Over the past decade, the focus on male aesthetics has reached unprecedented levels. The surge in hair transplant procedures has paved the way for a new trend: penile enlargement.
Since prehistoric times, penis size has been perceived as a symbol of virility and masculinity. This notion has carried through to modern society with little alteration. Complex civilizations such as the Egyptians depicted Amun-Min with an oversized phallus. Today, excessive importance is still placed on penis size.
Penile enlargement surgery consists of two main approaches: lengthening and thickening. While there is broad consensus on lengthening techniques, thickening procedures present greater variation. Non-surgical options, such as hyaluronic acid injections, have gained popularity due to their simplicity, but their effects rarely last beyond four months and can lead to complications such as cysts and skin necrosis. Surgical options, on the other hand, fall into four major categories: stem cell grafting, mesh implants, fat grafting, and silicone implants.
Focusing on mesh implants, they offer a viable alternative for achieving significant girth enhancement. These implants, derived either from animal sources or the patient’s own skin, are placed beneath the penile skin. The procedure involves retracting the penile skin, separating it from the underlying structure, securing the mesh to the fascial layers, and then repositioning the skin. The purpose of the mesh is to create a thick scar between the skin and the penile shaft.
Adverse Effects of Mesh-Based Penile Enlargement
While increasing penile girth can be desirable, the potential adverse effects of mesh implantation must be carefully considered. The most significant risk is a possible reduction in erectile strength and penile size during erection. This occurs because the penis functions like a balloon that must fill with blood to achieve an erection. During arousal, a large influx of blood increases penile size and firmness. However, a mesh implant creates a scar around this structure, potentially restricting its expansion and limiting the erection. Another drawback is the lack of glans enlargement, sometimes resulting in an unnatural transition between the shaft and the glans. Other complications include infection or rejection of the mesh.
It is important to note that mesh implants have long been used in burn patients. In cases where grafts are applied to delicate areas such as tendons, additional skin thickness is necessary. In the 1990s, their use in penile surgery was explored, but due to frequent long-term erectile complications, some manufacturers, such as Allergan, have since advised against using mesh in penile procedures.
Each of the remaining thickening techniques presents its own advantages and disadvantages when compared to mesh implantation. The choice of method should be individualized, considering both the patient’s specific needs and the surgeon’s expertise.
From our perspective, mesh implants should be reserved for secondary cases—patients for whom less invasive techniques, such as stem cell grafting, have failed—or for those with complications from previous surgeries.
The NEF Technique for Penile Lengthening and Thickening
Penile surgery is expected to become more common in the near future. It is crucial for the medical community to focus more on improving these techniques and sharing surgical experiences to refine procedures. Notably, American and European conferences on plastic surgery and urology still lack dedicated discussions on penile surgery, which remains a taboo subject both in society and within the medical field. At Clínica NEF, we have presented a study featuring the largest published series of penile enlargement procedures using the NEF technique. We hope this study serves as both a stimulus and a stepping stone for increasing awareness and training among both medical professionals and patients. The more information we provide to society, the better the care and results we can offer to our patients.
