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Dermal Fat Grafts & AlloDerm (ADM) Wraps — Surgical Graft-Based Penile Girth Augmentation

Autologous dermal fat grafts and acellular dermal matrix (ADM) wraps (AlloDerm and porcine variants) are two related graft-based surgical approaches to penile girth enhancement. Both place tissue around the penile shaft to increase circumference, and they differ in material source, integration biology, complication profile and durability. Xu's two dermal-fat series reported mean flaccid circumference gains of 1.53–1.67 cm at 6 months; Alei's porcine ADM series reported 3.1 cm flaccid at 1 year, and Xu's ADM series reported a 1.1-cm mean circumference gain at 3 months.[3][7][12][14] A narrative review reported skin necrosis or ulcers, wound infection or reoperation in 8 of 15 surgical-treatment studies (53.3%), and the authors judged adverse events to be probably under-reported.[1][2]

For the broader male cosmetic-genital-surgery decision framework see the Male Cosmetic Genital Surgery atlas page. For the FDA-cleared cosmetic penile implant, see Penuma & Himplant.[28] For the bovine-pericardium and plasma-gel composite see the Hardrock Sandwich Technique.

Part I — Autologous Dermal Fat Grafts​

Concept and rationale​

Autologous dermal fat grafts harvest a composite strip of dermis and subcutaneous fat from a donor site (typically the gluteal crease, lower abdomen, or groin), de-epithelialize the skin surface, and wrap or place the graft around the penile shaft in the subcutaneous plane. The dermal component provides structural integrity and resistance to resorption, while the fat component provides volume. The dermal component is intended to address the main limitation of pure fat injection, unpredictable resorption. Fat-graft resorption of 25–80% and survival of 40–80% have been reported in general (non-penile) fat-grafting literature.[3][4][5]

Surgical technique​

  • Donor-site harvest. Fusiform or rectangular strip of skin and subcutaneous fat excised from the gluteal crease, lower abdomen, or inguinal region. The epidermis is removed (de-epithelialization), leaving the dermis and attached fat intact.[3][6] In a six-patient dermofat subgroup, Adhikari harvested a 3–5 mm fat layer; two patients developed liquid-fat collections, which the author associated with thicker grafts.[32]
  • Penile preparation. Penile degloving through a circumcoronal (subcoronal) or infrapubic incision, dissecting the plane between dartos fascia and Buck's fascia.
  • Graft placement. The dermal fat strip is wrapped circumferentially or placed as dorsal / lateral patches around the penile shaft. Dermal surface outward (toward the skin); fat surface inward (toward Buck's fascia). Secured with absorbable sutures.[3][7] In Adhikari's subdartos technique, the ventral urethral surface is left uncovered, sutures avoid visible dorsal neurovascular bundles, and the tunneled proximal graft end remains free to glide during erection.[32]
  • Modified tunneling technique (Xu 2016). A specially designed tunneling instrument facilitates pericavernous thickening without degloving and avoids unnecessary trauma to the neo-urethra and neurovascular bundle. It was developed for post-hypospadias adults.[7]
  • Closure. Penile skin re-draped over the graft and closed; compressive dressing applied.

Key studies​

StudynPopulation / contextGirth gainLength gainNotes
Xu 2016 Ann Plast Surg[3]23Dermal fat graft with suspensory-ligament division (SLD) and suprapubic skin advancement+1.67 ± 0.46 cm flaccid (6 mo)+2.27 ± 0.54 cm flaccid (combined with lengthening)"Inconspicuous" graft shrinkage on US/CT; no curvature; significant MGIS improvement
Xu 2016 Aesthet Plast Surg[7]15Modified tunneling, post-hypospadias adults+1.53 ± 0.23 cm flaccid (6 mo)+1.67 ± 0.24 cm flaccidNo erection deficits or fistulae; MGIS 31.73 → 40.20
Spyropoulos 2005[6]3 (graft subset of 11)Free dermal-fat graft shaft coverage+2.3 cm at base, +2.6 cm subcoronally (p = 0.003 / p = 0.0012)Not reported for the subsetAcross the 11 patients, 91% reported improvement (20–53%) in sexual self-esteem and function; the authors described the size change as not spectacular

Advantages​

  • Biocompatible. Autologous tissue avoids immunogenic rejection.
  • Dermal scaffold. Graft shrinkage was inconspicuous in one series, unlike the resorption reported with pure fat injection.[3]
  • No allograft exposure. Autologous tissue avoids donor-material exposure but requires a harvest site.[3][12]
  • Natural feel as the graft integrates with native tissue.

