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Non-Autologous Penile Injectables — Paraffin, Mineral Oil, Vaseline, Liquid Silicone, PMMA

Non-autologous penile injectables, including liquid silicone (industrial), paraffin or mineral oil, Vaseline (petroleum jelly), and polymethylmethacrylate (PMMA), are substances injected subcutaneously into the penile shaft for girth augmentation. The oil-based substances (paraffin, mineral oil, Vaseline) and industrial liquid silicone are not used in medical practice because of severe complications, including sclerosing lipogranuloma (paraffinoma or siliconoma), necrosis, and penile destruction. The SMSNA 2024 position statement strongly recommends against penile fillers made of permanent materials, including paraffin and silicone.[1][2][31] PMMA remains off-label for penile use. The EAU 2026 guideline discusses PMMA, weakly recommends soft-tissue fillers for penile girth enhancement, and strongly recommends against their use in men with penile dysmorphic disorder; the SMSNA 2024 position strongly recommends against permanent penile fillers.[31][32] For adults without structural or functional penile abnormalities, BAUS/AGUS 2026 strongly recommends comprehensive medical, surgical and psychosexual assessment with validated psychometric measures for all augmentation requests, with psychological referral when indicated; it strongly recommends against non-absorbable penile fillers because of severe complications, reoperation and long-term morbidity, and recommends against absorbable fillers because high-quality supporting evidence is absent.[37] One large series reports favorable short-term outcomes, but PMMA lacks FDA approval for penile use and is permanent; capsular contracture has been described after PMMA filler injection at other sites, but its penile frequency is unknown.[2][3][12][34]

For the broader male cosmetic-genital-surgery decision framework see the Male Cosmetic Genital Surgery atlas page. For the foundations biomaterial profile of injected liquid silicone see Free Silicone Injection. For the operative atlas of the reconstructions these injections drive, see Penile Skin / Shaft Reconstruction (04e).

Do not offer silicone, paraffin or oil-based fillers for penile girth enhancement. The ICSM 2024 consensus, published in 2026, gives this a Strong Recommendation with Moderate Quality of Evidence.[33] Published complication reports include self-injection and unregulated injection, while the Casavantes PMMA series describes physician-administered injections in a medical office.[1][3] Counseling should state that EAU strongly recommends against silicone, paraffin and Vaseline, gives a Weak recommendation for soft-tissue fillers as a class, and gives a Strong recommendation against HA, soft-tissue fillers and autologous fat for men with penile dysmorphic disorder; SMSNA strongly recommends against permanent fillers.[32][31] PMMA penile injection remains off-label despite favorable single-practitioner short-term data.[1][2][3][31][32][34]

I. Historical Context and Epidemiology​

The practice of injecting foreign materials into the penis for augmentation has been documented for over 1,500 years. In modern times the practice persists primarily in specific populations and geographic regions.[1][2][4][5][6]

  • Southeast Asia. Particularly Thailand, Myanmar, Laos, Vietnam, the Philippines (mineral oil or Vaseline injection widespread among migrant workers and military personnel).
  • Central and Eastern Asia. Kazakhstan, Korea, parts of Russia.
  • Eastern Europe. Bulgaria, Romania, Hungary.
  • Immigrant communities. Laotian, Thai, and Southeast Asian immigrants in Western countries.
  • Incarcerated populations. Prison settings worldwide; injections performed with improvised materials.

The largest published series, Svensøy 2018, documented 680 patients presenting with complications from penile mineral-oil self-injection at a single Thailand–Myanmar border clinic over 5 years. The authors conclude that the practice is more prevalent than previously acknowledged.[4]

Demographics (Pang 2024 single-centre cohort, n = 35)[1]​

  • Mean age at presentation 36.9 years (SD 9.1; range 22–61).
  • Mean time between injection and presentation 7.8 years (SD 5.8; range 1 day to 20 years).
  • Most common injection site: penile shaft (33/35, 94.3%); foreskin and scrotum were each reported in 11/35 (31.4%).[1]
  • The accompanying systematic review of 68 studies found paraffin (112/235, 47.7%) and silicone (37/235, 15.8%) to be the most commonly recorded substances among patients with injectate data.[1]
  • Most injections are self-administered or performed by non-medical personnel (lay practitioners, traditional healers, fellow inmates).

