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Reduction Scrotoplasty (Scrotal Lift / Tuck)

Reduction scrotoplasty is a surgical procedure that removes excess scrotal skin to reduce scrotal laxity, improve genital cosmesis, and — when penoscrotal webbing is corrected concurrently — enhance the perceived penile length by exposing the ventral penile shaft. The aesthetic application remains poorly addressed in the international literature: the only systematic review on aesthetic scrotoplasty identified just 11 eligible articles, most of which are case reports or technique descriptions.[1][2]

For the broader male cosmetic-genital-surgery decision framework see the Male Cosmetic Genital Surgery atlas page. For reconstructive scrotoplasty (Fournier's, lymphedema, oncologic resection, hidradenitis suppurativa, buried penis) see Scrotal Reconstruction.

I. Definition and Terminology​

The term "scrotoplasty" encompasses a broad range of procedures with inconsistent nomenclature.[1][2]

  • Reduction scrotoplasty / scrotal reduction — excision of excess scrotal skin to reduce scrotal size and laxity.
  • Scrotal lift / scrotal tuck — colloquial terms for aesthetic reduction scrotoplasty.
  • Scrotopexy — fixation of the scrotum in a more superior position, sometimes combined with skin excision.
  • Ventral phalloplasty — correction of penoscrotal webbing at the ventral penile-scrotal junction; often performed concurrently with or as part of a scrotoplasty.
  • Scrotectomy — partial or total excision of scrotal skin, typically used in pathological contexts (lymphedema, malignancy, Fournier's gangrene) rather than cosmetic surgery.

The distinction between aesthetic scrotoplasty (cosmetic) and reconstructive scrotoplasty (pathological) is important — indications, techniques, and evidence base differ substantially.[2]

II. Indications​

A. Aesthetic / cosmetic indications[1][2][3]​

  • Scrotal laxity / scrotomegaly — an enlarged, pendulous scrotal sac that hangs > 1–2 cm below the tip of the penis, causing discomfort or dissatisfaction. Poorly defined entity with no standardized diagnostic criteria.[1]
  • Penoscrotal webbing (scrotal web) — a web of scrotal skin extending onto the ventral penile shaft, creating a "tethered" appearance that shortens visible penile length and can interfere with condom use and sexual function.[1][4][5]
  • Age-related scrotal ptosis — progressive loss of scrotal-skin elasticity with aging, analogous to facial-skin laxity.
  • Genital rejuvenation — increasingly sought as part of comprehensive male aesthetic genital surgery, often combined with penile augmentation or suprapubic lipectomy.[3]
  • Adolescent genital dissatisfaction — webbed penis and concealed penis among the most common pathologies in adolescents seeking genital cosmetic surgery, with significant improvement in genital self-evaluation scores postoperatively.[4]

B. Functional / medical indications[1][2]​

  • Discomfort while wearing loose clothing, walking, exercising, or during intercourse from excessive scrotal skin.
  • Recurrent scrotal dermatitis or intertrigo from skin-on-skin contact.
  • Hygiene difficulties related to redundant scrotal tissue.

C. Combined with penile prosthesis implantation[5][6][7][8]​

Scrotoplasty has become a common adjunctive procedure during inflatable penile prosthesis (IPP) insertion to:

  • Correct penoscrotal webbing that obscures the ventral penile shaft.
  • Improve the patient's perception of penile length — in the landmark Miranda-Sousa 2007 series, 84% of patients who underwent ventral phalloplasty (penoscrotal-web release) at the time of IPP reported some degree of increased penile length, vs the historical 84% of standard-IPP patients without web release who complained of perceived penile shortening.[5]
  • Optimize the cosmetic result of the prosthesis by creating a more defined penoscrotal junction.

D. Reconstructive indications (out of scope for this page)[2][9][10][11]​

  • Fournier's gangrene — post-debridement scrotal reconstruction.
  • Scrotal lymphedema (filarial or idiopathic).
  • Post-oncologic resection (scrotal malignancy).
  • Hidradenitis suppurativa.
  • Buried / concealed penis repair.
  • Trauma.

For these indications see Scrotal Reconstruction.

