Penis length · guide
Penis Lengthening Surgery
Ligamentolysis increases flaccid length by 1 to 2 cm. It does not increase erect length. Most men who have it are not satisfied.
Penis lengthening surgery (the severing of the suspensory ligaments, "ligamentolysis") is the most commonly offered surgical procedure for penis length. Surgery will only increase the flaccid length of the penis; no increase in the erect length is possible.
Androfill Canada does not perform penis lengthening surgery. Our Edmonton clinic offers non-surgical girth enhancement with hyaluronic acid filler only. This page is here because men considering surgery deserve a candid explanation of what it does, what it does not do, and what the alternatives are.
Explanation: erect length
Surgery involves cutting the suspensory ligaments to allow more of the penis to protrude, or hang down from the body, when flaccid. The ligaments run from the pubic bone to the penile shaft; releasing part of them lets the shaft drop.
The flaccid penis will hang further down, and the patient becomes more of a "shower" than a "grower". The increase in visible penis length in the flaccid state is between one third and three quarters of an inch. The increase in erect length is zero, because the penile shaft is not lengthened by the procedure.
Results: increase in flaccid length
1.0 to 2.0 cm
0.3 to 0.75 inches. Individual results vary.
None
Ligamentolysis does not result in increased erect length.
"As the penile shaft is not made longer by the procedure, there will be no increase in erect length. Any increase in erect length is due to the compulsory use of a penis extender device following lengthening surgery, rather than due to the surgery itself."
Treatment outcomes are patient dependent. An experienced doctor can inform you of the limits of the procedure and the fine balance between maximum penis length and optimal penis function.
Recovery
Penis lengthening surgery is completed under general anesthesia. Pain medication is given afterwards; most men need it for no more than five days. To keep the length gained, it is necessary to wear weights or a traction device and to wrap the penis for up to eight weeks, during the day only. Patients usually take one week off work; heavy work such as the building trade may need longer. Sex must be avoided for at least one month and high-impact sport for at least six weeks. It is a surgical procedure requiring careful consideration.
What are the risks?
Six risks of ligamentolysis
Risk 1
The long-term satisfaction rate is low
A seven-year study at St Peter's Andrology Centre, London (Li et al., European Urology 2006) assessed patients requesting length enhancement by division of the suspensory ligament. The procedure led to an average increase of 1.3 cm in flaccid length.
"The overall patient satisfaction rate was 35% but lower in the group with penile dysmorphic disorder at 27%."Li CY et al., European Urology 2006
"The cut ligament may also not provide the support it originally did, which means that you might find your erections less satisfactory as a result. There is also a risk that this type of surgery may cause the side effect of pain during sex."Dr Louise Draper
Risk 2
Major medical bodies say it has not been shown to be safe or effective
"The American Urological Association considers the division of the suspensory ligament of the penis for increasing penile length in adults to be a procedure which has not been shown to be safe or efficacious."AUA Board of Directors, position first adopted 1994, most recently reaffirmed October 2018. AUA statement
Risk 3
It can make sex uncomfortable
The cut ligaments are what lift and stabilize the penis when erect. After surgery the erection points lower and can be less stable horizontally and vertically.
"A lot of men who have this treatment don't truly appreciate this loss of angle. It can make sex quite uncomfortable. You've got to do a lot more manoeuvring with your partner. The advantage of a 2 cm gain in flaccid length is far outweighed by the loss of angle of erection."Professor Kevan Wylie, quoted by the UK NHS
Risk 4
It leaves a scar
To reach the suspensory ligaments an incision is made at the base of the penis, in a V, Y or Z shape. When healed the scar is partly covered by pubic hair, but some of it will always be visible.
If you are in a long-term relationship and your partner knows about the surgery, the scar may not embarrass you. If you are a young man who expects to have several sexual partners, consider whether you will feel comfortable explaining the scars to current and future partners.
Risk 5
The most common complication is penile shortening
"Penile shortening is a major complication of penile lengthening surgery, usually resulting from the freely hanging penis reattaching to the pubic bone located higher on the corporal bodies. The likelihood of this complication can be minimised by the placement of surrounding soft tissues, fat tissues, silicone, polytetrafluoroethylene, Gore-Tex, and other artificial materials."Park, Kim, Moon, Penile Augmentation, Springer 2016
The risk of reattachment can be lowered by inserting a silicone buffer, which in a small number of cases becomes infected and must be removed. Wearing a penis extender for eight hours a day for a year after surgery also helps prevent retraction. If you do not, the ligaments are likely to reattach further down the shaft, leaving the penis shorter than before surgery.