II. Substances Used​

A. Paraffin / mineral oil / Vaseline (petroleum jelly)​

Paraffin was the most frequently identified substance in Pang 2024: 112 of 235 review patients with injectate data (47.7%).[1]

  • Liquid paraffin (mineral oil). Saturated hydrocarbons (C24–C40) derived from petroleum distillation.[7]
  • Vaseline (petroleum jelly). Semi-solid hydrocarbons, often heated to liquid form before injection; the most common substance in the Kazakhstan series (16 of 18 patients, 88.9%).[8]
  • "Super Extenze". A mineral-oil compound with tocopherol acetate (vitamin E) marketed in the US; identified by mass spectroscopy in a series of Laotian immigrants.[5]
  • Baby oil, cooking oil, cod-liver oil also reported.[6]

Injected oil-based substances can produce sclerosing lipogranuloma (paraffinoma or oleogranuloma).[1][9]

B. Free liquid silicone (grade often unreported)​

Second most commonly injected substance. Silicone accounted for 37 of 235 review patients with injectate data (15.8%) and 16 of 35 men in the UK single-centre series (45.7%).[1]

  • Industrial-grade liquid silicone is polydimethylsiloxane and is not medical-grade silicone.
  • Often obtained from hardware stores, automotive suppliers, or industrial sources.
  • Injected by non-medical practitioners or self-administered.
  • Free silicone can produce a foreign-body granulomatous reaction termed siliconoma; a penile silicone lesion has also been diagnosed histologically as sclerosing lipogranuloma.[45]
  • Unlike medical-grade silicone (used in breast implants within a shell), free liquid silicone injected into tissues cannot be fully removed and migrates along tissue planes.[1][2]

This is a fundamentally different category from the FDA-cleared preformed silicone penile implant (Penuma, later rebranded Himplant)[31][35]; see Penuma & Himplant for that contrast.

C. Polymethylmethacrylate (PMMA)​

PMMA has published series from medical settings.[3][10]

  • Metacrill. A suspension of PMMA microspheres in carboxymethyl-cellulose carrier gel, used primarily in Latin America.[3] In one microscopy study of Metacrill 30%, 76.1% of measured particles were 1–36 µm rather than uniformly 30–50 µm.[41]
  • Lipen-10. A cross-linked dextran plus PMMA mixture developed in South Korea.
  • Bellafill (ArteFill). FDA-approved for nasolabial folds and moderate-to-severe atrophic, distensible cheek acne scars (not for penile use); contains PMMA microspheres in bovine collagen.[36]
  • PMMA is permanent and non-resorbable; microspheres become encapsulated by fibrous tissue, creating a permanent volumizing effect.
  • Not FDA-approved for penile injection. All penile use is off-label or with non-FDA-approved formulations.[3]

D. Other substances (less common)​

  • Polyacrylamide hydrogel (PAAG). Eastern European and Asian series.
  • Cod-liver oil, sesame oil, olive oil. Isolated case reports.
  • Metallic mercury. Extremely rare; reported in psychiatric patients.

III. Pathophysiology — The Foreign-Body Granulomatous Response​

Oil-based substances and free silicone can produce chronic foreign-body granulomatous inflammation. PMMA microspheres may be surrounded by fibrous capsules; nodules and contracture have been described, but the cited penile PMMA series documented no true granulomas.[3][7][9][11][12]

A. Sclerosing lipogranuloma (paraffinoma / oleogranuloma) — oil-based substances​

Smetana and Bernhard introduced the term in 1950; Oertel and Johnson later proposed defining the genital lesion as a local reaction to injected exogenous lipid.[52][9]

Histopathological features.[7][9][13]

  • "Swiss cheese" pattern. Multiple variably sized round-to-oval vacuoles (lipid spaces) within a dense fibrous stroma, giving the tissue a sponge-like appearance.
  • Multinucleated foreign-body giant cells surrounding and engulfing lipid vacuoles.
  • Dense fibrosis and sclerosis. Progressive replacement of normal subcutaneous tissue with dense collagenous scar.
  • Chronic inflammatory infiltrate. Lymphocytes, histiocytes, plasma cells.
  • No birefringence under polarized light (distinguishing from crystalline foreign bodies).
  • Infrared absorption spectrophotometry confirms paraffin hydrocarbons in 21/23 cases in the Oertel series.[9]
  • Field-desorption mass spectrometry identifies saturated hydrocarbons (C24–C40), confirming exogenous origin.[7]

Differential diagnosis on histology. Adenomatoid tumor, sclerosing liposarcoma, lymphangioma.[9]

Pathological progression.[1][4][8][11]

  1. Acute phase (days–weeks): local inflammation, edema, erythema.
  2. Subacute phase (weeks–months): granuloma formation, induration, nodularity.
  3. Chronic phase (months–years): progressive fibrosis, skin ulceration, fistula formation, tissue necrosis.
  4. Late complications (years–decades): penile deformity, buried penis, urethral obstruction, erectile dysfunction, lymphedema, autoamputation.

