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Male Cosmetic Genital Surgery

Male cosmetic genital surgery is the elective or aesthetic end of male genital surgery: augmentation phalloplasty, girth enhancement, suspensory-ligament division, suprapubic lipectomy, Penuma, and scrotal aesthetic procedures. Reconstructive operations for trauma, oncologic resection, lichen sclerosus, FGM/C, or congenital anomaly are covered at 04e Genital Reconstruction; gender-affirming pathway surgery is covered at 04k Gender-Affirming Surgery. For the clinical-conditions framework on small penis syndrome (SPS) or penile dysmorphic disorder (PDD) see Small Penis Syndrome.

Society positions and evidence-quality caveat. The SMSNA 2024 position statement is expert opinion, limited by sparse research.[1] The EAU 2026 guideline gives strong recommendations against grafts and subcutaneous penile implants for girth enhancement because it considers them experimental.[31] The SMSNA statement covers injectable fillers, suspensory-ligament division, graft-and-flap procedures, silicone sleeve implants and sliding/slicing techniques.[1] Systematic reviews rate the study quality as low and describe augmentation procedures as investigational.[4][5] For comparison, ACOG Committee Opinion No. 795 (2020) states that procedures to alter sexual appearance or function, other than those done for clinical indications, are not medically indicated.[2] FIGO (2025) holds that it is ethically inappropriate for obstetrician-gynecologists to recommend, perform or refer patients for cosmetic genital surgery.[21] The FDA 2018 safety communication warned against energy-based devices for "vaginal rejuvenation" or cosmetic indications and reported no cleared device for these uses.[3] Screening for body dysmorphic disorder (BDD) and penile or genital dysmorphic disorder belongs at the start of every consultation.

Decision Framework​

Planning includes psychological assessment and objective measurement, followed by consideration of conservative therapy and, for selected indications, invasive options.[31] For adults without structural or functional penile abnormalities, BAUS/AGUS 2026 recommends against absorbable fillers and surgical enhancement; EAU 2026 weakly recommends fillers for girth enhancement and suspensory release in its congenital intrinsic-shortness section.[34][31] The 2026 ICSM identifies a high likelihood of additional procedures when cosmesis is suboptimal or functional complications occur and calls for counseling about this risk.[35] The 299-patient retrospective Penuma cohort excluded prior penile enhancement surgery and uncircumcised men; circumcision was offered at least three months before implantation, and the authors advised against implantation with impaired wound healing or current tobacco use.[32] The main sources follow.

  • SMSNA 2024 issued expert-opinion position statements on invasive procedures (Trost).[1]
  • Romero-Otero 2021 (BJU Int) reviewed 57 studies: 1,764 healthy men concerned about penile size and 2,587 men with concomitant pathology, mostly Peyronie's disease or erectile dysfunction. Study quality was low, and standardized criteria for efficacy, safety and satisfaction were missing.[4]
  • Vyas 2020 (Plast Reconstr Surg) reviewed augmentation phalloplasty in 1,192 patients (16 articles). The pooled complication rate was 14.6%, highest with combined length and girth procedures.[5]
  • Wessells 1996 (J Urol) described 12 men with complications of augmentation done elsewhere, and Furr 2018 (J Sex Med) described 11 referral-center patients with severe complications.[10][9]
  • Elist 2018 (single surgeon) and Siegal 2023 (single center) report early Penuma outcomes; Wilson 2022 is an invited update, and a 2024 four-center cohort of 299 men reported 5.0% erosion and 7.0% explantation for grade IIIb complications over a median 11.6 months.[11][12][13][32] Penuma/Himplant has FDA 510(k) clearance.[13]
  • Yang 2019 and 2020 are randomized trials of HA versus PLA fillers.[19][20]
  • Toussi 2021 (J Urol) is a randomized trial of penile traction therapy after prostatectomy.[17]
  • Mansfield 2020, Thomson 2024 and Zhang 2025 inform BDD screening.[6][14][15]

