Studies have been undertaken since 2002 to determine the suitability of injectable dermal filler for penile girth enhancement. In relation to the use of dermal filler in the face, studies go back to the 1980s and show the substance to be safe and effective. Dermal filler was an effective technique to enhance penis size with no inflammatory signs or serious adverse reactions in all participants.
References
The Effects of Penile Girth Enhancement using Injectable Hyaluronic Acid Gel, a Filler
Kwak TI, Oh M, Kim JJ, Moon DG. The Journal of Sexual Medicine, 2011 · Available here
Introduction. Despite the debates on penile girth enhancement (PGE), demands for enhancement are increasing. Recently, various fillers have been widely used for soft tissue augmentation with proven efficacy and safety.
Aims. To identify the feasibility and efficacy of PGE by injection of filler.
Methods. Fifty patients with subjective small penis who visited Korea University Guro outpatient clinic were enrolled and prospectively followed. Restylane Sub-Q was injected into the fascial layer of penile body via 21G cannula with "Back & Forth Technique" and homogenized with a roller.
Main outcome measures. From April 2006 to February 2008, 50 patients were enrolled and 41 were followed until 18 months after PGE. Changes in penile girth at midshaft were measured by tapeline at 1 and 18 months. Patient's visual estimation of residual volume, patient's satisfaction, and any adverse reactions were also evaluated.
Results. Mean injected volume was 20.56 cc (18–22). Compared with basal girth of 7.48 ± 0.35 cm, maximal circumference was significantly increased to 11.41 ± 0.34 cm at 1 month (P < 0.0001) and maintained at 11.26 ± 0.33 cm until 18 months. At 18 months, all patients answered as Gr 4 without asymmetry. Patient's and partner's satisfaction score was 3.71 ± 0.46 and 3.65 ± 0.48 at 1 month and 3.34 ± 0.53 and 3.38 ± 0.49 at 18 months. There were no inflammatory signs or serious adverse reactions in all cases.
Conclusions. Considering the property of material, methods, and follow-up results of 18 months, PGE using filler is a very effective and safe technique for penile augmentation.
Use of Macrolane VRF 30 [Hyaluronic Acid] in emicircumferential penis enlargement
Sito G, Marlino S, Santorelli A. Aesthetic Surgery Journal 2013;33(2):258–64 · Available here
Background. Penis enlargement is increasingly in demand. Methods can be classified into surgical, nonsurgical (filling), and mechanical. Each has shown only relatively successful results. A new formulation of injectable, stabilized, hyaluronic acid (HA)-based, nonanimal gel is available that may have applications for this use.
Objectives. The authors propose a new technique for emicircumferential-injection filling of the penis and assess the safety and efficacy of this procedure compared with lipofilling (fat injection).
Methods. Retrospective review of 83 patients who underwent penis enlargement with either HA injection or lipofilling between December 2007 and July 2011.
Results. Circumferential enlargement from both techniques ranged from 3.2 to 4.5 cm, with a decrement during erection. Increase in penis length ranged from 1.8 to 3.6 cm. No complications were seen in patients treated with HA, whereas 8 patients treated with lipofilling developed granuloma and another experienced fat necrosis. The vast majority (n = 72) reported being "very satisfied".
Conclusions. The ideal technique should be nonsurgical, with a satisfactory and predictable result, a low rate of complications, and long-term stability. Emicircumferential enlargement with HA filler meets these requirements. However, results have been durable but not definitive, and repeated treatment (with associated costs) is necessary.
Nonsurgical Medical Penile Girth Augmentation: A Retrospective Study of Psychological and Psychosexual Outcomes
Sharp G, Oates J. Aesthetic Surgery Journal 2018, 1–11 · Available here
Objectives. To investigate the psychological and psychosexual outcomes of nonsurgical medical penile girth augmentation.
Methods. Twenty-five men who had undergone augmentation between 1 and 12 months prior (mean 6.6 months) completed an online questionnaire measuring procedure motivation and satisfaction, genital self-image, penile-focused body dysmorphic disorder symptoms, self-esteem and sexual relationship satisfaction. Six completed in-depth interviews.