B. Siliconoma — liquid silicone​

  • Foreign-body giant cell reaction with silicone droplets visible as clear vacuoles.
  • Fibrotic encapsulation of silicone deposits.
  • Regional extension. After genital silicone injection, deposits can extend into suprapubic tissue; scrotal involvement is reported.[1][6]
  • More difficult to excise completely than paraffinoma due to diffuse tissue infiltration.

C. PMMA granuloma​

  • Individual microsphere encapsulation. Each PMMA microsphere becomes surrounded by a thin fibrous capsule.[12]
  • Capsular contracture. When capsules are close together they form concentric capsular groups, leading to tissue hardening and clinical nodulation.[12]
  • Late complications after PMMA filler use at nonpenile sites have included nodules, extrusion, and local hardening; their frequency after penile injection is unknown.[12]
  • The pathological process differs from oil-based granulomas in that PMMA microspheres maintain their spherical shape and do not dissolve or migrate as readily.

IV. Clinical Presentation​

A. Presenting symptoms (Pang 2024 SR)[1]​

SymptomIncidence
Pain, swelling, or penile deformity715/918 (77.9%) of literature patients in Pang’s review[1]
Cosmetic dissatisfaction20/35 (57.1%) in Pang’s single-centre series[1]
Pain and / or swelling16/35 (45.7%) in Pang’s single-centre series[1]
Penile or scrotal necrosis at presentation3 of 35 (8.6%; 2 penile, 1 scrotal) in the UK series[1]; 13 of 18 (72.2%) in the Kazakhstan mixed-injectate series[8]
Purulent secretion21.8% (680-patient Thai series[4])
Ulceration12.8%[4]
Induration42.9%[4]
Erectile dysfunctionVariable; reported in multiple series[14][15]
Voiding difficulty / urethral obstructionWhen granuloma compresses the urethra[14][15]
PhimosisWhen prepuce involved[15]
LymphedemaChronic penile and scrotal lymphedema from lymphatic obstruction[1]

B. Time course​

The latency between injection and clinical presentation is highly variable.[1][4][6][15]

  • Acute presentations (days–weeks): pain, swelling, infection, necrosis.
  • Delayed presentations (months–years): progressive induration, deformity, cosmetic dissatisfaction.
  • Mean time to presentation: 7.8 years (Pang); 10.8 years (Kazakhstan series); 36.7 months (Thai series).
  • Presentations as late as 20–30 years after injection have been documented.

V. Imaging​

A. Ultrasound[11][14][16]​

  • Heterogeneous echogenicity of the subcutaneous tissue.
  • Hyperechoic foci with posterior acoustic shadowing. Shadowing can occur with chronic foreign-material nodules.[46]
  • Color Doppler. May show hypervascularity in acute inflammation or avascularity in necrotic areas.
  • Useful for initial assessment and guiding surgical planning.
  • Limitations: operator-dependent; may not fully delineate the extent of disease.

B. MRI[11][17][18][19][20][21]​

  • T1-weighted. Heterogeneous signal; oil-based substances may show intermediate-to-high signal (lipid content).
  • T2-weighted. Heterogeneous, often with areas of low signal (fibrosis) and high signal (inflammation or edema).
  • Post-contrast. Enhancement varies; chronic penile paraffinoma has shown minimal or no enhancement in case reports.[47][48]
  • Role. Delineating the extent of tissue involvement for surgical planning; MRI findings may overlap with those of malignancy.[11][21]
  • Paraffinoma can mimic liposarcoma on imaging, as reported for an abdominal-wall paraffinoma; the history of injection is needed for correct diagnosis.[21]
  • Small round components hypointense on all sequences were seen in that case.[21]

C. CT for suspected gas-forming infection​

In selected patients with suspected Fournier gangrene, CT can show subcutaneous gas and map scrotal or perineal extension.[11]

D. Ascending urethrography[11]​

  • Indicated when urethral involvement is suspected.
  • May demonstrate urethral compression, stricture, or fistula.