Mandatory Psychological Screening​

AssessmentToolAction if Positive
BDD screeningBDDQ-AS (7-item self-report, 1–2 min; adopted by the Thomson 2024 group to meet the Australian regulator's requirement for a validated screen); BDD-YBOCS (used to identify BDD in Zhang 2025, although its validated role is grading current BDD symptom severity rather than stand-alone screening)[15][36]Refer to psychiatry and do not proceed with cosmetic surgery. Cosmetic procedures are reported not to relieve core BDD symptoms and to be associated with persistent dissatisfaction[14][6][15]
Penile dysmorphic disorder / SPSBDDQ or Cosmetic Procedure Screening Scale for PDD, plus objective penile measurement; MGSIS records genital self-image.[31]Counsel on normal anatomy (Veale nomograms); CBT / psychosexual referral if pain remains; do not equate SPS with surgical indication
Realistic-expectation assessmentClinical interview; APPSSI may document expectations but lacks objective validation.[31]Defer surgery if expectations unrealistic; partner / counseling involvement
General prevalence framingBDD affects about 2.5% of US adults (Mansfield 2020) and 11.3% of one Chinese plastic-surgery outpatient cohort (n = 531, Zhang 2025)[6][15]Expect higher BDD prevalence in self-referring cosmetic-augmentation candidates

Objective Assessment​

Measure flaccid length, stretched penile length (SPL), erect length, and circumference using standardized technique. Published nomogram means (Veale 2015) are flaccid pendulous length 9.16 cm (n = 10,704), stretched length 13.24 cm (n = 14,160), erect length 13.12 cm (n = 692) and erect circumference 11.66 cm (n = 381).[18] Micropenis is defined statistically, as a stretched length well below the population mean, and warrants endocrine workup. Most men who request surgical penile enhancement have a normal-sized, fully functional penis (Vardi 2008), and the primary problem is often psychological.[7]

A 2022 narrative review of 14 papers (1,661 patients) found similar length gains from invasive and non-invasive approaches, judged the study quality low, and suggested non-invasive techniques as first-line treatment after psychological evaluation.[8] EAU 2026 strongly recommends against testosterone or other hormonal therapies solely to increase penile size after puberty.[31]

A 2022 narrative review of 14 papers (1,661 patients) found similar length gains from invasive and non-invasive approaches, judged the study quality low, and suggested non-invasive techniques as first-line treatment after psychological evaluation.[8]

Patient ConcernFirst-LineExpected Outcome
Short penile length (cosmetic)Penile traction therapy uses indication-specific protocols: short-penis extender cohorts reviewed by EAU 2026 used at least 4 hours/day for 3–6 months, whereas the randomized RestoreX trial after prostatectomy tested 30–60 minutes/day on 5–7 days/week.[31][17] Randomized data exist after prostatectomy and in Peyronie's disease; evidence for cosmetic lengthening in men with normal anatomy is very limited[16][17]Gain in normal anatomy is not established; +1.6 cm stretched length vs +0.3 cm in controls after prostatectomy
Apparent shortening from suprapubic adiposityWeight management.[31] Cryolipolysis has preliminary evidence: in Azab 2021, an uncontrolled prospective 46-man series, apparent stretched length increased from 12.1 to 12.88 cm across three sessions (p < 0.001), without reported long-term durability.[28]Variable; depends on fat reduction
Post-prostatectomy length lossPTT (RestoreX) ± VED. Toussi 2021 RCT (82 randomized; 6-month data in 55, with objective length measured in 26 PTT and 25 control patients): PTT +1.6 cm vs +0.3 cm in controls (p < 0.01)[17]Statistically significant length preservation in this indication
Psychological distress about normal-size penisCBT / psychosexual therapyAddresses BDD / SPS symptoms without procedural risk