Limitations​

  • Donor-site morbidity. Separate incision for harvest with associated scarring, pain, and wound complications.
  • Longer operative time versus allograft or injectable approaches.
  • Variable fat survival. Partial fat resorption can occur despite the dermal scaffold. In general fat-grafting literature, survival of 40–80% and resorption of 25–80% have been reported, and the range depends on technique, recipient-site vascularity and graft processing.[4][5][8]
  • Irregular resorption can produce penile lumps, nodules, and asymmetric deformity. A 1995 case report (Leithauser) documented a poor cosmetic and functional result after irregular fat resorption. Biopsy showed that all the grafted fat was dead, and the authors compared this with pseudolipoma of Glisson's capsule, in which dead fat cells persist for years.[9]
  • Penile length. In retrospective series of graft implantation, girth and satisfaction improved but length was negatively affected.[2]

Part II — Autologous Fat Injection (Lipofilling) — Comparator Context​

Fat injection is distinct from dermal fat grafting and is the fat-based girth procedure described most often. It is included here for comparison.

  • Kang 2012 (n = 52). Fat was injected into the superficial, middle and deep layers of Colles' fascia. Mean injected volume was 38.54 mL. At 6 months, circumference increased from 7.01 to 9.29 cm proximally and from 7.06 to 9.34 cm distally (both p < 0.001). One patient (1.9%) had nodular fat.[10]
  • Deskoulidi & Caminer 2023 (n = 75; 15-year experience). Their combined procedure used inverted V-Y plasty and suspensory-ligament division for lengthening, two distally based fat flaps to fill the ligament-release space, and fat injection for girth. The authors report a circumference increase of about 1 cm with "excellent natural results"; 3 of 75 patients (4%) returned for revision of fat injections at 6–12 months.[11]
  • Main limitation. Fat resorption is the main limitation. Resorption of 25–80% has been reported in general fat-grafting literature, and the penile shaft, with repeated erection and detumescence, may be a challenging recipient site.[4][5][8] A fatal fat embolism after penile-shaft fat injection combined with a lengthening procedure has been described in a single case report.[35]

Part III — Acellular Dermal Matrix (ADM) Wraps — AlloDerm and Alternatives​

Concept and rationale​

ADM is processed human or animal dermis from which all cellular components have been removed, leaving an intact extracellular-matrix scaffold of collagen, elastin, and basement membrane. The scaffold serves as a template for host-tissue ingrowth and remodeling. The advantages over autologous dermal fat grafts are the absence of donor-site morbidity and a shorter operation, as claimed in the Alei series.[12]

Available ADM products​

Three major allograft (human-derived) ADM products have been compared in penile augmentation.[13]

  • AlloDerm (LifeCell/AbbVie). Human cadaveric ADM: the original AlloDerm was freeze-dried, whereas current AlloDerm SELECT RTM is supplied hydrated.[34] The SELECT IFU requires a minimum 2-minute soak in sterile saline or lactated Ringer's solution and says not to use a dry graft. It specifies integumental repair or other homologous use, does not list cosmetic penile girth augmentation, and contraindicates use in patients sensitive to Polysorbate 20 or the antibiotics listed on the package.[33]
  • Belladerm (MTF Biologics). Human dermis.
  • Repriza. Human dermis. Preparation differs between manufacturers.

In addition, xenograft (animal-derived) ADM products have been used.

  • Porcine dermal acellular grafts. Processed porcine dermis.[12]

Surgical technique​

  • Exposure. Access is through a circumcoronal incision with degloving or through a small penopubic incision; the graft lies in the subcutaneous plane between dartos and Buck's fascia.[12][13]
  • Graft preparation. ADM sheet rehydrated (if lyophilized), trimmed to dimensions, and shaped to wrap circumferentially around the penile shaft.
  • Graft placement. At the level of Buck's fascia circumferentially around the shaft. Some techniques place the graft dorsolaterally only, leaving the ventral (urethral) surface ungrafted to avoid urethral compression.[12][13]
  • Fixation with absorbable sutures.
  • Closure. Penile skin re-draped and closed; compressive dressing.
  • Alei penopubic-incision technique. A short transverse incision at the penile base along the penopubic junction is used to insert the ADM and advance it distally. The scar is concealed in a crease covered by pubic hair.[12]

