Avanti Derma’s Penile Girth Enhancement is an outpatient, minimally invasive procedure developed by Dr. Casavantes and designed to give patients a bigger, beefier and heavier penis.
What is Penile Girth Enhancement?
Avanti Derma’s Penile Girth Enhancement is an outpatient, minimally invasive procedure developed by Dr. Casavantes and designed to give patients a bigger, beefier and heavier penis by increasing the shaft circumference with injectable soft tissue fillers.
Our outpatient girth enhancement procedure does not involve surgical cuts or drains, and downtime is minimal. Patients can leave our facilities immediately following the procedure, but are required to remain in the area for at least 24 hours to supervise their understanding of their post care, which helps minimize the possibility for irregularities.
Patients receive detailed instructions at the time of their appointment.
Temporary or Permanent? It’s your choice
Depending on the filler used, girth increase can be temporary or permanent. The following are the most popular products used for girth enhancement:
Injectable soft tissue fillers comprised of non-absorbable micro-spheres of PMMA offer lasting results; once implanted, the vehicle is absorbed leaving the particles in the tissues, where they become surrounded with the patient’s collagen. [Lemperle G, et al.]
Injectable soft tissue fillers comprised of slowly absorbable micro-particles of PCL offer long lasting results. Both PMMA and PCL work the same way by promoting collagen growth; the difference is that PCL particles degrade and dissolve completely, reversing the volume to baseline after one to three years, depending on the longevity option used. There is a variant of PCL (Ellanse ETM) that lasts four years but is not available in Mexico for the moment.
Injectable soft tissue fillers comprised of slowly absorbable micro-spheres of CaHA offer long lasting results. Both PMMA and CaHA work the same way by promoting collagen growth; the difference is that the CaHA particles are slowly degraded by the metabolic functions of the body, dissolving completely and reversing the volume to baseline after several months. [Carson C, et al.]
Medical grade silicone is an off-label product for permanent soft tissue augmentation. It is a sterile oil, which is safe only when implanted in small volume using the micro-droplet technique. [Jones D, et al.]
When using low volume and the micro-droplet technique, silicone oil creates multiple individual micro-implants that remain independent avoiding any pooling or migration. It is useful for the correction of small tissue deficits, or to moderately increase the entire penile shaft.
Using excessive amounts of silicone makes unstable implants that can migrate to the foreskin or the neck area in circumcised patients creating a bell-shaped penis. Furthermore, the large volume will cause an abnormal shape and size increase that interferes with normal sexual activity due to inability to penetrate completely.
HA is a safe product for facial tissue augmentation because it holds water and remains as a soft substance. However, it is the least desirable alternative for penile girth enhancement because it doesn’t get surrounded by enough of the host’s collagen and can easily migrate due to the dynamics of the penis.
HA’s only convenience is its short lifespan, or the possibility of reversal with injections of hyaluronidase if results are not satisfactory. [Kwak T, et al.]
Even though it is a common request, due to the high cost and questionable benefit, Avanti Derma does not offer penile girth enhancement procedures with HA gel.
Another alternative available at Avanti Derma is PRP that rejuvenates with multiple growth factors contained within and temporarily augment the tissue volume when injected in the proper layer of the penile structures.
Centrifugation of the patient’s blood separates the platelet and growth factor rich plasma which is re-injected into the corpora cavernosa, glans and the alveolar space of the penis. There are numerous claims of PRP being beneficial for most human tissues, supporting the idea of its use for temporary and moderate girth increase, as well as an aid in stronger erections, and increased sensation. PRP can be performed as an isolated procedure, or in combination with temporary or permanent fillers.
PMMA is a non-absorbable soft tissue filler that provides lasting results by triggering the formation of the host’s collagen.
Common Penile Girth Enhancement procedures
|Permanent soft tissue filler injected with micro-cannulas through tiny skin openings that heal in hours.||Yes||Yes|
|CaHa Calcium hydroxylapatite||Slowly absorbable soft tissue filler injected with micro-cannulas through tiny skin openings that heal in hours.||Yes||Yes|
|HA Hyaluronic acid||Temporary soft tissue filler injected with needles or micro-cannulas through small tiny openings that heal in hours. The product remains in the tissues as a gel that can easily shift.||Yes||Occasionally|
|Silicone Polydymethylsiloxane (Low Volume)||Permanent soft tissue filler, safe and well tolerated when injected in low volumes using micro-needles. Healing is immediate.||Yes||Yes|
|Silicone Polydymethylsiloxane (Large Volume)||Permanent soft tissue filler, not safe and not stable when injected in large volumes using cannulas and oppressive bandages. Slow recovery and migration are common.||Yes||No|
|Autologous fat transfer||Surgical procedure combining liposuction and fat re-injection in the penis. Some fat survives, but some die and get absorbed by the body, leaving a lumpy appearance.||No||No|
|Alloderm™ Veloderm™||Surgical procedure involving cuts, degloving, stitches and drains to implant a membrane under the skin. The membranes are slowly absorbed, and volume eventually returns to base conditions.||No||No|
|Subcutaneous soft silicone implant||Surgical procedure involving cuts, de-gloving, stitches and drains to implant a large, thick foreign object, requiring an extensive recovery time. The silicon scaffolding is known to rupture, protrude through the skin, get infected, or become uncomfortable enough to be removed through a second aggressive surgery.||No||No|
Even though most prospective patients are good candidates for our penile girth enhancement procedures, some conditions and circumstances can create restrictions or disqualify them.