Before having surgery, first buy a penis extender and make sure you can wear it for eight to ten hours a day as part of your routine. You will need to wear one every day after lengthening surgery.
Risk 6
Infection
Infection is a major risk of any surgery at the base of the penis, and in some cases the results are severe. Infection of a silicone buffer requires its surgical removal.
Frequently asked questions
Penis lengthening surgery FAQs
Is penis lengthening surgery effective?
In medicine, penis enlargement surgery remains controversial. It has among the highest rates of reported complications and among the lowest rates of long-term satisfaction.
"The use of cosmetic surgery to enlarge the penis remains highly controversial. There is a lack of any standardization of all described procedures. Indications and outcome measures are poorly defined, and the reported complications are unacceptably high. In our opinion, until new, reliable, and more objective and reproducible data are available, these procedures should be regarded as investigational and patients should be discouraged from undergoing these invasive treatments."Vardi et al., European Urology 2008. PubMed
Surgeons offering penoplasty often neglect to explain that ligament division only increases flaccid length. Read widely, including independent sources, and search for cases where surgery has not been successful. The downside risks are real, potentially severe, and not infrequent. A lower-risk girth procedure with hyaluronic acid filler, supported by peer-reviewed research, is what we offer in Edmonton.
What is the satisfaction rate?
Short answer: 35%. The seven-year St Peter's Andrology Centre study found only 35% of patients were happy with the results, and an average gain of 1.3 cm in flaccid length. We believe this is down to poor technique and mis-selling of the benefits, for example claiming it lengthens the erect penis.
Why is there no increase in erect length?
The suspensory ligaments work like elastic bands anchored to the pubic bone at one end and the shaft at the other. During an erection they are stretched to their maximum; afterwards they pull the penis back up inside the body. Cutting them means nothing pulls the penis back, so it hangs at nearly its full erect length, giving the illusion of a longer flaccid penis. The shaft itself has not been made longer, so there is no increase in erect length.
To increase erect length surgically, the shaft itself would have to be lengthened by dividing the penis and grafting tissue into the middle. It is highly invasive and very expensive, and is not offered by Androfill Canada.
After lengthening surgery you must wear a penis extender daily for a year to prevent reattachment. Any minor increase in erect length observed in that year is due to the extender, not the surgery. A penis extender, or liposuction of the pubic fat pad, are the only options that work if the patient is seeking additional erect length.
How can I increase my erect length?
Method 1: wear a penis extender for a long time. There is some evidence of length gain with sustained daily traction (BJU International 2011). See penis extenders.
Method 2: liposuction of the pubic fat pad. An excellent option if you are overweight. Fat below the abdomen can partially bury the penis; removing it brings more of the penis out so it protrudes further and appears longer.
Method 3: shaft-lengthening surgery. A highly invasive surgical approach that increases both erect and flaccid length, at very high cost and risk. Not offered by Androfill Canada.
Better methods to increase flaccid length
Adding hyaluronic acid filler to the penis, or having a fat transfer, gives almost the same increase in flaccid length as ligamentolysis, because the added weight reduces retraction. Given the risks, limited benefit and effective alternatives, lengthening surgery is not suitable for the majority of patients. A penis extender is also an option for flaccid and erect length.
What is the most common complication?
Penile shortening, if the ligaments reattach. A silicone buffer and a year of daily extender use reduce the risk. Make sure you are used to wearing an extender before surgery.
Will I be left with any scarring?
Yes: a V, Y or Z-shaped scar at the base of the penis. A scar is unavoidable to reach the ligaments, and it will not be fully hidden by pubic hair.
Alternatives we offer
Non-surgical options in Edmonton
Hyaluronic acid filler adds around 20% circumference and some flaccid length, in about an hour, reversible. How it works.
The only non-surgical method with evidence for erect length, and mandatory after any lengthening surgery. Extender guide.
A side-by-side comparison of risks, recovery, cost and results. Read the comparison.
Talk it through before you decide
Dr Anwer will tell you plainly whether filler suits your goals, and if length is what you want, what does and does not work.