Key studies — ADM wraps​

StudynMaterialGirth gain (flaccid)Girth gain (erect)ComplicationsNotes
Alei 2012[12]69 (of 104 referred)Porcine dermal ADM+3.1 cm (8.1 to 11.3 cm) at 1 year+2.4 cm (10.8 to 13.2 cm) at 1 yearNo major complications reported; 9/69 moderate graft fibrosis with minor penile retraction (mean 0.52 cm in affected men), 2/69 transient seromas; other short-term minor complications resolved with conservative care within 3 weeks[12]Psychosexual impact beneficial in most; sexual activity resumed at 1–2 months
Solomon 2013[13]47Human allograft ADMNot reportedNot reportedInfection/open wound with graft exposure 20/47 (42%); exposure only 17/47 (36%); total graft loss 3/47 (6%)No statistical difference among products; mean follow-up 11.25 months (range 1–120)
Xu 2019[14]78ADM (type not specified)+1.1 cm (range 0.5–2.1) at 3 monthsNot reportedErectile discomfort 60.3% (47/78); delayed healing 15.4%; unobvious effect 12.8%; hematoma 10.3%; prepuce edema 9.0%; infection 5.1%; skin necrosis 3.8%; ADM removal 9% (7/78)Authors concluded ADM "is not an ideal or safe method for PGE"

Critical analysis of ADM outcomes​

Alei's single-center porcine ADM series reported favorable outcomes. In a separate 18-patient Pelvicol pilot, 8 patients developed severe edema and ischemic shaft ulcers, and 4 required graft removal.[27] Solomon's human-ADM series and Xu's ADM series (matrix type unspecified) report concerning complications.[13][14] Another 2020 report of 182 human-ADM recipients describes one-year girth gains, five graft retractions with minor fibrosis and five large ecchymoses, but no major events. Its investigators and enrollment years overlap with Xu 2019; individual-patient overlap and the divergent adverse-event reporting remain unresolved.[36]

  • Alei 2012 had the most favorable results. Porcine dermal ADM via a penopubic incision gave the largest girth gains among the ADM series cited (+3.1 cm flaccid, +2.4 cm erect at 1 year), with no major complications. Authors concluded ADM has "several advantages over autogenous dermis-fat grafts: the elimination of donor-site morbidity and a significantly shorter operation time."[12]
  • Solomon 2013 was a comparative allograft series. Circumferential AlloDerm, Belladerm or Repriza at the level of Buck's fascia gave 42% infection or open-wound graft exposure and 6% total graft loss, with no statistical difference between brands. No AlloDerm patient had total graft loss (0/9), but the sample was too small for a meaningful comparison.[13]
  • Xu 2019 was the largest ADM-complication series cited. Erectile discomfort occurred in 60.3% and 9% required ADM removal. The authors concluded that even with standardized methods and rigorous postoperative care, complications of girth enhancement with ADM are severe and that it is not an ideal or safe method.[14]

Part IV — ADM as Infrapubic Space Filler (Combined With SLD)​

A distinct application of ADM is as a space filler in the infrapubic dead space after suspensory-ligament release rather than as a circumferential girth wrap.

  • Zhang 2019 (n = 15 adults with "small-sized penis"). SLD and suprapubic liposuction were combined with folded ADM placed between the corpora cavernosa and pubic symphysis; the authors proposed this method for selected patients with buried penis. Penile length increased by 2.4 cm at 3 months (from 3.0 to 5.4 cm). Complications included edema, ecchymosis and poor wound healing. No patient was dissatisfied with appearance or function.[15] The ADM in this application is placed to fill the dead space after SLD.[15]

Part V — Comparator Techniques​

Tissue-engineered biodegradable scaffolds (PLGA + autologous fibroblasts)​

The Perovic / Djordjevic tissue-engineering technique differs from passive graft placement. PLGA (poly-lactic-co-glycolic acid) biodegradable scaffolds seeded with autologous fibroblasts degrade over months while the seeded cells generate autologous neotissue that replaces the scaffold.[16][17][18]