VI. Complications — Comprehensive List​

Complications range from cosmetic dissatisfaction to life-threatening emergencies.[1][2][4][8]

Local.

  • Penile deformity: irregular nodularity, asymmetry, grotesque enlargement.
  • Penile pain: 84% in the 680-patient series.[4]
  • Penile swelling: 82.5%; induration: 42.9% in the 680-patient complication cohort.[4]
  • Skin ulceration: 12.8%.[4]
  • Purulent secretion: 21.8% in the 680-patient complication cohort.[4]
  • Necrosis at presentation: 3 of 35 (8.6%; 2 penile, 1 scrotal) in the UK series and 13 of 18 (72.2%) in the Kazakhstan series.[1][8]
  • Erectile dysfunction: from fibrosis encasing the corpora cavernosa.
  • Urethral obstruction: from circumferential granuloma compressing the urethra.
  • Phimosis: when prepuce involved.
  • Fistula formation: urethrocutaneous or cutaneous.

Regional.

  • Scrotal involvement: migration of injected material to the scrotum.
  • Perineal extension: granuloma extending to the perineum.
  • Inguinal lymphadenopathy: granulomatous involvement of regional lymph nodes.[5]
  • Penile or scrotal lymphedema: chronic lymphatic obstruction.

Catastrophic.

  • Penile amputation. Pang’s mixed-injectate review recorded two surgical amputations: one partial penectomy after HA-associated necrosis and one total penectomy after metallic-mercury injection.[1]
  • Gangrene requiring emergency debridement.[2]
  • Fournier’s gangrene. Necrotizing infection has been reported after penile injection.[32] For suspected Fournier’s gangrene, EAU 2026 recommends broad-spectrum antibiotics on presentation and repeated surgical debridement within 24 hours (both Strong).[43]
  • Sepsis and death: reported in the literature.[2]

VII. PMMA — The Controversial Exception​

PMMA differs from oil-based substances because it has been injected in a medical setting and reported in clinical series, although significant concerns remain.[3][10][12]

Casavantes & Lemperle 2016 (752 treated; 729 records and 203 questionnaires evaluated)[3]​

  • The largest published series of penile PMMA injection.
  • Product: Metacrill (PMMA microspheres in carboxymethyl-cellulose), injected subcutaneously.
  • 1–3 injection sessions.
  • In Casavantes’s uncontrolled series, paired flaccid mid-shaft girth measurements increased from 10.54 to 12.76 cm (2.22 cm) among 203 men; the abstract’s 3.5-cm figure conflicts with these measurements.[3]
  • Mean length increase 0.7 cm (9.8 to 10.5 cm), attributed by the authors to the weight or stretching force of the implant.
  • Among 203/729 questionnaire responders, overall satisfaction was 8.7/10.[3]
  • About half of questionnaire responders perceived contour irregularities, which the authors report caused no problems; among the same 203 responders, 1.5% reported decreased erectile function and 2% reported decreased penile sensitivity.[3]
  • PMMA nodule excision was recorded in 3/729 men (0.4%), all uncircumcised.[3]
  • Authors' conclusion: PMMA "appears to be a natural, safe, and permanently effective method."

Lipen-10 (PMMA + cross-linked dextran) — Yang 2013 (n = 20)[10]​

  • In 20 men, flaccid girth increased 3.7 cm (50.8%) at the base and 4.2 cm (59.0%) at mid-shaft at 6 months.[10]
  • In 20 men, flaccid length increased 2.3 cm (63.2%) at 6 months.[10]
  • Complications: one mild asymmetry required a corrective procedure, and a 5-mm nodule persisted through 18 months; 15/20 men completed 18-month follow-up.[10][44]
  • No serious adverse events.

