Penis Enlargement
Penis size has historically been used as a symbol of power and sexual adequacy for many men in all societies. Today, this topic has become more widely discussed, especially with the proliferation of the internet and digital content.
Procedures performed to make the penis appear longer or thicker are generally referred to as "penis enlargement." Recent advances in cosmetic surgery have led even men with normal penis size to become interested in enlargement surgery. On the other hand, for individuals with true micropenis or those undergoing gender reassignment, this surgery is much more important than a cosmetic need.
When examining the historical development of penis enlargement procedures, it can be said that people have been seeking ways to enlarge the penis for a long time. The techniques we use today for penis enlargement, however, are relatively new in modern medicine.
As the number of urologists focusing on male sexual health has increased over the past 20 years, penile surgery has also made scientific progress. Many issues, including the perception of the penis among young and healthy men and its effect on their self-confidence, can now be measured more accurately. There are also studies examining not only men's but also women's views on penis size. More recent and comprehensive research is continuing to increase.
What Is the Actual Penis Size? Average Values
According to a multi-center study published in Turkey in 2024, the average length of the penis when stretched was measured as 12.2 cm. This value is quite similar to global averages. In international studies, the average length of the erect penis was found to be 13.1 cm, while the length when flaccid was around 9.2 cm. A similar pattern is observed when considering penis circumference, or thickness. The average circumference of the penis in a flaccid state is 9.3 cm, while in an erect state, it is approximately 11.7 cm.
These measurements show that many men who believe they are "below average" actually have completely average values. However, due to media influence, individuals may not even realize they are normal because they compare themselves to unrealistic standards.
Micropenis: True Medical Indication
A condition that truly requires medical intervention is called micropenis. Micropenis is defined as a penis length of less than 8.5 cm when stretched. This clinical diagnosis is usually caused by hormonal disorders or genetic factors. Individuals diagnosed with micropenis may require hormone therapy or surgical methods. For men who do not meet the criteria for micropenis but are dissatisfied with its appearance, this is not a medical condition but an aesthetic preference.
Why is Psychological Evaluation Important?
In the majority of individuals who seek penis enlargement methods, there may be a psychological perception disorder rather than a physical problem. This condition is called penile dysmorphic disorder. Despite having a penis of normal size, the individual constantly perceives it as inadequate and small. Surgical procedures in such cases do not lead to patient satisfaction. In fact, post-surgery regret or increased anxiety may occur.
For this reason, it is recommended that every individual who seeks penis enlargement undergo a psychological evaluation to rule out penile dysmorphic disorder.
Pre-Penis Enlargement Surgery Evaluation
Individuals seeking penis enlargement fall into two main groups:
- Patients with True Micropenis or Hormonal Issues
- Penile lengthening and thickening may be recommended for penises measuring 8.5 cm or less when stretched or erect.
- The most accurate method for measuring penis length is to stretch the penis and measure from the pubic bone to the tip.
- For adults, a penis length of less than 8.5 cm is considered the "small penis" threshold.
- Some patients may have hypogonadism or other endocrine disorders.
- Therefore, hormone tests should be performed in patients scheduled for surgery, followed by the development of a plan tailored to the anatomical structure.
- Healthy Men with Normal-Sized Penises Who Want a Larger Penis
- Most patients seeking penis enlargement fall into this category.
- There may be a body image disorder; a psychological evaluation is essential.
Penis enlargement surgeries can be categorized into two main techniques: lengthening and thickening.
Penis Lengthening Surgery
Penis uzatma operasyonları, genellikle hem estetik beklentilere yanıt vermek hem de kişinin cinsel özgüvenini artırmak amacıyla yapılır. Aşağıda, bu amaçla uygulanan başlıca cerrahi teknikler ele alınmıştır.
1- Reduction of Pubic Fat Tissue (Liposuction/Lipectomy)
In some men, excess fat accumulates in the lower abdomen (pubic region). This layer of fat can cause the penis to appear shorter.
- Liposuction (fat removal): If the fat tissue is soft and mobile, a single small incision is made and excess fat is removed using a thin cannula. Patients can usually be discharged on the same day.
- Lipectomy/Panniculectomy (surgical removal of fat tissue): If the fat layer is thick, the surgeon makes an incision in the area and directly removes the excess fat. A drain may be placed after the procedure, and a compression dressing is applied.
Both methods make the penis root more visible, making the penis appear longer than it actually is.
2. Cutting the Suspensory Ligament (Ligamentum Suspensorium Surgery)
The penis is directed upward by a "suspensory ligament" attached to the pubic bone. This ligament helps the penis remain erect, especially during erection.
- In this surgery, the suspensory ligament is carefully cut.
- This causes the part of the penis inside the body to extend slightly outward.
- When flaccid, the penis appears longer. When erect, the angle may shift slightly downward.
3- Ensuring Skin Compatibility (V-Y Plasty)
If the skin covering the penis is insufficient when it is extended, this length will not be noticeable from the outside.
The most commonly used method to prevent this is the "V-Y plasty" skin extension technique. An inverted V-shaped incision is made at the base of the penis, which is then sutured in a Y-shape, preserving the penopubic angle while closing the extended area.
4- Scrotum (Testicle Sac) Corrections
In some men, especially after circumcision or in cases of buried penis, the scrotum (testicle sac) may extend toward the penis. This causes the penis to appear shorter than it actually is. This excess tissue, called a scrotal web, is removed using special surgical techniques to restore the natural angle (penoscrotal angle) between the base of the penis and the sac.
