Dear Dr Holmes,

I am a 48-year old businessman who has had a successful life so far. People think I have everything in life I could possibly want, but there is one thing I want more badly than anything else: a normal-sized penis. Lately, I came across some information about operations actually being done to enlarge one's penis. Do such things really exist? How safe are they and how feasible is it to have such a thing done?

A.M.

Dear Mr. A.M.,

Yes, operations to enlarge one's penis actually exist. So far, there are two ways of doing this: through fat injections and through dermal graphs. Other methods are being tested, but only the first two have actually been done on humans where the men lived to talk about it. And, while it's true that most wax eloquent about the penile-enlargement procedures they underwent, others have been dissatisfied and some, even downright angry. Angry enough, as a matter of fact, to file lawsuits against the doctors who performed the penile enlargement operations on them.

In the first nine months of 1995 alone, for example, seven lawsuits were filed against Dr. Rosentein in the Los Angeles Country Courthouse alone. Six of these were for medical malpractice. The lawsuits included descriptions ranging from "disfigurement, shortening, loss of use of patient's (plaintiff's) penis" to "infection and gangrene of scrotum and penis" to impotence and operations negligently and carelessly performed."

I mention Melvyn Rosenstein because he is the most aggressive among the doctors who perform such operations. To quote Esquire, 1995 (upon which most of this column is based, by the way) Rosenstein, who has become known as 'Dr. Dick,' is the one "making a fortune off the demand for this surgery, a demand he is largely responsible for creating through his aggressive marketing scheme." Ironically (or understandably enough) it is Rosenstein, too, who has become the target of the growing number of lawsuits by patients claiming he has mangled and deformed their penises.

Notwithstanding the seven lawsuits and some major disgruntlement, men flock to his office. He tells potential patients that he has performed over thirty-five hundred penile enlargements (he likes to call them "augmentations" but that is consistent with his predilection for marketing himself). He further tells patients that his thirty-five hundred operations comprise 70 percent of all such surgeries reported worldwide.

But the fact that men flock to him is not necessarily a recommendation to get this operation done. After all, lemmings meet in droves to dive off cliffs to their death and you don't see other animals following suit. Frankly, the operation sounds scarier than a dive off a high cliff. Rosenstein uses an electrified cauterizing knife which burns as it cuts (and thus seals blood vessels and reduces bleeding) by making an incision directly above the man's penis. He then inserts this into the cavity and cuts through the suspensory ligament, which attaches the base of the penis to the pubic bone. When this ligament is severed, that part of the penis that is inside the patient's body can be made to extend outside, creating the impression of greater length.

After the ligament is cut, the flap of skin formed by the incision is sewn down, onto the top of the patient's section of newly extended penis.

One problem of this operation is that it can change the angle of the penis during erection. Instead of pointing upward, it may point horizontally. This eventually happens to all men, sometimes when they hit their 50's. More often when they reach 65 and over. In a way, one could rationalize that, should this happen to him as a result of the operation, then, in addition to lengthening his penis, it has merely made him a man "ahead of his times." Yes, yes, even if his penis erects not horizontally, but pointing downward which, again, is not necessarily a cause for alarm (although it could be if due to peyronie's syndrome) but more commonly merely a function of age.

But other problems cannot be dealt with as philosophically. For example, the scar tissue that forms due to the suturing to close the wound can reconnect the severed halves of the suspensory ligament and pull the penis back into the body. As a result, the patient can end up with no increase in length at all. Even worse, he can sometimes end up with even less length than he enjoyed before the operation.

Alas, my column is not as extendable as penises apparently can be under the tutelage of Dr. Dick (that is, if he does it right and the patient is extremely lucky). Thus, I must cut this short (in a manner of speaking) and continue next issue. I promise (or threaten, depending on your point of view, I guess) that after that, no more talk of penises for a while, okay?

MG HOLMES

SECOND REPLY:

Dear Mr. A.M.,

I wish I could say I had both good news and bad news when it came to penile enlargements; but alas, all I can give you is the latter. Dr. Rosenstein would, of course, disagree with me. But wouldn't you do so too if you were making a minimum of $24,000.00 a day doing this the way he was? True, not everyone who's had a penile enlargement suffers disfigurement, shortening and/or malfunctioning of his penis, but enough have for this to be a real concern. Even more sobering is the realization that there is no known way to minimize the risks. It's not as if research has been systematically conducted and thus certain safeguards established to maximize safety and minimize unwanted side effects.

To quote Dr. Grossmanm, a plastic surgeon from Denver, "penile enhancement operations never worked through a process of clinical research evaluation to determine the success and risks ... This is a fringe operation. This is a scam. It does not lend respect or credibility to the practice of medicine. It just appeals to the greed of physicians and the insecurities of men."

Grossman further points out that when fat is harvested from one part of the body (which is the standard technique Rosenstein uses for penis thickening), it loses its blood supply and many of the walls of the individual fat cells are destroyed. If the fat is then injected into another part of the body, it has difficulty re-establishing a blood supply. Without blood, the fat will die. Some physicians maintain that with fat injections, as much as 90% of the fat does die and is either re-absorbed into the body or forms cystlike lumps. My feeling is, if you want lumps, our very own bolitas is a cheaper, less intrusive way of getting them (joke only).

In 1994, the American Urological Society (AUS) went so far as to declare that "subcutaneous fat injection for increasing penile girth is a procedure which has not been shown to be safe or efficacious."

There are several reasons for the AUS's pronouncement. The procedure is not taught at medical schools nor is it subject to board certification. Malpractice insurance policies do not cover it. So much for penile widening.

The news is just as bad when it comes to penile lengthening. As described in greater length in my previous response on this issue, this is done by severing the suspensory ligament. The AUS considers such as operation experimental, and thus neither safe nor efficacious.

It is apocryphal that the marketing director of the Rosenstein Medical Group, which is the business operation Rosenstein created to sell penile augmentations, should make this analogy (and I quote): "Two point two million women have had their breast enlarged. Only - let's take a high guesstimate - (only) Eight thousand men have had their penises enlarged.

Our goal is to make this as common as breast implants."

I wonder if their goal is to also make it as (un)safe.

Remember that for years (25 or so) breast implants were considered safe. It is only in the last few years that harmful side effects of such breast augmentations are being taken seriously.

The old adage "if it ain't broke, don't fix it" is not one I usually agree with. I find it encourages mediocrity and stifles creativity. However, when it comes to personal property like genitals, frankly, I can't think of a better guideline than this.

Good luck, whatever your decision is.

MG Holmes

(BodyMind Vol. 1 No. 6 - First posted: 11-30-97)

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