Invasive-Procedure Selection by Clinical Goal​

Clinical GoalOption and evidenceAlternative(s)Avoid
Girth enhancement (70.6% girth-only procedures among 1,192 surgical augmentation recipients in 16 studies)[5]Hyaluronic-acid (HA) filler injection. Reversible (hyaluronidase) and office-based. Yang 2019 and 2020 randomized trials compared HA with PLA, and both increased girth;[19][20] Zhang 2022 (n = 38) reported +2.44 cm flaccid girth at 12 months;[26] Boiko 2023 (132 completing treatment and follow-up of 148 enrolled) reported +1.7 cm midshaft girth, and psychosocial gains did not correlate with size change[27]PLA filler (collagen-stimulating; not reversible; girth gain was greater with HA at 4 weeks in Yang 2019, with no significant difference at 48 weeks (31 of 72 participants dropped out during the 2019 trial), and showed no statistically significant between-group girth difference in Yang 2020, with 46 of 67 injected men completing 18-month follow-up);[19][20] Penuma silicone sleeve (FDA 510(k)-cleared, but EAU 2026 strongly recommends against subcutaneous implants for girth enhancement as experimental[13][31]; Elist 2018, single surgeon: among 400 consenting patients of 526 implanted, 56.7% midshaft girth increase at 30–90 days and 3% device removal;[11] Siegal 2023, single center, n = 49: 52% flaccid length increase with a mean follow-up of 6 months[12]); autologous fat injection (counsel on unpredictable resorption; in Wessells's 1996 series of 12 complication referrals after mixed procedures, 7 had residual fat nodules, 10 had received fat injection and all 12 had suspensory-ligament release)[10]Liquid silicone, paraffin and Vaseline — EAU strongly recommends against their use for girth enhancement; granulomatous inflammation can require reconstructive excision.[31] PMMA is included in the EAU's Weak recommendation for soft-tissue fillers, while SMSNA strongly recommends against permanent penile fillers.[31][1]
Visible flaccid-length enhancement; erect gain unprovenSuspensory-ligament division (SLD) ± V-Y plasty. In one 75-man series combining SLD, V-Y plasty and distally based fat flaps, the authors reported 2–4 cm of flaccid length gain; erect-length gain was not reported. Experienced surgeons only.[33]None — sliding / slicing penile-disassembly techniques are PD-specific, not cosmetic; see Sliding & Slicing Techniques (Peyronie's section)SLD without a plan to limit retraction (scrotalization in 4 of 12 patients in Wessells 1996);[10] SLD in a patient who does not understand that erect-state gain is minimal or absent
Apparent shortening (suprapubic lipodystrophy)Suprapubic liposuction (Ghanem 2017, n = 10: significant increase in flaccid and stretched length at 3 months)[29]Open suprapubic lipectomySurgical lipectomy in patient unwilling to address weight regain
Penoscrotal webbing (apparent shortening)Penoscrotal-Web Correction (Z-plasty) at the penoscrotal junction. The Álvarez Vega 2025 series is pediatric (100 consecutive Z-plasty procedures for mixed indications including penoscrotal webbing): 98% primary healing, and all 97 patients who completed follow-up had stable correction at 1–2 years[24]Combined SLD + suprapubic lipectomy + Z-plasty for maximal apparent length; ventral phalloplasty with IPP (Miranda-Sousa 2007, implant patients: 36 of 43 reported some increase in perceived length after web release)[30]Web correction without addressing suprapubic lipodystrophy when present; V-Y plasty in patients with diabetes (higher dehiscence risk has been reported)
Scrotal laxity / aesthetic concernsReduction scrotoplasty (Thomas 2021 Aesthet Plast Surg systematic review and proposed algorithm; 11 eligible articles, mostly case reports or technique descriptions;[25] vertical midline scrotal-skin resection ± Z-plasty for penoscrotal webbing). See Scrotal Reconstruction Atlas for the full reconstructive scrotal toolkitEnergy-based devices (RF / laser); no published scrotal-skin clinical evidence was identifiedAesthetic-only intervention without addressing buried-penis or lymphedema disease when present
Patient with refractory dissatisfaction after normal outcomeRe-evaluate for BDD, refer to psychiatry, and avoid repeat proceduresMental-health-led care + CBTSurgeon-shopping for repeat augmentation