III. Relevant Scrotal Anatomy​

Understanding scrotal anatomy is essential for safe reduction scrotoplasty.[2][9]

  • Scrotal skin — thin, rugated, highly elastic, richly vascularized. Redundancy and elasticity allow up to 50% of the scrotum to be resected and closed primarily.[9]
  • Dartos fascia — smooth-muscle and connective-tissue layer beneath the skin; provides contractility (responsible for scrotal wrinkling in response to cold / cremasteric reflex).
  • Scrotal septum (median raphe) — divides the scrotum into two compartments; division of the septum is a useful maneuver for mobilizing tissue during closure of large defects.[9]
  • Tunica vaginalis — serous membrane surrounding each testis; serves as a graft bed for split-thickness skin grafts when needed.[9]
  • Spermatic cord — vas deferens, testicular artery, pampiniform plexus, and cremasteric muscle; must be preserved.
  • Gubernaculum — division allows superior mobilization of the testes.[9]
  • Blood supply — external pudendal arteries (from femoral) and scrotal branches of the internal pudendal artery provide robust dual blood supply, contributing to excellent wound healing and low infection rates.
  • Innervation — anterior scrotal nerves (ilioinguinal, genitofemoral) and posterior scrotal nerves (perineal branch of pudendal).

IV. Surgical Techniques​

A. Thomas & Navia algorithm (2021)​

The only published management algorithm for aesthetic scrotoplasty.[1] A two-component approach based on the specific anatomical problem:

1. For excessive scrotal skin (scrotomegaly / laxity).

  • Vertical midline scrotal-skin resection — elliptical or fusiform excision of redundant skin along the median raphe.
  • Amount excised determined by laxity, with the goal of reducing the scrotal sac to hang no more than 1–2 cm below the penile tip.
  • Closure in layers (dartos fascia + skin) along the midline raphe, concealing the scar in the natural raphe line.

2. For penoscrotal webbing.

  • Z-plasty at the penoscrotal junction — designed to break up the linear web, redistribute tissue, and create a more defined angle between penile shaft and scrotum.
  • The Z-plasty lengthens the ventral penile skin while shortening the web, "unmasking" the ventral penile shaft.

3. Combined approach.

  • When both scrotomegaly and penoscrotal webbing coexist, both components are performed simultaneously.

B. Ventral phalloplasty (penoscrotal-web release)[5][7][8]​

The most commonly described technique in the context of penile-prosthesis surgery.

  • V-Y advancement plasty or Z-plasty at the penoscrotal junction.
  • The V-Y plasty makes a V-shaped incision at the penoscrotal junction, advances the flap distally, and closes in a Y configuration — effectively lowers the scrotal insertion point and exposes more of the ventral penile shaft.
  • A simple transverse elliptical excision of the web with vertical closure is an alternative.
  • Adds approximately 12 minutes to operative time when combined with IPP insertion.[5]

C. V-I penoscrotal reconfiguration (Bagnara 2024)[12]​

A newer technique specifically for congenital webbed penis.

  • V-shaped incision at the penoscrotal junction; the flap is advanced and closed in a linear (I) configuration.
  • In 21 patients — no postoperative complications, no redo surgeries, and excellent cosmetic outcomes (81% rated satisfaction 4/5 on Likert scale).[12]

D. Other described techniques[2][13][14]​

  • Longitudinal incision with Z-plasty at the penoscrotal junction — used for concealed-penis correction; the Z-plasty opens the degloving dead cavity for drainage.[13]
  • Combined dorsal + ventral phalloplasty — used with suspensory-ligament release and penile prosthesis for maximal length perception.[15]
  • Tissue expansion followed by V-Y scrotoplasty — two-stage technique for scrotal reconstruction after extensive skin loss; tissue expanders generate additional scrotal skin before definitive scrotoplasty.[16]

V. Scrotoplasty Combined With Penile Prosthesis — Outcomes and Complications​

The largest dataset on scrotoplasty outcomes comes from the penile-prosthesis literature.

Gupta 2019 (n = 103) — only study specifically examining scrotoplasty complications[6]​

OutcomeResult
Total wound dehiscence14.6% (15/103)
Mild dehiscence (conservative management)8.7% (9/103)
Moderate dehiscence (clinic suture reinforcement)4.9% (5/103)
Major dehiscence (return to OR, IPP exchange)1.0% (1/103)
Diabetes as risk factor for dehiscenceOR 6.1 (95% CI 1.5–25.0, p = 0.013)
V-Y plasty technique as risk factor for dehiscenceOR 4.9 (95% CI 1.2–8.6, p = 0.003)
Age, Peyronie's, HTN, smoking, device manufacturerNot associated with dehiscence

Key findings.