Critical concerns about PMMA[2][12][22]​

  • Permanence is a double-edged sword. PMMA cannot be dissolved or easily removed if complications arise, unlike hyaluronic acid (dissolved with hyaluronidase).
  • Capsular contracture. A nonpenile PMMA complication series described hardening, nodules and filler extrusion; the frequency after penile injection is unknown.[12]
  • Late complications may take years to manifest. A prospective, nonrandomized 24-week comparison recorded local adverse events in 6/42 recipients (14.3%) of a PMMA-containing filler.[3][38]
  • Not FDA-approved for penile use. Metacrill is not FDA-approved at all; Bellafill is FDA-approved only for nasolabial folds and acne scars.[3]
  • Non-standardized products. Many PMMA formulations used internationally lack regulatory oversight.
  • Bias concerns. The Casavantes series was conducted by the developer or practitioner of the technique; only 203 of 729 surveyed patients returned questionnaires (27.8%).[3]
  • The Ramazan 2026 narrative review classified oil-based injectables as causing "sclerosing lipogranuloma requiring complex treatments" and noted that even regulated injectables carry risks.[2]

VIII. Surgical Management of Complications​

For the dedicated atlas page covering operative steps, six reconstructive options, single-stage versus two-stage scrotal-flap selection, NPWT-assisted STSG protocol, and outcomes by series, see Paraffinoma Excision and Penile Resurfacing.

A. Principles[1][8][23][24][25][26]​

  • Acute necrosis. In Pang’s retrospective series, the three men with penile or scrotal necrosis underwent acute debridement, then deferred foreign-material excision and scrotal-flap reconstruction.[1] For other symptomatic or destructive disease, excise clinically involved foreign-body tissue according to anatomic extent and viable skin.[1][25]
  • Residual granulomatous tissue persists if excision is incomplete.
  • Malignancy assessment. If an ulcer or mass is suspicious and malignancy is not clinically obvious, obtain pretreatment biopsy before definitive resurfacing .[42]
  • Resurface the shaft if excision leaves it denuded.[1][23]
  • A multidisciplinary approach (urology and plastic surgery) is often necessary.[25]
  • Postoperative glans necrosis has been reported after paraffinoma removal (four cases in a 2025 systematic review).[40]

B. Surgical techniques​

Per the Pang 2024 SR and multiple case series.[1][8][23][24][25][26]

  1. Local excision with primary closure. For limited disease; it was the most common primary procedure among the 32 operated men in Pang (19/32, 59.4%) and was used in 9/18 (50%) in the Kazakhstan series.[1][8] Feasible when sufficient uninvolved penile skin remains. Circumcision was the primary procedure in 5/32 operated men (15.6%) in Pang’s series.[1]
  2. Excision with split-thickness skin graft (STSG). For extensive disease where primary closure is not possible. Kang 2026 reported 11 mixed-injectate patients (six Vaseline, one Vaseline plus HA, one HA and three unknown; none identified as paraffin) treated with NPWT, Matriderm and STSG. Near-complete graft take occurred in 10/11 (90.9%) at the day-5 dressing change; median satisfaction was 37/45 and median follow-up was 18 months.[24]
  3. Excision with full-thickness skin graft (FTSG). Has been described in case reports and reviews (Lauria 2026 used grafts from the biceps and thigh).[14][26]
  4. Scrotal-skin flap reconstruction. The most commonly used flap technique requires sufficient uninvolved, well-perfused scrotal skin; extensive anterior or whole-scrotal infiltration can preclude it.[8][23][26] Techniques include:
    • Bipedicle scrotal-skin flap (Murányi 2022, n = 49). Denuded penis pulled through a subcutaneous tunnel created between a scrotal incision and proximal penile incision. The overall complication rate was 26.5%. Of the 30 patients who completed the questionnaire, 27 (90%) rated surgery successful and all reported sexual-intercourse ability.[23]
    • Two-stage scrotal-skin flap. Stage 1: excision and burial of denuded penis in scrotal skin; Stage 2: release of penis from scrotum after skin maturation for definitive coverage. In a nonrandomized comparison, 10/12 two-stage versus 10/23 single-stage patients had no Clavien-Dindo complication, while mean total hospital stay was 10.86 versus 7.43 days.[39]
  5. Medial prepuce-suprapubic advancement flap. For cases with intact prepuce and suprapubic skin.[26]
  6. Penile amputation. 2 cases reported in the SR; the most extreme outcome.[1]