Procedure-Specific Sub-Comparisons​

Girth: HA vs Penuma vs Autologous Fat​

FactorHA FillerPenuma (FDA-Cleared)Autologous Fat
ReversibilityReversible (hyaluronidase)Explantable, but removal can leave curvature or shortening and may require reconstruction; long-term removal risk is unknown[1]Irreversible (fat-resorption unpredictable)
DurabilityTemporary (repeat injections needed)Permanent unless removedVariable (resorption is unpredictable)
Evidence qualityBest of the three (randomized HA-versus-PLA trials, Yang 2019 and 2020;[19][20] 2023 meta-analysis of 4 studies, n = 283[23])Low (EAU 2026 rates long-term implant evidence level 4; retrospective Elist 2018 single-surgeon: 400 consenting patients of 526 implanted; Siegal 2023 single-center n = 49; Siegal 2024 four-center n = 299 with mean 11.6-month follow-up)[31][11][12][32]Lower (mostly retrospective; Wessells 1996 referral-center series: nodules in 7 of 12, sexual dysfunction in 4 of 12)
Complication severityMild, transient in most seriesModerate (seroma 4.8%, scar 4.5%, infection 3.3% in Elist 2018)[11]Potentially severe (nodules, deformity, necrosis, infection)
SettingOffice-basedOperating roomOperating room

A 2025 narrative review describes lower complication rates with standardized low-volume HA protocols than with PLA, PMMA, silicone or self-injected materials; in a randomized HA-versus-PLA trial, injection-related adverse events occurred in 3/33 versus 2/34 men (p = 0.972), and a 2023 meta-analysis found no significant difference in reported pain or inflammation.[22][20][23] Typical HA problems are migration, nodules, Tyndall effect, phimosis and infection.[22] A 2023 meta-analysis of four HA-versus-PLA studies (283 men) found greater girth enhancement with HA (P = 0.01).[23]

Length: PTT vs Suprapubic Lipectomy vs SLD​

FactorPTTSuprapubic LipectomySLD + V-Y
Anatomic basisNone — relies on tissue remodelingSuprapubic lipodystrophy (true anatomic cause of apparent shortening)Normal anatomy + desire for length
InvasivenessNon-invasiveMinimal–moderateModerate
Erect-length gainIndication-specific; gain in normal-anatomy cosmetic patients is unestablished[31][17]None (apparent only)Not established for combined SLD + V-Y; the cited series did not report erect length[33][1]
Flaccid-length gain+1–2 cmVariable (depends on fat volume)+1–4 cm
Risk of intercourse instabilityNoneNoneYes — loss of suspensory support
Compliance requirementHigh (daily × months)None post-opNone post-op

Postoperative Management​

  • PTT post-SLD. Traction is commonly advised to limit retraction and scar contracture and to maintain length gains.
  • Postoperative dressing. Follow procedure-specific dressing protocols after fat injection or HST. In the 299-patient Penuma series, patients used a protective mesh tube wrap without pressure.[32]
  • Sexual-activity restriction. Typically 4–6 weeks post-surgery.
  • Standardized follow-up measurements. Flaccid, SPL, erect and circumference measurements at 1, 3, 6 and 12 mo using the same technique as preoperative.
  • HA or PLA maintenance injections. Plan for repeat dosing as filler resorbs.
  • Weight management. Weight regain negates results after suprapubic lipectomy or liposuction.