  • Diabetes was the strongest risk factor for wound dehiscence (OR 6.1) — diabetic patients should be counseled about the increased complication risk when scrotoplasty is performed concurrently with IPP.[6]
  • V-Y plasty technique was associated with a nearly five-fold increased dehiscence risk (OR 4.9), possibly due to advancement-flap tension.[6]
  • Despite the risk, scrotoplasty improves patient satisfaction with IPP.[6]

Miranda-Sousa 2007 (n = 43, ventral phalloplasty)[5]​

  • 98% overall satisfaction with the combined procedure.
  • 84% reported increased penile-length perception vs the historical 84% of standard-IPP controls who complained of shortening.
  • Complications — wound hematoma 4.7% (2/43), focal superficial wound dehiscence 7.0% (3/43); all minor and managed conservatively.

Abdelwahab 2025 RCT (n = 61)[15]​

  • Randomized comparison of IPP + suspensory-ligament release + Z-plasty + dorsal / ventral phalloplasty (Group A, n = 31) vs IPP alone (Group B, n = 30).
  • Mean functional and visible penile lengths were significantly greater in Group A (p < 0.05).

VI. Complications of Reduction Scrotoplasty​

Based on the available literature.[1][2][5][6]

  • Wound dehiscence — the most common complication (14.6% when combined with IPP); higher with V-Y plasty and in diabetic patients.[6]
  • Hematoma — 2–5%; the scrotal skin is highly vascular; meticulous hemostasis is essential.
  • Seroma — fluid accumulation in the dead space created by skin excision.
  • Infection — relatively uncommon given robust blood supply.
  • Scrotal asymmetry — uneven skin excision can produce cosmetically unsatisfactory asymmetry.
  • Altered scrotal sensation — damage to anterior or posterior scrotal nerves during skin excision.
  • Over-resection — excessive skin removal results in a tight, uncomfortable scrotum with restricted testicular mobility, pain with sitting, and difficulty with testicular self-examination.[9]
  • Scar visibility — midline raphe scars are generally well-concealed; penoscrotal-junction scars may be more visible.
  • Recurrence of laxity — scrotal skin continues to age and lose elasticity; long-term recurrence of ptosis is possible.

VII. Non-Surgical Alternatives — Energy-Based Devices​

Radiofrequency (RF) and other energy-based devices have been used for skin tightening in various body areas; their application to scrotal-skin tightening has been explored anecdotally.[17][18][19]

  • Monopolar and bipolar RF devices produce measurable improvement in skin laxity through thermal stimulation of collagen contraction and neocollagenesis.[18][17]
  • Fractional RF microneedling (e.g., Morpheus8) combined with bipolar RF has been described for skin tightening in various body areas.[18]
  • No published clinical studies specifically evaluating RF or laser devices for scrotal-skin tightening were identified.
  • Theoretical concerns include the proximity of the testes to the treatment area and the potential for thermal injury to spermatic-cord structures, spermatogenesis, and scrotal skin (which is thinner than most body sites).
  • A systematic review of energy-based skin tightening concluded that clinically evident skin tightening "remains poorly measured and documented" even in well-studied body areas.[19]

VIII. Scrotoplasty in Specific Clinical Contexts​

A. Buried / concealed-penis repair[10][20]​

Scrotoplasty is a standard component of buried-penis repair in morbidly obese patients.

  • Combined with escutcheonectomy (suprapubic-fat-pad removal) and penile split-thickness skin grafting.
  • Fuller 2017 series (n = 12, mean BMI 45.4) — all had durable unburying at 8-month follow-up with 91.7% STSG take rate.[10]
  • Wound dehiscence is common (88% in one series), reflecting the challenging patient population.[20]

For the operative deep-dive see Suprapubic Lipectomy and Buried Penis Repair (04e).

B. Scrotal lymphedema[11]​

  • Singh 2011 filarial-lymphedema series (n = 48) — scrotoplasty with excision of diseased scrotal skin and reconstruction using lateral and posterior mobilized flaps; satisfactory cosmetic results in all patients at median 48-month follow-up.
  • All patients resumed sexual activity and reported improved ambulation.[11]

C. Hidradenitis suppurativa[9]​

  • Up to 50% of the scrotum can be resected and closed primarily.
  • Helpful maneuvers — division of the scrotal septum, mobilization of dartos fascia, division of the gubernaculum, and orchidopexy to secure testes superiorly.[9]

D. Gender-affirming surgery[21]​

  • Miller 2021 transgender scrotoplasty using labia majora rotational advancement flaps (n = 147) — distal flap necrosis 4.1%, large dehiscence 4.7%, hematoma 3.4%.

