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Procedure: Genital Cosmetic Surgery

Author: Min Ahn

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Penile Enlargement

Penile Enlargement

Cosmetic procedures involving the penis include penile lengthening, penile widening, correction of penile curvature and penile implants.  These all fall under the surgical category of phalloplasty.  The goal of these procedures is to improve the appearance of the penis and can often have functional benefits as well.

 

Penile Lengthening

The objective of penile lengthening surgery is to increase the length of the penis in both the flaccid and erect state.  Inside the pelvis, the penis is anchored to the pelvic bone by the suspensory ligament. This ligament can be released and thus allow more of the penis to be apparent outside of the body. Typically, no incision is made in the penis itself, but rather a small horizontal incision is made in the area just under the pubic hair. Once the hair grows back in completely conceals the small incision.  The amount of length gained is greatly dependent upon the initial size of the penis.  Men with a larger penis can expect to gain more length from the ligament release than a man with a smaller penis.  In addition, liposuction of the pubic fat area above the penis can also enhance penile length.  Finally, some men have a skin web between the scrotum and the penis (“turkey-neck deformity”) and this can also be released to gain more length on the penis.  This is an outpatient procedure performed under either spinal or general anesthesia.

 

Correction of Penile Curvature

Curvature of the penis is known as Peyronie’s disease.  Inside the penis are two erectile bodies called the corpora cavernosum.  If plaques form on the sides of these erectile bodies, the penis can curve when erect in the direction toward the plaque.  This condition can be either congenital or acquired.  Significant curvature of the penis can result in difficulty with sexual intercourse and erectile dysfunction. A relatively simple procedure called the Nesbitt procedure can be performed to correct penile curvature. In this procedure, a portion of the corpora cavernosum is removed opposite the area of the plaque in order to straighten the penis. This is known as penile placation.  This can result in some degree of penile shortening, so penile lengthening procedures can be performed simultaneously.  This procedure is done as an outpatient under either spinal or general anesthesia.

 

Penile Widening Procedure

The penile glans and shaft can be widened in several different ways. The preferred method by most cosmetic surgeons and urologists is with some form of bulking agent. A common agent used for this technique is AllodermTM with is a dermal matrix engineered from donor human skin. It is treated to remove all of the cellular components. It has been used in many other cosmetic surgery procedures including lip augmentation, breast augment surgery, facial rejuvenation, rhinoplasty, among others. Typically the AllodermTM can be placed through the same pubic incision that is used for penile lengthening and is often performed at the same time. For widening of the glans penis, a small incision is made at the glans/shaft junction and the AllodermTM is inserted there for glans and shaft widening near the tip of the penis.  Patients can often expect to gain a 20-30% increase in the penile diameter.  In addition to AllodermTM, other bulking agents can be used including autologous fat grafting.  One of the potential disadvantages of fat transfers is the non-uniform bulking that can occur and the penis can appear “lumpy” in some areas.  The glans penis can also be enlarged as well. This can be done using a hyaluronic acid gel. This was FDA approved in 2004 and has been used as an injectable bulking agent for the glans penis. 

 

Penile Implantation

One of the most common procedures for male erectile dysfunction is the implantation of an inflatable penile prosthesis.  This procedure is done under general or spinal anesthesia. It typically requires a one night stay in the hospital although some centers perform this as an outpatient. The state of the art implant involves three components.  First, two cylinders are placed into each erectile body of the penis (corpora cavernosum).  Second, a saline filled reservoir is placed inside the abdomen in a place that the patient cannot feel. Third, a pump is placed in the scrotum. The cylinders remain in the flaccid state until the scrotal pump is activated. Once the scrotal pump is compressed a saline solution goes from the abdominal reservoir into the cylinders in the erectile bodies of the penis. This results in an instant, natural appearing erection. Once the individual has completed sexual activity, the scrotal pump is compressed again and the saline fluid leaves the cylinders of the penis and returns to the abdominal reservoir and penis returns to the flaccid, non-erect state. 