Evidence Hierarchy and SMSNA 2024 Recommendations​

ProcedureSMSNA PositionEvidence LevelRecommendation
Penile traction therapyNot addressed (the SMSNA statement covered only injection and surgical procedures)[1]Randomized data after prostatectomy and in Peyronie's disease; limited for cosmetic use[16][17]Reasonable first step for length concerns
HA / PLA filler injectionLimited data suggest girth gain; SMSNA urges IRB-approved safety and efficacy analyses[1]Randomized HA-versus-PLA comparisons; limited long-term safety dataCounsel about uncertainty and complications, and assess for penile dysmorphic disorder before invasive treatment[1]
Penuma silicone implantSMSNA 2024 considers it investigational despite FDA 510(k) clearance[1]Retrospective series with limited long-term safety ascertainmentSMSNA advises IRB oversight with long-term safety endpoints, no patient cost, and experienced surgeons only[1]
Suspensory-ligament divisionMay provide modest flaccid gains; risk of instabilityLow (retrospective series)Caution; experienced surgeons only; discuss potential complications, including instability[1]
Autologous fat injectionSignificant complication riskLow (retrospective; high complication rates at referral centers)Approach with caution; counsel extensively
Non-autologous injectables (silicone / paraffin / Vaseline / PMMA)Strongly discouragedN/A — complication reports onlyStrongly discouraged for permanent fillers[1]

Treatment Database​

21 of 21 procedures
ProcedureDomainBest for / indication
Penile Traction TherapyNon-InvasiveFirst-line non-invasive lengthening; daily device wear over months.
Vacuum Erection Device (VED)Non-InvasiveAdjunct for post-prostatectomy rehabilitation; cosmetic length gain is unestablished.
CryolipolysisNon-InvasiveNon-invasive suprapubic fat reduction to expose buried length.
Hyaluronic Acid (HA) FillerInjectable GirthReversible girth augmentation with hyaluronidase rescue available.
Glans Augmentation with Hyaluronic AcidInjectable GlansOffice HA injection into the glans for cosmetic enlargement; experimental for premature ejaculation.
Polylactic Acid (PLA) FillerInjectable GirthLonger-lasting biostimulator girth augmentation; not reversible.
Autologous Fat InjectionInjectable GirthAutologous girth augmentation accepting variable resorption.
Non-Autologous InjectablesInjectable GirthHistorical / illicit silicone or paraffin — counsel against; manage complications.
Suspensory-Ligament Division (SLD)Surgical LengtheningFlaccid-length increase by exposing the inner portion of the corpora.
Suprapubic LipectomySurgical LengtheningSurgical fat reduction to expose buried penile length.
V-Y Advancement Plasty (all genital applications)Surgical LengtheningDorsal penopubic advancement, penoscrotal-web correction, V-Y scrotoplasty, buried-penis adjunct.
Penuma / HimplantSurgical GirthExperimental subcutaneous silicone sleeve for girth enhancement; EAU 2026 strongly recommends against use.
Hardrock Sandwich Technique (HST)Surgical GirthCombined girth augmentation with dermal-fat and biomaterial layering.
Dermal Fat Grafts / AlloDerm WrapsSurgical GirthInvestigational autologous or acellular dermal-matrix girth grafting; research-protocol use only (SMSNA 2024, ref. 1).
Reduction Scrotoplasty (Scrotal Lift / Tuck)Scrotal AestheticBothersome scrotal laxity hanging > 1–2 cm below penile tip (Thomas 2021 algorithm).
Penoscrotal-Web Correction (Z-Plasty)Scrotal AestheticPersistent penoscrotal webbing; Z-plasty release at the junction (pediatric series of 100 mixed Z-plasty procedures: 98% primary healing; ref. 24).
Reduction Scrotoplasty + Z-Plasty (Combined)Scrotal AestheticCoexistent scrotal laxity and penoscrotal webbing — combined midline resection + Z-plasty; adjunct to IPP.
Scrotal BoNT/A Injection ("Scrotox")Scrotal AestheticOff-label dartos relaxation for smoother, lower-hanging scrotum; counsel re: fertility + thermoregulatory signals.
V-I Penoscrotal Reconfiguration (Bagnara)Scrotal AestheticPediatric congenital webbed penis — flap-free linear closure after dartos-band release.
Scrotal-Raphe Approach for Concealed Penis (Borsellino)Reconstructive ContextPediatric buried / webbed penis — scrotal-raphe approach; the linked page gives subtype outcomes and follow-up with the original citation.
Longitudinal Incision + Penoscrotal-Angle Reconstruction (Xu)Scrotal AestheticConcealed penis — degloving + ventral longitudinal incision + tunica-to-dartos fixation.