  • Perovic 2006 (n = 204, multicenter prospective). This was the foundational study. An 84-patient random subset was followed for 1–5 years (median 24 months). Girth gain was 1.9–4.1 cm (mean 3.15 cm). Infection (3), skin pressure necrosis (2) and seroma (5) were all treated conservatively. Mean satisfaction score was 4.25 of 5.[16]
  • Perovic and Sansalone 2010 (n = 12, histomorphometric). Biopsies at 10–14 mo showed highly vascularized loose tissue with collagen deposition, fibroblast-like hyperplasia, and neoangiogenesis; at 22–24 mo inflammation almost disappeared and the tissue closely resembled native dartos fascia. Girth +2.1 ± 0.28 cm flaccid, +1.9 ± 0.28 cm erect; satisfaction 75% "very good" and 25% "good."[17]
  • Djordjevic 2018 (n = 21 repeated procedure). Second PLGA enhancement after a first procedure; additional girth +1.1 ± 0.4 cm flaccid and +1.0 ± 0.3 cm erect (statistically significant); ultrastructural analysis confirmed abundant collagen fibrils with scattered fibroblasts; stable neotissue formation.[18]

Saphenous vein grafts (albugineal surgery)​

This is intracorporeal grafting: saphenous vein is placed into longitudinal incisions in the tunica albuginea to expand the corpora cavernosa themselves, which enhances girth during erection and not in the flaccid state.

  • Austoni 2002 (n = 39). Bilateral longitudinal albugineal incisions with saphenous-vein grafts. At 9 months, flaccid diameter did not change meaningfully; erect diameter increased by 1.1 to 2.1 cm, reaching a mean postoperative diameter of 4.2 cm (p < 0.01).[19]
  • Yang 2009 (n = 20). Saphenous-vein grafts and ePTFE patches were used for albugineal augmentation. On-table circumference increased by 1.0–2.3 cm flaccid and 1.5–3.0 cm erect, and the gains were reduced by 0.5–1 cm in some cases at 12 months to 5 years. Seventeen married patients resumed satisfactory sexual activity at 1 month.[20]

This approach enhances erect girth by expanding the corpora rather than adding subcutaneous bulk. Tunical disruption carries a theoretical risk of erectile dysfunction, and saphenous-vein harvest adds donor-site morbidity.

Part VI — Comparative Summary​

TechniqueMaterialGirth gainDurabilityDonor-site morbidityComplication rateKey concern
Autologous dermal fat graftPatient's own dermis and fatMean flaccid circumference gain at 6 mo: 1.67 cm (23 adults); 1.53 cm (15 post-hypospadias adults)Six-month outcomes in the principal series; longer-term retention uncertain[3][7]Yes (gluteal / abdominal)3/6 in Adhikari's small dermofat subgroup (one foreskin necrosis needing debridement; two liquefied-fat collections); no major events reported in Xu's 23-person series[32][3]Fat resorption; irregular nodules
Autologous fat injectionPatient's own fat+2.28 cm at 6 months in Kang[10]Unpredictable (25–80% resorption reported for fat grafts generally)[5]Minimal (liposuction)Low in the series cited; referral-center reports describe nodules and deformity[10][9]Unpredictable resorption; nodules; deformity
ADM wrap (human allografts in Solomon; type unspecified in Xu)Human cadaveric dermis (Solomon); ADM type unspecified (Xu)+1.1 cm at 3 months (Xu 2019, type unspecified); not reported (Solomon)VariableNone42% infection/open wound with graft exposure (Solomon); 60.3% erectile discomfort (Xu)High complication rate; "not ideal or safe" per Xu[13][14]
Porcine ADM wrap (Alei)Porcine dermis+3.1 cm flaccid / +2.4 cm erect1-year dataNoneNo major events reported; 9/69 graft fibrosis with minor penile retraction; 2/69 transient seromas[12]Single-center
PLGA scaffold and fibroblastsBiodegradable scaffold and autologous cells+3.15 cm mean in an 84-man follow-up subset[16]Stable collagen-rich neotissue on biopsy at a mean of 23 months in a separate 12-man series; median clinical follow-up 24 months in the 84-man subset[17][16]Minimal (scrotal biopsy)3 infections, 2 skin pressure necroses, 5 seromas; all treated conservatively; unique-patient rate not stated[16]Requires cell-culture lab; very limited availability
Albugineal expansion (vein or ePTFE)Autologous saphenous vein or ePTFE patchAustoni (vein, n = 39): erect diameter +1.1–2.1 cm at 9 months. Yang (mixed materials, n = 20): erect circumference +1.5–3.0 cm on table[19][20]Yang reported 0.5–1 cm loss in some patients by 12 months to 5 yearsLeg harvest with vein onlyNo serious complications reported in these small seriesTunical incisions; Yang also reported on-table flaccid circumference gain
Hardrock Sandwich TechniqueBovine pericardium + autologous plasma gel+43.1% (+4.51 cm at POD 1)Not established (POD-1 girth gain reported in the abstract)NoneSeroma 6.12%; dehiscence 2.34%; infection 2.65%; hematoma 1.40%; skin necrosis 0.22%; overall patient rate not statedSingle-center retrospective[29]
Penuma / HimplantSilicone elastomer (FDA 510(k))[28]+56.7% (+4.9 cm flaccid midshaft circumference) in a 400-man single-surgeon series[30]Girth measured through 30–90 days; patient-reported satisfaction reassessed at 2–6 years in 77% of the 400 consenting participants[30]None3% removal in the 400-man series; up to 10% in a narrative review[30][2]Permanent foreign body; single-surgeon foundational data