C. Outcomes of surgical reconstruction​

StudynTechniqueGraft / flap takeErectile functionComplications
Murányi 2022[23]49Bipedicle scrotal flapGraft/flap take not reported; 27 of 30 questionnaire responders (90%) were satisfied or very satisfied at least 18 months after surgeryED in 2 of 30 responders26.5% overall (Clavien 1–3b)
Kang 2026[24]11NPWT + Matriderm + STSG10 of 11 (90.9%) near-complete at day 5Not reportedPartial graft loss with hematoma 1/11 (9.1%); chronic discharge from remnant filler 1/11 (9.1%)
Marín-Martínez 2023[25]8 analyzed (10 treated; 2 lost)Single / two-stage (algorithm)Graft/flap take not separately reported; surgery successful in all 8 analyzed at mean 16-month follow-upErectile function preserved in all 8 analyzedVariable
Napolitano 2023 (SR)[26]152Multiple techniquesVariableVariableReported postoperative events include wound disruption, delayed healing, infection, scar contracture, and focal necrosis
Suleiman 2024[8]18Excision with primary closure (9) or two-stage scrotal flap (9)Not reportedNot reportedNecrosis 72.2% at presentation
Svensøy 2018[4]680Surgery in 507/680 (74.6%): 503 excisions, 4 circumcisionsNot reportedNot reportedPostoperative complications not reported; pain (84%) and swelling (82.5%) were presenting symptoms

D. Repeat procedures​

A striking feature of surgical management is the high rate of repeat operations.[1]

  • Pang 2024 single-centre series: 18/35 (51.4%) required > 1 procedure.[1]
  • 8/35 (22.9%) required 3 or more procedures in Pang’s cohort.[1]
  • Pang did not distinguish planned stages from complication-driven reoperations in the 18/35 count.[1]

For the operative atlas of these reconstructions see Penile Skin / Shaft Reconstruction (04e).

IX. Comparison of Non-Autologous Injectables​

FeatureParaffin / mineral oil / VaselineLiquid silicone (industrial)PMMA (Metacrill)
Guidance and US approvalEAU Strong recommendation against penile use[32]EAU Strong recommendation against penile use; injectable silicone is not FDA-approved for aesthetic augmentation[32][34]No FDA-approved penile filler indication; EAU Weak recommendation for soft-tissue fillers as a class, while SMSNA strongly recommends against permanent fillers[31][32][34]
SettingSelf-injection / lay practitionersSelf-injection / lay practitionersMedical office (single-practitioner series)
PermanencePermanent (cannot be removed without surgery)Permanent (cannot be removed)Permanent (cannot be dissolved)
PathologySclerosing lipogranulomaForeign-body granuloma (siliconoma)Capsular encapsulation ± contracture
Girth gainVariable, uncontrolledVariable, uncontrolled2.22 cm (10.54 to 12.76 cm) in 203 paired flaccid mid-shaft measurements; the abstract reports a discrepant 3.5 cm[3]
Complications in published cohortsAmong symptomatic oil-injection patients, 507/680 (74.6%) underwent surgery in Svensøy; no injection-wide rate is available[4]Severe complications are reported; no injection-wide rate is available[1][2]Three of 729 records (0.4%) had nodules excised in Casavantes; 52% of 203 questionnaire respondents perceived irregularities[3]
Necrosis at presentation in complication cohortsPang’s mixed-injectate UK cohort: 3/35 (8.6%); Kazakhstan oleogranuloma cohort: 13/18 (72.2%), in which 16/18 overall had injected Vaseline[1][8]No injection-wide estimate in the cited seriesNo injection-wide estimate from the Casavantes series[3]
ReversibilityIrreversible; requires surgical excisionIrreversibleIrreversible; nodule excision occurred in 3/729 reviewed records[3]
MigrationYes (along tissue planes)Yes (extensive migration)Less than oil-based substances (microspheres are encapsulated)
Malignancy riskCase reports of SCC arising in paraffinomaOne SCC case reported within a silicone granuloma[49]Not established
MortalityOne fatal case after repeated scrotal mineral-oil injection (systemic lipogranulomas and pulmonary edema)[50]One fatal silicone embolization case after combined penile, scrotal and chest injections[51]Not reported in the Casavantes penile series[3]

X. Comparison With Hyaluronic Acid​

For context, the non-autologous permanent injectables contrast sharply with hyaluronic acid (HA), the most-studied penile soft-tissue filler; penile HA injection is off-label in the United States, where FDA dermal-filler approvals apply to specified facial and hand sites.[2][22][27][28][29][34]

  • HA is biodegradable, reversible (dissolved with hyaluronidase), and had a 4.3% complication rate over 6 months in a series of 230 patients.[27]
  • In that series, penile circumference increased by 2.66 cm at 1 month and 1.80 cm at 6 months. A narrative review reports satisfaction of 75–100% across injection therapies.[22][27]
  • The Ramazan 2026 review reports that prospective studies of HA fillers show they "are better tolerated" than oil-based substances, though follow-up periods are short.[2]
  • In the first randomized HA-versus-PLA filler trial (Yang 2019; 72 enrolled), HA gave greater girth gain at 4 weeks and the between-group difference was not significant at 48 weeks; 31/72 men (43.1%) dropped out during follow-up. Reported adverse events were mild and transient.[29]

For the canonical HA deep-dive see Hyaluronic Acid Filler. For PLA see Polylactic Acid Filler.