 

This procedure can also improve penile length and width in addition to its benefits in sexual function. In addition to 3-piece inflatable penile implants there are also malleable implants that can be used as well. These do not result in as natural of an erection as the 3-piece implants, however. Advantages of malleable implants are there ease of insertion, reduced cost and potentially longer durability.

 

Penile implant surgery is typically reserved for men who have failed oral medication or penile injection therapy for their sexual dysfunction. This surgery is typically performed by a board certified urologic surgeon.
 

Vaginoplasty

Vaginoplasty

Vaginal Rejuvenation surgery, also known as vaginoplasty is a cosmetic procedure in which the vaginal tissue is tightened in an attempt to reclaim the youthful appearance of the vulvar (internal) and vaginal regions.  In this technique the vaginal lumen and vaginal size are restored to one that is similar to that which a woman had when she was younger before having children.  Labioplasty and clitoroplasty can also be combined with vaginoplasty in order to improve the overall cosmetic appearance of the vaginal region.

 

What Causes the Vagina to Stretch?

Several factors can contribute to vaginal stretching in a woman.  The most common reason is childbirth.  Multiple births or even a single pregnancy can result in expansion of the vaginal tissue.  As the baby passes through the birth canal, the vaginal tissue and pelvic muscles can stretch. After birth, these areas often do not regain their normal integrity and a woman begins to notice an overall looseness of the pelvic (lower) floor and vaginal tissue.  Women who have had a c-section can experience similar looseness of the pelvic floor muscles as well.  This can result in a “loose and unsatisfying feeling” during sexual intimacy for both the woman and her sexual partner.  Patients who experience “loosening” of the pelvic floor/vaginal tissue often experience other problems. For example, women may also notice a prolapse or “dropping” of the bladder. This is called a cystocele and can also be repaired surgically at the same time.  In addition, the uterus can descend as well causing discomfort and even urinary leakage and incontinence. This can be repaired with a uterine suspension procedure typically performed by a gynecologist or a urologist.

 

Who is a Candidate for Vaginoplasty?

Any woman who notices looseness of the vaginal/pelvic floor tissue is a candidate for vaginoplasty.  Women often complain of a diminished sense of friction during sexual intercourse. The goal of vaginoplasty is to restore the “tightness” of the vaginal lumen. 

What are symptoms of vaginal prolapse or laxity?

Women after childbirth, typically after a torn episiotomy, often complain of “loosening” of the pelvic and vaginal tissue. Symptoms can include a feeling of pelvic fullness, urinary leakage (incontinence) or even constipation. Often women experience a “bulge” in the pelvis either before or after a bowel movement that they can often feel and see.  Women often state that they need to physically push on the vaginal area to complete their bowel movement. In addition, women often state that they cannot feel their partner during sexual intercourse due to looseness of the vaginal tissue.  Many women can leak urine when coughing or sneezing as well.

 

How is the Vaginoplasty Performed?

This procedure is performed in an operating room or surgical center.  Typically this is performed by a board certified gynecologist or a general plastic surgeon. This can be done under general anesthesia or alternatively has been done under regional anesthesia with a spinal block with some intravenous sedation. The entire lumen of the vaginal canal is tightened, not just the opening.  Often the excess vaginal lining (mucosa) is removed as the extra tissue is removed.  If additional elements of pelvic prolapsed exist such as bladder prolapse (cystocele), rectal prolapse (rectocele) or uterine prolapse, these can be repaired simultaneously.  This procedure has also been done using laser surgery. A procedure known as Laser Vaginal Rejuvenation (LVR) is done.  This aims to decrease both the internal and external vaginal diameters and strengthen the pelvic floor tissue.

 

Potential Risks of Vaginoplasty

As with any surgical procedure risks of vaginoplasty include bleeding, infection and postoperative pain. These should all be discussed with the operating physician prior to embarking on any surgical procedure.