See Also​

References​

1. 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

2. Committee on Gynecologic Practice, American College of Obstetricians and Gynecologists. Elective female genital cosmetic surgery: ACOG Committee Opinion No. 795. Obstet Gynecol. 2020;135(1):e36–e42. doi:10.1097/AOG.0000000000003616

3. US Food and Drug Administration. Statement on efforts to safeguard women's health from deceptive health claims and significant risks related to devices marketed for use in medical procedures for "vaginal rejuvenation". FDA Safety Communication. 2018. fda.gov

4. Romero-Otero J, Manfredi C, Ralph D, et al. Non-invasive and surgical penile-enhancement interventions for aesthetic or therapeutic purposes: a systematic review. BJU Int. 2021;127(3):269–291. doi:10.1111/bju.15145

5. Vyas KS, Abu-Ghname A, Banuelos J, Morrison SD, Manrique O. Aesthetic augmentation phalloplasty: a systematic review of techniques and outcomes. Plast Reconstr Surg. 2020;146(5):995–1006. doi:10.1097/PRS.0000000000007249

6. Mansfield AK. Genital manifestations of body dysmorphic disorder in men: a review. Fertil Steril. 2020;113(1):16–20. doi:10.1016/j.fertnstert.2019.11.028

7. 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

8. García Gómez B, Alonso Isa M, García Rojo E, Fiorillo A, Romero Otero J. Penile-length-augmentation surgical and non-surgical approaches for aesthetic purposes. Int J Impot Res. 2022;34(4):332–336. doi:10.1038/s41443-021-00488-7

9. 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

10. 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

11. Elist JJ, Valenzuela R, Hillelsohn J, Feng T, Hosseini A. A single-surgeon retrospective and preliminary evaluation of the safety and effectiveness of the Penuma silicone-sleeve implant for elective cosmetic correction of the flaccid penis. J Sex Med. 2018;15(9):1216–1223. doi:10.1016/j.jsxm.2018.07.006

12. Siegal AR, Zisman A, Sljivich M, Razdan S, Valenzuela RJ. Outcomes of a single center's initial experience with the Penuma penile implant. Urology. 2023;171:236–243. doi:10.1016/j.urology.2022.07.066

13. Wilson SK, Picazo AL. Update on the Penuma — an FDA-cleared penile implant for aesthetic enhancement of the flaccid penis. Int J Impot Res. 2022;34(4):369–374. doi:10.1038/s41443-021-00510-y

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15. Zhang Y, Lyu Y, Liu D, et al. Exploring the prevalence and etiological factors of body dysmorphic disorder in cosmetic-surgery populations. Aesthet Plast Surg. 2025;49(14):4082–4086. doi:10.1007/s00266-024-04616-8

16. Sultana A, Grice P, Vukina J, Pearce I, Modgil V. Indications and characteristics of penile-traction and vacuum-erection devices. Nat Rev Urol. 2022;19(2):84–100. doi:10.1038/s41585-021-00532-7

17. Toussi A, Ziegelmann M, Yang D, et al. Efficacy of a novel penile-traction device in improving penile length and erectile function post-prostatectomy: results from a single-center randomized, controlled trial. J Urol. 2021;206(2):416–426. doi:10.1097/JU.0000000000001792

18. Veale D, Miles S, Bramley S, et al. Am I normal? A systematic review and construction of nomograms for flaccid and erect penis length and circumference in up to 15,521 men. BJU Int. 2015;115(6):978–986. doi:10.1111/bju.13010