Results. Most men were satisfied with their penile size, appearance and function after augmentation, and reported statistically significant improvements in genital self-image (P < 0.001) and self-esteem (P = 0.008), and a reduction in penile-focused body dysmorphic disorder symptoms (P = 0.002). Interview themes: high satisfaction with increased girth; increased self-confidence, particularly where the penis would be seen; increased sexual confidence, with some mixed impacts on sexual relationships.
Conclusions. Most men appear to be satisfied with their nonsurgical penile girth augmentation results and also seem to experience improvements in overall self-esteem.
Nonsurgical Medical Penile Girth Augmentation: Experience-Based Recommendations
Oates J, Sharp G. Aesthetic Surgery Journal 2017;37(9):1032–1038 · Available here
Penile augmentation is increasingly sought by men dissatisfied with the size or appearance of their penis, yet procedures remain controversial with no standardized recommendations and limited outcome data. The authors focus on girth enhancement, as girth appears particularly important for sexual satisfaction, discuss the advantages and disadvantages of common techniques with a focus on minimally invasive injectable augmentation, and offer suggestions for patient screening, technique selection and perioperative care.
Effects of hyaluronic acid gel in penile augmentation
Moon DG, Kwak TI, Kim JJ, Cho HY. International Journal of Impotence Research 2002;14(Suppl 3):S40. Preliminary study. · Available here
Glans enhancement using hyaluronic acid
Injection of hyaluronic acid gel into the penis glans
Moon DG, Kwak TI, Kim JJ, Cho HY. International Journal of Impotence Research 2003;15:439–443 · Available here
Conclusion. In human glans penis, injecting hyaluronic acid gel into the dermis was not so difficult and the implants showed long-term residence in the patient's visual estimation and resulted in high satisfaction rate of patients. These results suggest that injectable hyaluronic acid gel is a safe and effective material for soft-tissue augmentation in patients with small glans penis. Long-term efficacy of more than 1 y needs to be demonstrated.
Glans Penis Augmentation Using Hyaluronic Acid Gel as an Injectable Filler
Moon DG, Kwak TI, Kim JJ. World Journal of Men's Health 2015;33(2):50–61 · Available here
Injection of HA to the glans: treatment of premature ejaculation
A clinical study to assess the effectiveness of a hyaluronic acid-based procedure for treatment of premature ejaculation
International Journal of Impotence Research 2013;25(3):117–20 · Available here
Permanent girth gain: hyaluronic acid and neocollagenesis
Note: there is insufficient evidence to reliably predict the amount of permanent penis girth gain stimulated by neocollagenesis (new collagen formation stimulated by HA) or other processes.
The Lasting Effects of Fillers through Neocollagenesis
Koger CL, Cohen JL. The Dermatologist 2014;22(4) · Available here
In vivo stimulation of de novo collagen production caused by cross-linked hyaluronic acid dermal filler injections in photodamaged human skin
Wang F, Garza LA, Kang S, et al. Arch Dermatol 2007;143(2):155–163 · Available here
Association between collagen production and mechanical stretching in dermal extracellular matrix: in vivo effect of cross-linked hyaluronic acid filler. A randomised, placebo-controlled study
Turlier V, Delalleau A, Casas C, et al. J Dermatol Sci 2013;69(3):187–194 · Available here
Clinical experience
A permanent increase in penis thickness stimulated by hyaluronic acid filler has also been reported by senior Korean urologist Dr Kim Jin Hong, a pioneer of the treatment with over 4,000 procedures and numerous journal publications. He describes HA as undergoing isovolumic degradation of approximately 4% per month, with older HA varieties leaving a "permanent" gain of about 39% of the original volume after two years, and current penis-specific formulations acting as a longer-lasting scaffold that leaves new tissue of about 50% of injected volume. He notes that nothing about the body is truly permanent; "permanent" here means a result that changes very little over a long period.