IX. Practical Considerations​

Patient selection​

  • Careful assessment of the degree of scrotal laxity, presence / absence of penoscrotal webbing, and patient expectations.
  • No standardized grading system exists for scrotal laxity — Thomas & Navia propose that a scrotum hanging > 1–2 cm below the penile tip constitutes a "bothersome scrotum."[1]
  • Mandatory psychological screening (BDDQ-AS / BDD-YBOCS), particularly in patients seeking purely cosmetic scrotoplasty, to identify body dysmorphic disorder.[22]
  • Diabetes should be identified as a significant risk factor for wound dehiscence (OR 6.1).[6]

Operative considerations​

  • Can be performed under local anesthesia with sedation (isolated aesthetic scrotoplasty) or general anesthesia (when combined with other procedures).
  • Conservative skin excision is recommended — better to under-resect than over-resect; excessive removal leads to a tight, uncomfortable scrotum with restricted testicular mobility.[9]
  • Meticulous hemostasis is essential given rich vascularity.
  • Layered closure (dartos + skin) provides the most durable result.
  • V-Y plasty carries higher dehiscence risk than other techniques (OR 4.9) and should be used judiciously.[6]

Postoperative care​

  • Scrotal support (supportive underwear or jockstrap) for 2–4 weeks.
  • Activity restriction (no heavy lifting, strenuous exercise, or sexual activity) for 4–6 weeks.
  • Wound monitoring, particularly in diabetic patients.
  • Ice application to minimize edema.

X. Evidence Summary and Limitations​

FeatureCurrent evidence
Level of evidenceLevel IV (case reports, technique descriptions, single-surgeon series)
Systematic reviews2 — Thomas & Navia 2021; Schifano 2022 — both note scarcity of data
Largest outcome studyGupta 2019 (n = 103, scrotoplasty + IPP)
RCTs1 — Abdelwahab 2025 (n = 61, IPP ± lengthening / phalloplasty)
Standardized outcome measuresNone validated for aesthetic scrotoplasty
Diagnostic criteriaNo consensus; Thomas & Navia propose > 1–2 cm below penile tip
NomenclatureNo consensus; multiple overlapping terms
Long-term follow-upLimited; no studies with > 2-year follow-up for aesthetic scrotoplasty

XI. Clinical Summary​

Reduction scrotoplasty is a technically straightforward procedure — described by Schifano 2022 as "easy, safe, and effective" for improving genital cosmesis — that can be performed in isolation or combined with penile-prosthesis implantation, suspensory-ligament release, or other genital aesthetic procedures.[2] The Thomas & Navia 2021 algorithm recommends vertical midline scrotal-skin resection for scrotomegaly and Z-plasty at the penoscrotal junction for webbing correction.[1] When combined with IPP, ventral phalloplasty dramatically improves patient perception of penile length (84% report increased length vs ~ 84% of historical controls who complained of shortening).[5] The primary complication is wound dehiscence (14.6% with IPP), with diabetes (OR 6.1) and V-Y plasty technique (OR 4.9) as the strongest risk factors.[6] The evidence base remains limited — dominated by case reports and technique descriptions — and no standardized diagnostic criteria, grading systems, or validated outcome measures exist for aesthetic scrotoplasty.[1][2] Non-surgical alternatives (energy-based devices) lack any published clinical evidence specifically for scrotal-skin tightening and carry theoretical safety concerns regarding the proximity of the testes to the treatment area.[19]

See Also​

References​

1. 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

2. Schifano N, Castiglione F, Cakir OO, Montorsi F, Garaffa G. Reconstructive surgery of the scrotum: a systematic review. Int J Impot Res. 2022;34(4):359–368. doi:10.1038/s41443-021-00468-x

3. Zaccaro C, Subirà D, López-Diez I, et al. History and future perspectives of male aesthetic genital surgery. Int J Impot Res. 2022;34(4):327–331. doi:10.1038/s41443-022-00580-6

4. Zampieri N, Dando I, Camoglio FS. Adolescent male genitalia dissatisfaction: a surgical perspective. Asian J Androl. 2022;24(2):176–179. doi:10.4103/aja.aja_60_21