Part VII — Complications: Comprehensive Overview​

In a narrative review, surgical treatments were more often associated with serious complications than injection therapies: skin necrosis or ulcers, wound infection or reoperation were reported in 8 of 15 surgical studies (53.3%), whereas injection studies reported a low rate of mild complications.[1]

Wound-related.

  • Wound infection occurred in 4/78 patients (5.1%) in Xu 2019.[14] Solomon 2013 defined infection as an open wound with graft exposure and reported it in 20/47 patients (42%).[13]
  • Skin pressure necrosis occurred in 2/84 followed Perovic patients (2.4%); dorsal skin necrosis occurred in 3/78 Xu patients (3.8%).[16][14]
  • Delayed healing 15%.[14]
  • Hematoma 10%.[14]

Graft-related.

  • Erectile discomfort or constriction. This occurred in 60.3% of ADM-wrap patients in one series, and the graft may restrict penile expansion during erection.[14]
  • Unobvious augmentation effect occurred in 13%.[14]
  • Graft resorption or contraction is variable; dermal fat grafts show "inconspicuous" shrinkage in favorable series and unpredictable resorption in others.[3][9]
  • Graft removal required 9% with ADM.[14]
  • Penile length. Retrospective series of graft implantation report a negative effect on length.[2]

Severe / referral-center complications.

  • Furr 2018 referral series. Eleven patients presented after genital-enlargement procedures, including injected silicone, fat and subcutaneous implants, with sexually disabling penile deformity, severe shortening, curvature, edema, subcutaneous masses, infection, non-healing wounds and sexual dysfunction. Ten required corrective surgery, and 3 needed split-thickness skin grafting.[22]
  • Wessells 1996. Twelve men presented over 16 months after augmentation elsewhere (all had SLD, 10 had fat injection). Chief complaints were poor cosmetic appearance: irregular fat nodules in 7, skin deformity or scarring in 4 and scrotalization in 4. Six needed reoperation, 6 had wound complications and 4 reported sexual dysfunction. Only 1 reported a subjective length increase.[21]
  • Alter 1997. More than 30 patients presented for reconstruction of deformities after penile-enlargement surgery (SLD with V-Y advancement and autologous fat injection). Deformities included disappearance of fat, penile lumps and nodules, shaft deformity, hypertrophic scarring, proximal penile hump and low-hanging penis; 19 men underwent reconstruction.[23]

Part VIII — Critical Appraisal and Position Statements​

  • Vardi 2008. Comprehensive critical analysis of penile-enhancement procedures concluded that "unwanted outcomes and complications, namely penile deformity, paradoxical penile shortening, disagreeable scarring, granuloma formation, migration of injected material, and sexual dysfunction were reported frequently." Patient-satisfaction rates were "disappointing" in most studies. The authors concluded that these procedures should be regarded as investigational and that patients should be discouraged from undergoing them.[24]
  • Society positions. The 2024 SMSNA expert-opinion statement recommends against graft-and-flap penile augmentation until further outcome data are available.[25] The 2026 EAU guideline recommends against grafts, biodegradable scaffolds, and subcutaneous penile implants such as Penuma for girth enhancement because it considers them experimental (all Strong).[31] The 2026 ICSM report advises offering grafts and biodegradable scaffolds only with caution in an experimental environment.[26] For adults seeking cosmetic enhancement without structural or functional pathology, the 2026 BAUS consensus strongly recommends medical, surgical and psychosexual assessment with a focused examination and validated psychometric instruments, plus psychological referral when indicated; multidisciplinary care remains appropriate.[2][37]
  • Manfredi 2022 narrative review: "good efficacy and satisfaction with a non-negligible risk of complications in patients undergoing surgical treatments," but adverse events are "probably largely under-reported" and these procedures "should still be considered under investigation."[1]

