I underwent lengthening and widening with dermal grafts. I was 5 7/8 erect and 4 1/2 girth. I am now 7 X 5 3/4 midshaft. As my wife likes girth and I am tired of using the pump. I am considering girth enhancement with alloderm.  The dermal seems to have decreased from just under the head to approx midshaft.  Can alloderm be used in conjunction with already placed dermal? As I want no more than 3/4 - 1″, to take out the dermal and replace with alloderm would make my girth less than it is now.  Also, how many sheets of allo do you typically use and what is the size of a sheet. 
 
Any information would be greatly appreciated. 

 

 

 

Hi Stan, 

 

We had had experience with AlloDerm for almost 10 years now and before that we did dermal-fat grafts, and before that transfer of liposuctioned of fat (autologous fat transfer or AFT) .  As a phalloplasty surgeon I evolved into the AlloDerm because it seems to be the most predictable performer.  Liposuctioned fat transfer can result in uniform or zonal reabsorption and the formation of fibro-fatty nodules or lumps under the skin. 

Dermal-fat grafts are living and in order for them to survive as soft as one might feel under the skin before surgery, they do need to pick up a sufficient blood supply.  Otherwise they will undergo some degree of atrophy which translates into fibrosis, the lowest common denominator of wound healing before necrosis.  Fibrous grafts tend to lose of course the original girth as the fat cells die off first, but worse yet they contract and result in shortened penile length. 

AlloDerm is a cadaveric product, and has no immediate biological requirements such as early re-vascularization.  If your dermal-fat graft in the distal shaft is not bothering you, you could consider Allo-Derm placed over it.  If it is truly fibrous, I would remove it, as AlloDerm should rest between a sandwich of healthy well vascularized tissue for a good take. 

We use extra-thick AlloDerm but avoid stacking sheets as this can predispose to a wound infection.  There is no blood supply whatsoever between the layers, and all it takes is a small amount of skin bacteria  which healthy tissue can repress.  The thicker a man’s penis is when he sees me, the less impact visually one extra thick layer of AlloDerm has.  Think of “a drop in the ocean.”  For men who have not had previous girth enhancement, we say about a 3/4″ increase in circumference.

Your circumference of 5 3/4 is OK and you may wish to rest on your laurels.  Most likely with AlloDerm you will get up to 6 or more inches.  In cosmetic surgery there is an expression, “less is more,” meaning that overdoing things can lead to complications.

Please do see phalloplasty before and after photos and images on our web-site.  The phalloplasty cost is also mentioned.

 

Hope this addresses your questions.  

Best wishes,

Harold M. Reed, M.D.

305-865-2000                                                                                                                   

 

 

 

Last week, a man who had an adult circumcison a few years ago had a penile lengthening procedure and we noted puckers on the underside of the penis, like little skin ears. 

This happens when the tissue from either side is not gathered or approximated evenly and in this case was corrected just by removing the puckers down to skin level and putting in a few stitches of rapidly absorable suture material.

We like to apply Sur-Strips over this area to splint the closure, less stress and better wound healing.

Harold M. Reed

In a few days,