5- Lengthening of the Cavernous Tissue
There are also procedures aimed at increasing the length of the cavernous tissue, which is responsible for erection within the penis. This technique should be considered as part of a multi-stage treatment plan, particularly for patients with congenital micropenis.
6- Penis Lengthening with Silicone Implants (Penuma®)
The Penuma implant, available at® , is a silicone implant that is placed on the surface of the penis to increase length and girth when flaccid and erect. It was first used for aesthetic purposes in the United States in 2018.
Penis Thickening Methods
Penis thickness is also an important parameter for sexual satisfaction. It can be achieved in two ways.
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Thickening of the Erectile Tissue (Corpus Cavernosum)
In some men, the erectile tissues within the penis may be too thin due to congenital micropenis or during prosthesis surgery, preventing the prosthesis from passing through. In such cases, the penis's inner structure can be thickened by adding tissue (graft) to its outer membrane.
Subcutaneous Injection Methods
The most commonly used methods for penis thickening involve injecting fat or filler material under the skin:
- The most commonly used method in penis thickening procedures is the injection of hyaluronic acid fillers into the penile skin. Hyaluronic acid is a substance naturally found in the body and known for its water-retaining properties. Its effects are temporary, lasting an average of 6 to 12 months.
- Another thickening method involves injecting fat tissue taken from the patient's own body into the penis. Fat is taken from the patient's own body (usually from the abdomen or waist area), processed through special procedures, and then injected into the penis. This procedure is called lipofilling. However, fat tissue may dissolve over time. On average, 40–60% of the injected fat may be permanent.
Both methods can increase the thickness of the penis by up to 2–4 cm. However, silicone and paraffin-based substances, known as permanent fillers, are no longer recommended in modern medicine as they can cause serious problems such as tissue damage, nodule formation, and infection in the long term.
The procedures are typically performed under local anesthesia, and patients can be discharged on the same day. Fat or filler is injected using special tools to ensure symmetrical thickening of the penis. In some cases, fat strips or special biological tissues may also be surgically implanted.
Procedures Targeting the Penis Head
After the penis shaft is thickened, the head (glans) may remain thinner. To achieve aesthetic balance, filler material can also be applied to the penis head. This method is also used in the treatment of premature ejaculation. The most commonly used method involves carefully injecting hyaluronic acid filler into the head area using very fine needles. This improves both appearance and sensitivity.
Both Lengthening and Thickening: Combined Applications
Some patients desire both length and thickness increases. In such cases, methods such as suspensory ligament release and hyaluronic acid filler can be combined in the same session. These combined procedures can yield more satisfying results, especially in patients with high aesthetic expectations. However, the surgery duration increases, the recovery period requires more careful monitoring, and the risk of complications may slightly rise.
Pre- and Post-Surgery Process for Penis Enlargement Surgery
Before surgery, the patient undergoes a detailed urological examination. Hormonal tests, blood tests, and infection screenings are performed. In addition, the patient's expectations and psychological state should be evaluated in detail. Patients who smoke are advised to quit smoking before surgery, as smoking can adversely affect tissue healing.
In the post-operative period, swelling, bruising, and mild pain may occur. Compression bandages and rest are recommended. Sexual activity and intense physical activities should be avoided for the first 4–6 weeks. Final results are typically evaluated by the 3rd month.
Results of Penis Enlargement Surgery
When performed on the right patient with appropriate indications and by surgeons with sufficient surgical experience, penis enlargement surgery yields satisfactory results. Patient satisfaction rates are quite high following both lengthening and thickening surgeries, as well as surgeries that combine both procedures.
Risks of Penis Enlargement Surgery
As with any surgical procedure, there are certain risks associated with penis enlargement surgery.
- Serious vascular damage may occur during the cutting of the suspensory ligaments.
- There is a risk of damage to the spermatic cord and nerves.
- If the spaces under the skin are not properly closed, the wound may open or an infection may develop.
- Some patients may experience temporary loss of sensation after the procedure. Careful wound care is required during the healing period. In some cases, implants may shift or appear asymmetrical.
Non-Surgical Penis Enlargement Methods
There are also alternative methods available for individuals who do not wish to undergo surgery or are not suitable candidates for surgical intervention.
Vacuum pumps use cylindrical devices placed over the penis to create negative pressure, thereby increasing blood flow to the penis. This procedure can temporarily increase penis size. With regular and patient use, mild permanent lengthening may also be observed.
Stretching devices (extenders) work by gently stretching the penis for specific periods of time to promote lengthening. By encouraging cell proliferation, they may provide a permanent lengthening of approximately 1–2 cm over the long term.
Weight loss, especially in the abdominal and groin areas, reduces fat and makes the buried part of the penis more visible. This allows for optical lengthening without surgery.
Results and Recommendations
Penis enlargement methods are medically indicated in cases of micropenis and buried penis, but they can also be performed for aesthetic purposes if the individual's body structure is suitable, their expectations are realistic, they have not developed an obsession with penis size, and they genuinely experience self-confidence issues or sexual problems related to penis size.
Penis enlargement surgeries can increase penis length by 1.5–4 cm and girth by 2–4 cm. The increase achieved with non-surgical methods is more limited.