Key Clinical Considerations​

  • The cited ADM series report different adverse outcomes: Solomon observed open-wound graft exposure in 20/47 recipients of human ADM, while Xu observed erectile discomfort in 47/78 recipients of ADM of unspecified type.[13][14] The Xu 2019 study (n = 78) concluded that ADM is "not an ideal or safe method" for penile girth enhancement, with erectile discomfort in 60%.[14]
  • Porcine ADM (Alei technique) gave the best ADM outcomes among the series cited (+3.1 cm flaccid girth, no major complications).[12]
  • PLGA tissue engineering (Perovic / Djordjevic) was reported by its originating group in 204 men, with 84 selected for 1–5-year follow-up; it described 3 infections, 2 skin pressure necroses and 5 seromas, all treated conservatively.[16] A separate 12-man histomorphometric study found stable collagen-rich neotissue on biopsy in 6 men at 22–24 months (mean 23 months).[17] It requires a cell-culture laboratory, is available at very few centers, and is a two-stage process (biopsy, weeks of cell culture, then implantation).[16][17][18]
  • In a 23-man dermal-fat graft series, no major complications were reported and graft shrinkage was inconspicuous; in a separate 15-man post-hypospadias series, no erection deficiencies or urinary fistula were reported at 6 months. Dermal-fat grafting did not require cell culture in either series.[3][7] Donor-site morbidity and variable fat survival remain limitations.[3][7]
  • Pure fat injection is technically the simplest, and its long-term results are unpredictable because of fat resorption. The referral-center reports cited describe complications after fat injection, including nodules and deformity.[9][21][23]
  • Most graft-based approaches require penile degloving. Xu's tunneling approach avoids shaft degloving; Alei's penopubic incision conceals the scar but degloves the shaft skin while preserving Buck's fascia.[7][12] Degloving carries risks of lymphatic disruption, edema, altered sensation and skin compromise.

See Also​

References​

1. Manfredi C, Romero Otero J, Djinovic R. Penile girth-enhancement procedures for aesthetic purposes. Int J Impot Res. 2022;34(4):337–342. doi:10.1038/s41443-021-00459-y

2. Ramazan M, Øbro LF, Wiborg MH, et al. Complications of penile augmentation: a narrative review of injectables, implants, and surgical grafts. Int J Impot Res. 2026;38(3):238–246. doi:10.1038/s41443-025-01190-8

3. Xu L, Zhao M, Chen W, et al. Augmentation phalloplasty with autologous dermal fat graft in the treatment of "small penis." Ann Plast Surg. 2016;77(Suppl 1):S60–S65. doi:10.1097/SAP.0000000000000782

4. Limido E, Weinzierl A, Harder Y, Menger MD, Laschke MW. Fatter is better: boosting the vascularization of adipose-tissue grafts. Tissue Eng Part B Rev. 2023;29(6):605–622. doi:10.1089/ten.TEB.2023.0069

5. Kølle SF, Fischer-Nielsen A, Mathiasen AB, et al. Enrichment of autologous fat grafts with ex-vivo expanded adipose-tissue-derived stem cells for graft survival: a randomised placebo-controlled trial. Lancet. 2013;382(9898):1113–1120. doi:10.1016/S0140-6736(13)61410-5

6. Spyropoulos E, Christoforidis C, Borousas D, et al. Augmentation phalloplasty surgery for penile dysmorphophobia in young adults: considerations regarding patient selection, outcome evaluation and techniques applied. Eur Urol. 2005;48(1):121–127. doi:10.1016/j.eururo.2005.02.021

7. Xu L, Zhao M, Yang Z, et al. Modified penile augmentation by dermal-fat graft in post-hypospadias adults. Aesthet Plast Surg. 2016;40(1):120–129. doi:10.1007/s00266-015-0593-6

8. Tocco I, Widgerow AD, Lalezari S, et al. Lipotransfer: the potential from bench to bedside. Ann Plast Surg. 2014;72(5):599–609. doi:10.1097/SAP.0000000000000154