Am I a good candidate for Penile Girth Enhancement?
The following are typical scenarios seen at Avanti Derma; Patients with specific conditions not listed below can call our office for further discussion.
The ideal individuals for girth enhancement meet most of the following statements:
- Small to above average size penis (bigger than 7 cm or 2.75 in during full erection)
- Non-retractive or moderately retractive penis during relaxation
- Lean individuals with regular pubic fat pad
- Psychologically stable
- Realistic goals, expecting a moderate increase of between 1.2 – 2.5cm (0.5 – 1in)
- No previous implants or surgeries other than the circumcision
The ideal candidate for girth enhancement is a circumcised patient.
The erectile structures of the penis are contained in a tight membrane (Buck’s fascia) and on top of it lies a ‘bag’ of skin. In circumcised patients, such bag is tight, and its movement is restricted; it is loose and very mobile in non-circumcised patients.
Implanting any filler into the loose bag of an uncircumcised patient is very challenging, and the possibilities of migration and product clumping are very high; also, the implant should never involve the foreskin to preserve the aesthetics and dynamics.
Non-circumcised patients are treated in a conservative way, using limited volume and sessions to augment the shaft no more than 0.6 cm (0.25 in). A higher increase will cause an accordion effect of the thicker skin at the base of the penis when retracting it, or when penetrating during sexual intercourse.
Uncircumcised patients seeking larger volume increases are encouraged to have the circumcision performed three months before their girth enhancement procedure.
Some individuals believe that they have a small penis when in reality their size is average or above average; more than with psychological therapy, these patients benefit tremendously from receiving a real, palpable size increase through our girth enhancement procedures. [Spyropoulos E, et al.]
Research shows that the mean length of the erect penis is 13.12 +/- 1.66 cm (5.17 +/- 0.65 in). A small penis measures less than the mean size, but it is larger than 7 cm (2.75 in) during erection; individuals with a small penis are considered good candidates for girth enhancement, provided they are circumcised.
Micro-penis is an abnormally small penis that measures less than 7 cm (2.75 in) during erection; These patients should consider a very conservative augmentation to preserve acceptable girth/length ratios.
Buried penis (or hidden penis) is a condition in which the penis is hidden below the surface of the skin. It commonly associates with obesity or other conditions that increase the volume of the pubic fat pad. Buried penis can be of average size, making these patients good candidates for girth enhancement; these patients can further benefit with a fat pad reduction, either through diet or surgery.
An uncircumcised patient with micro-penis and buried penis is the least desirable candidate for girth enhancement.
Prospective patients for girth enhancement are taken based on the results and nature of their previous penile procedures:
Autologous fat transfer typically results in irregularities. However, associated fibrosis creates firmer and more stable tissues, which facilitate the new implant of soft tissue fillers. These patients are good candidates for girth enhancement.
Biological membranes Alloderm™ and Veloderm™ are implanted through invasive surgical procedures that include incisions, degloving of the penis and drains. While being slowly reabsorbed by the body, they leave the skin firmer due to residual scar tissue. These patients are good candidates for girth enhancement with soft tissue fillers, although some areas may be problematic due to the presence of surgical scars and skin adherences.
Rubber silicone scaffoldings require of very invasive surgical degloving of the penis, which requires a long and painful downtime. The implant consists of a large foreign body stitched under the skin of the penis at one end and in the pubic area on the other one. The longevity of this implant is very limited due to complications such as pain, protrusion or infection that will eventually affect every individual; another cause for removal is the fact of having a permanent pseudo-erection that could be embarrassing in certain circumstances. Even though patients recover after a second surgery needed to remove these implants and tissues tighten up facilitating the grafting of soft tissue fillers, others develop excessive amounts of redundant skin, or penile retraction and deformity, making them less than ideal candidates for girth enhancement.
Penile hard, or inflatable implants placed inside the corpora cavernosa do not alter the superficial tissues and most patients are good candidates for girth enhancement with soft tissue fillers.
Patients with a history of previous surgeries or implants will need to provide all medical records, along with a brief summary of the current condition of the area.
Failure to disclose any and all previous procedures may disqualify candidates, and all incurred expenses will be the patient’s responsibility.
History of unknown products or materials implanted in the penis disqualify most patients for girth enhancement at Avanti Derma™.