5. 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

6. Gupta NK, Sulaver R, Welliver C, et al. Scrotoplasty at time of penile implant is at high risk for dehiscence in diabetics. J Sex Med. 2019;16(4):602–608. doi:10.1016/j.jsxm.2019.02.001

7. Whelan P, Levine LA. Additional procedures performed at time of penile-prosthesis implantation: a review of current literature. Int J Impot Res. 2020;32(1):89–98. doi:10.1038/s41443-019-0118-y

8. Lo Re M, Alonso Isa M, Garcia Rojo E, et al. Advancements in penile-lengthening techniques concurrent with penile-prosthesis placement: a narrative review. Asian J Androl. 2025. doi:10.4103/aja202512

9. Hamad J, McCormick BJ, Sayed CJ, et al. Multidisciplinary update on genital hidradenitis suppurativa: a review. JAMA Surg. 2020;155(10):970–977. doi:10.1001/jamasurg.2020.2611

10. Fuller TW, Theisen K, Rusilko P. Surgical management of adult acquired buried penis: escutcheonectomy, scrotectomy, and penile split-thickness skin graft. Urology. 2017;108:237–238. doi:10.1016/j.urology.2017.05.053

11. Singh V, Sinha RJ, Sankhwar SN, Kumar V. Reconstructive surgery for penoscrotal filarial lymphedema: a decade of experience and follow-up. Urology. 2011;77(5):1228–1231. doi:10.1016/j.urology.2010.10.026

12. Bagnara V, Donà A, Berrettini A, et al. The "V-I penoscrotal reconfiguration": a simple technique for the surgical treatment of congenital webbed penis. Int J Urol. 2024;31(8):886–890. doi:10.1111/iju.15476

13. Xu JG, Lv C, Wang YC, Zhu J, Xue CY. Management of concealed penis with modified penoplasty. Urology. 2015;85(3):698–702. doi:10.1016/j.urology.2014.06.044

14. Chen YB, Ding XF, Luo C, et al. A new plastic surgical technique for adult congenital webbed penis. J Zhejiang Univ Sci B. 2012;13(9):757–760. doi:10.1631/jzus.B1200117

15. Abdelwahab M, AbdelKader A, Abdelrassoul M, et al. Maximizing postoperative satisfaction in penile-prosthesis surgery: the predictive power of preoperative length and its role in tailoring enhancement procedures. J Sex Med. 2025. doi:10.1093/jsxmed/qdaf169

16. Rapp DE, Cohn AB, Gottlieb LJ, Lyon MB, Bales GT. Use of tissue expansion for scrotal-sac reconstruction after scrotal-skin loss. Urology. 2005;65(6):1216–1218. doi:10.1016/j.urology.2005.02.006

17. Smith DM. The role of energy-based devices in male body contouring. Clin Plast Surg. 2022;49(2):329–337. doi:10.1016/j.cps.2022.01.001

18. Rohrich RJ, Schultz KP, Chamata ES, Bellamy JL, Alleyne B. Minimally invasive approach to skin tightening of the face and body: systematic review of monopolar and bipolar radiofrequency devices. Plast Reconstr Surg. 2022;150(4):771–780. doi:10.1097/PRS.0000000000009535

19. Atiyeh B, Greige G, Hajjar M, Rabay C, Emsieh S. Clinical relevance of skin tightening with minimally invasive subdermal energy-based (EB) technologies. Aesthet Plast Surg. 2025. doi:10.1007/s00266-025-05022-4

20. Corder B, Googe B, Velazquez A, Sullivan J, Arnold P. Surgical management of acquired buried penis and scrotal lymphedema: a retrospective review. J Plast Reconstr Aesthet Surg. 2023;85:18–23. doi:10.1016/j.bjps.2023.06.021

21. Miller TJ, Lin WC, Safa B, Watt AJ, Chen ML. Transgender scrotoplasty and perineal reconstruction with labia majora flaps: technique and outcomes from 147 consecutive cases. Ann Plast Surg. 2021;87(3):324–330. doi:10.1097/SAP.0000000000002602

22. Trost L, Watter DN, Carrier S, et al. Cosmetic penile-enhancement procedures: an SMSNA position statement. J Sex Med. 2024;21(6):573–578. doi:10.1093/jsxmed/qdae045