XI. Psychological Considerations​

A recurring theme is persistent body-dysmorphic dissatisfaction even after successful surgical reconstruction.[2][14]

  • Lauria 2026 noted "persistent dissatisfaction with penile size" in their paraffinoma patient despite satisfactory graft take, "highlighting the need for integrated psychological assessment alongside surgical management."[14]
  • Ramazan 2026 emphasized that "most men seeking these interventions have penile dimensions within the normal range" and recommended "a multidisciplinary approach" including psychological evaluation.[2]
  • The practice of self-injection is often driven by small penis syndrome (SPS); see Small Penis Syndrome or PDD.

XII. Clinical Summary​

Non-autologous penile injectables fall into two distinct categories.

Paraffin, mineral oil and Vaseline can cause sclerosing lipogranuloma (paraffinoma or oleogranuloma); injected liquid silicone can cause siliconoma. Published complication series include men in Southeast Asia and immigrant or incarcerated settings, and severe injury may require reconstruction.[1][4] Nonmedical oil injection can produce sclerosing lipogranuloma; among men presenting with complications after mineral-oil injection, 571/680 (84%) had pain, while 13/18 (72.2%) admitted with penile oleogranuloma in Kazakhstan had necrosis. Penile deformity, ED, amputation, and death have also been reported.[1][2][4][8] In the largest reported complication cohort, 507 of 680 men presenting after mineral-oil injection (74.6%) underwent surgery.[4] Symptomatic infiltrative or destructive disease may require excision and penile-skin reconstruction (primary closure, skin grafting, or scrotal flap); the approach depends on tissue involvement and viable skin, often with urology and plastic-surgery input.[1][23][25]

PMMA has uncontrolled series data: Casavantes treated 752 men, analyzed 729 records and 203 questionnaires; paired flaccid mid-shaft girth means in 203 men increased from 10.54 to 12.76 cm (2.22 cm), whereas the abstract states 3.5 cm.[3] Three men required nodule excision (0.4% of 729); about half of 203 respondents perceived irregularities.[3] Penile use is off-label and the material is permanent; capsular contracture is described after PMMA injection at other sites, but its penile frequency and long-term penile safety remain uncertain.[3][12] The 2021 Romero-Otero BJU Int systematic review found the quality of studies on penile-enhancement procedures published in 2010–2019 to be low, which prevented evidence-based recommendations.[30]

All major reviews emphasize that psychological assessment should precede any penile-augmentation procedure, as most men seeking these interventions have normal penile dimensions and may have underlying body-dysmorphic concerns that persist even after successful treatment.[2][14]

See Also​

References​

1. Pang KH, Randhawa K, Tang S, et al. Complications and outcomes following injection of foreign material into the male external genitalia for augmentation: a single-centre experience and systematic review. Int J Impot Res. 2024;36(5):498–508. doi:10.1038/s41443-023-00675-8

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. Casavantes L, Lemperle G, Morales P. Penile girth enhancement with polymethylmethacrylate-based soft-tissue fillers. J Sex Med. 2016;13(9):1414–1422. doi:10.1016/j.jsxm.2016.06.008

4. Svensøy JN, Travers V, Osther PJS. Complications of penile self-injections: investigation of 680 patients with complications following penile self-injections with mineral oil. World J Urol. 2018;36(1):135–143. doi:10.1007/s00345-017-2110-9

5. Manny T, Pettus J, Hemal A, Marks M, Mirzazadeh M. Penile sclerosing lipogranulomas and disfigurement from use of "Super Extenze" among Laotian immigrants. J Sex Med. 2011;8(12):3505–3510. doi:10.1111/j.1743-6109.2010.01980.x

6. Ahmed U, Freeman A, Kirkham A, et al. Self injection of foreign materials into the penis. Ann R Coll Surg Engl. 2017;99(2):e78–e82. doi:10.1308/rcsann.2016.0346

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