9. Leithauser LG, Gilbert E, Barton J. Complications of fat grafting to the penis. Ann Plast Surg. 1995;34(2):173–175. doi:10.1097/00000637-199502000-00010

10. Kang DH, Chung JH, Kim YJ, et al. Efficacy and safety of penile girth enhancement by autologous fat injection for patients with thin penises. Aesthet Plast Surg. 2012;36(4):813–818. doi:10.1007/s00266-012-9891-4

11. Deskoulidi PI, Caminer D. Lengthening phalloplasty with division of the suspensory ligament and distally based fat flaps in penis-enlargement operations. Plast Reconstr Surg. 2023;152(3):434e–437e. doi:10.1097/PRS.0000000000010313

12. Alei G, Letizia P, Ricottilli F, et al. Original technique for penile girth augmentation through porcine dermal acellular grafts: results in a 69-patient series. J Sex Med. 2012;9(7):1945–1953. doi:10.1111/j.1743-6109.2012.02744.x

13. Solomon MP, Komlo C, Defrain M. Allograft materials in phalloplasty: a comparative analysis. Ann Plast Surg. 2013;71(3):297–299. doi:10.1097/SAP.0b013e318281aece

14. Xu T, Zhang G, Bai W, et al. Complications and management of penile girth enhancement with acellular dermal matrix. J Sex Med. 2019;16(12):2011–2017. doi:10.1016/j.jsxm.2019.09.010

15. Zhang X, Huang Z, Xiao Y, et al. Suspensory ligament release combined with acellular dermal matrix filler in infrapubic space: a new method for penile length augmentation. Andrologia. 2019;51(9):e13351. doi:10.1111/and.13351

16. Perovic SV, Byun JS, Scheplev P, et al. New perspectives of penile enhancement surgery: tissue engineering with biodegradable scaffolds. Eur Urol. 2006;49(1):139–147. doi:10.1016/j.eururo.2005.08.016

17. Perovic SV, Sansalone S, Djinovic R, et al. Penile enhancement using autologous tissue engineering with biodegradable scaffold: a clinical and histomorphometric study. J Sex Med. 2010;7(9):3206–3215. doi:10.1111/j.1743-6109.2009.01545.x

18. Djordjevic ML, Bumbasirevic U, Stojanovic B, et al. Repeated penile girth enhancement with biodegradable scaffolds: microscopic ultrastructural analysis and surgical benefits. Asian J Androl. 2018;20(5):488–492. doi:10.4103/aja.aja_35_18

19. Austoni E, Guarneri A, Cazzaniga A. A new technique for augmentation phalloplasty: albugineal surgery with bilateral saphenous grafts — three years of experience. Eur Urol. 2002;42(3):245–253. doi:10.1016/s0302-2838(02)00264-6

20. Yang B, Liu XR, Hong QQ, Qiu RS, Ji CY. A comparative study on two kinds of surgical procedures of penile corpora cavernosa augmentation. J Plast Reconstr Aesthet Surg. 2009;62(3):357–364. doi:10.1016/j.bjps.2008.11.033

21. Wessells H, Lue TF, McAninch JW. Complications of penile lengthening and augmentation seen at one referral center. J Urol. 1996;155(5):1617–1620. doi:10.1016/s0022-5347(01)66144-5. PMID 8627836

22. Furr J, Hebert K, Wisenbaugh E, Gelman J. Complications of genital-enlargement surgery. J Sex Med. 2018;15(12):1811–1817. doi:10.1016/j.jsxm.2018.10.007

23. Alter GJ. Reconstruction of deformities resulting from penile enlargement surgery. J Urol. 1997;158(6):2153–2157. doi:10.1016/s0022-5347(01)68185-0

24. Vardi Y, Har-Shai Y, Gil T, Gruenwald I. A critical analysis of penile-enhancement procedures for patients with normal penile size: surgical techniques, success, and complications. Eur Urol. 2008;54(5):1042–1050. doi:10.1016/j.eururo.2008.07.080

25. Trost L, Khera M, Köhler T, et al. Cosmetic penile-enhancement procedures: an SMSNA position statement. J Sex Med. 2024;21(6):573–578. doi:10.1093/jsxmed/qdae045

26. Chung E, Jenkins L, Moon DG, et al. "Penile augmentation and cosmetic surgery: recommendations from the Fifth International Consultation on Sexual Medicine (ICSM 2024)." Sex Med Rev. 2026;14(1):qeaf067. doi:10.1093/sxmrev/qeaf067

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