19. Yang DY, Ko K, Lee SH, et al. A comparison of the efficacy and safety between hyaluronic acid and polylactic acid filler injection in penile augmentation: a multicenter, patient/evaluator-blinded, randomized trial. J Sex Med. 2019;16(4):577–585. doi:10.1016/j.jsxm.2019.01.310

20. Yang DY, Jeong HC, Ko K, et al. Comparison of clinical outcomes between hyaluronic and polylactic acid filler injections for penile augmentation in men reporting a small penis: a multicenter, patient-blinded/evaluator-blinded, non-inferiority, randomized comparative trial with 18 months of follow-up. J Clin Med. 2020;9(4):1024. doi:10.3390/jcm9041024

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22. Pignanelli M, Williams JM, Fernandez Crespo RE, et al. Complications and management of penile enhancement procedures. Transl Androl Urol. 2025;14(10):3367–3376. doi:10.21037/tau-23-519

23. Kusumaputra A, Setiawan MR, Soebadi MA, et al. Efficacy and complications of hyaluronic acid and polylactic acid for penile augmentation: a systematic review and meta-analysis. Ann Med Surg (Lond). 2023;85(9):4531–4538. doi:10.1097/MS9.0000000000001094

24. Álvarez Vega DR, Mendelson JL, Gitlin JS, Joshi P, Hanna MK. Optimizing pediatric genital reconstruction: the role of Z-plasty in enhancing aesthetic and functional outcomes. Urology. 2025;204:186–191. doi:10.1016/j.urology.2025.06.011

25. Thomas C, Navia A. Aesthetic scrotoplasty: systematic review and a proposed treatment algorithm for the management of bothersome scrotum in adults. Aesthet Plast Surg. 2021;45(2):769–776. doi:10.1007/s00266-020-01998-3

26. Zhang CL, Quan Y, Li H, et al. Penile augmentation with injectable hyaluronic acid gel: an alternative choice for small penis syndrome. Asian J Androl. 2022;24(6):601–606. doi:10.4103/aja20223

27. Boiko MI, Notsek MS, Boiko OM. The efficacy of injection penile girth enhancement as an option for small penis syndrome management. Aesthet Surg J. 2023;44(1):84–91. doi:10.1093/asj/sjad152

28. Azab SS, Hamed HA, Elseginy A, et al. Increase apparent penile length by cryolipolysis in the reduction of male suprapubic fat. Andrologia. 2021;53(3):e13963. doi:10.1111/and.13963

29. Ghanem H, ElKhaiat YI, Motawi AT, et al. Infrapubic liposuction for penile length augmentation in patients with infrapubic adiposities. Aesthet Plast Surg. 2017;41(2):441–447. doi:10.1007/s00266-017-0786-2

30. Miranda-Sousa A, Keating M, Moreira S, Baker M, Carrion R. Concomitant ventral phalloplasty during penile implant surgery: a novel procedure that optimizes patient satisfaction and their perception of phallic length after penile implant surgery. J Sex Med. 2007;4(5):1494–1499. doi:10.1111/j.1743-6109.2007.00551.x

31. European Association of Urology. "EAU Guidelines on Sexual and Reproductive Health: Penile Size Abnormalities and Dysmorphophobia." 2026. EAU guideline

32. Siegal AR, Celtik KE, Razdan S, et al. "A multi-institutional update on surgical outcomes after penile silicone sleeve implantation." Ther Adv Urol. 2024;16:17562872241241858. doi:10.1177/17562872241241858

33. 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

34. Mubarak M, Kalejaiye O, Kumar V, et al. "British Association of Urological Surgeons (BAUS) consensus document on male genital augmentation and enhancement procedures." J Clin Urol. 2026;19(2):149–166. doi:10.1177/20514158251391054

35. 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

36. Snorrason I, Jaroszewski AC, Greenberg JL, et al. "Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder: Factor Structure and Construct Validity of Subfactors." J Obsessive Compuls Relat Disord. 2024;42:100881. doi:10.1016/j.jocrd.2024.100881