This is typically a normal condition in which the scrotal skin extending sometimes midway up the ventral penile shaft. It requires special measures to prevent the filler from migrating into the virtually empty bag, but does not disqualify the patient. Surgical removal (ventral phalloplasty) of the excess skin is recommended for a more stable implant, comfort and a visually aesthetic and longer looking penis. [Carrion R]
Girth enhancement especially when performed with non-absorbable soft tissue fillers, is a permanent body alteration, and may have psychological consequences. Although it is almost impossible to predict a particular psychological outcome after the procedure, years of experience and thousands of patients treated, help us to identify some risk factors and make recommendations or deny services. It is common that independent symptoms and conditions are erroneously associated to the product implanted and occasionally patients want it reversed; however, we do not have one case where surgical removal has been medically necessary.
Prospective patients must understand that removal of the implant should not be considered as a viable option when making a clear and responsible decision to have any permanent procedure.
No other medical practice in the world has performed more Penile Girth Enhancement procedures with PMMA than us.
We offer the Girth Enhancement technique developed by Dr. Luis Casavantes
After thousands of procedures and over a decade of experience performing penile girth enhancement with the use of PMMA, our physicians have explored a large number of variants that have led to one of the best techniques available to date.
Our physicians do not induce erection for the penile girth enhancement procedure, because a properly placed implant requires the penis to be extended, bent, twisted and rotated while directing the micro-cannula in multiple directions to create an implant that reaches the entire shaft.
Another advantage of a relaxed penis is that the alveolar space (the layer where the implant is placed) is also relaxed and more accepting of both the micro-cannula and the product.
A rigid, erect penis is very difficult to manipulate making it difficult to reach most areas of the penile shaft with a rigid cannula. The theory that supports the induction of erection to facilitate the implant of a soft tissue filler is very questionable, and in our opinion is no more than a gimmick.
After being implanted in the penile shaft, any kind of soft tissue filler needs weeks to get surrounded by the host’s collagen; in the opinion of our physicians, the claim that the filler settles better if implanted during penile erection is no more than a statement that must be proven, since an erection cannot be forced for more than a couple of hours to avoid the danger of priapism. Once the erect penis returns to its flaccid state, the material ends up in the similar space as it does in a non erect penis.
Due to the cylindric shape of the penis, several entry points are necessary for the cannula to reach every single corner of the penile shaft. The use of a single entry point leaves many areas free of product, creating a fan-shaped and incomplete implant; using nonflexible cannulas aggravate this situation.
Small gauge micro-cannulas are flexible and thin, with a small orifice on the side of the tip. They facilitate the delicate approach to tissues and organs like the penis while protecting veins and arteries from being punctured.
Flexible micro-cannulas are the only option offered at Avanti Derma.
Large, rigid cannulas are used mainly for liposuction and aspiration of liquids and have been available for decades. They facilitate the extraction or insertion of large amounts of volume and are not needed, nor desired for a delicate and precise implant of soft tissue fillers in the penis.
PMMA based fillers come in different concentrations, typically 2, 10 and 30% of the micro-spheres, suspended in aqueous carriers like carboxymethyl-cellulose. Ten and thirty percent are used to create noticeable volume augmentation in the treated areas.
Depending on many variables, our physicians opt for what they consider the best option for the patient and the area of the implant. Most circumcised patients are treated with the 30% concentration from the circumcision scar to the base, and with 10% in the neck of the penis; almost every uncircumcised patient receives with the lower 10% only.
The use of an injection gun has been recommended by Dr. Casavantes for over a decade because it gives the physician more volume control when injecting the filler; every time the gun is activated, the tissues receive around 1/100cc of product in the shape of a sphere. Multiple mini implants are placed one next to each other, to obtain a uniform layer that is less prone to migration, clumping and shifting.
We don’t recommend manual injections that offer such limited control; even during the same procedure, one physician can deposit an array of uncontrolled volumes that tend to be excessive and random, facilitating clumping and shifting.
Will I get perfect results from the penile girth enhancement procedure?
The penis is a very distinctive and dynamic anatomic structure of the body; besides its specific functions, an important difference is that it lacks the layer of subcutaneous fat tissue, otherwise present under the skin throughout the rest of the body.
This lack of subcutaneous fat tissue in the penis can make the implants palpable and somewhat visible since they lay directly under the skin.
Other factors that can make the implant noticeable are:
- The number of treatments performed
- The patient’s understanding and compliance with the post care procedures
Our penile girth enhancement technique and post care are designed to minimize imperfections to the degree that is acceptable to the patient and not identified by his sexual partner(s).
Read about Dr. Casavantes and Dr. Morales’s extensive experience with girth enhancement using PMMA based fillers in the Journal of Sexual Medicine:
Casavantes L, Lemperle G, Morales P. Penile Girth Enhancement with PMMA-Based Soft Tissue Fillers. J Sex Med 2016;13:1414-1422.
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