Lipopenosculpture for Thickening and Lengthening in Montreal
The demand for penile augmentation has been steadily increasing for many years. In order to meet this demand, it was important to devise a global strategy that takes into consideration the desires of patients as well as technical limitations.
The perception of the size of one’s penis often varies significantly from one patient to the other, depending on his age and socioeconomic milieu. However, embarrassment can be so great that it can turn into a complex and then an inhibition, to the point where it becomes a real hindrance to social and intimate interactions.
The size of the shaft varies greatly from one patient to another. When flaccid, the average shaft is 10 cm long and 9 cm around. When erect, it is on average 15 cm long and 12 cm around. The shaft is composed of four erectile structures and four sheaths. The erectile organs include two corpus cavernosa, which extend from the pubic bone to the gland; the corpus spongiosum, through which the urethra passes throughout its length; and the gland.
The four sheaths of the shaft, from the outside in, are as follows:
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The skin, thin and very mobile
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The dartos, a sub-cutaneous muscular layer
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A highly vascularised cellular layer
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A fibroelastic envelope, or fascia, that contains the corpus cavernosa and the corpus spongiosum
The shaft is connected to the abdominal wall, the pubic symphysis and the pubis thorough the suspensory ligament. It consists of three bodies – one medial and two lateral.
Penoplasty Lenghtening Augmentation
Penile augmentation, also known as phalloplasty, is a surgical procedure aimed at increasing the size or girth of the penis in men. This procedure may involve various techniques, such as fat injection, the use of tissue grafts, or the implantation of synthetic materials, depending on the patient's needs and goals.
Penile surgery consists of two components that can be easily combined: thickening and lengthening.
LIPOPENOSCULPTURE - LENGTHENING PENILE SURGERY (LPS)
LENGTHENING PENILE SURGERY
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Penile lengthening emerged later, around the 1980s, and is the result of detaching the corpora cavernosa from their pubic bone attachments by cutting the suspensory ligament. The practice of these procedures has allowed for the standardization and reliability of the techniques.
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The surgical lengthening procedure involves a partial section of the suspensory ligament of the penis, dissection and incision of the superficial parts of the medial and lateral ligament bundles, and a skin plasty.
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After marking the width of the penis at its base, two vertical lines are drawn upward at both ends by one centimeter and then connected by a horizontal line. The skin is incised along these lines, and the incisions are extended downward by one centimeter on each side. Two horizontal incisions are made at the level of the natural peno-pubic folds. Once the skin is incised, the two lateral counter-incisions open, allowing an initial downward tilt of the penis. Dissection is performed between the spermatic cords, which must be preserved, to reach the bundles of the suspensory ligament, which are then cut while maintaining contact with the pubic bone.
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After determining the maximum detachment in the created space, this empty space between the bone and the corpora cavernosa is filled by bringing together the funicular fat to create a cushion that will prevent any secondary attachment between the bone and the corpora cavernosa. The skin is closed by suturing the lateral angles of the initial incision to the outer ends of the lateral counter-incisions.
This skin plasty phase is essential to ensure the permanence of the downward tilt of the initial incision. In the end, the scar will consist of a central vertical branch and two lateral branches at the level of the penis body.
LIPOPENOSCULPTURE - THICKENING PENILE SURGERY (LPS)
THICKENING PENILE SURGERY (LPS)
For decades, liquid silicone and other filler substances were used for penile thickening. These methods were ineffective and often harmful due to the formation of granulomas or the migration of the product.
Today, the autologous fat graft, which is effective and non-harmful, has proven to be the most reliable and least dangerous method.
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EXTRACTION OF ADIPOCYTES (Fat)
Fat is extracted from the pubic area, the inner and outer thighs, the abdomen, or sometimes the buttocks. These sites are rich in adipocytes with a2 receptors, which are less sensitive to diet and weight fluctuations compared to adipocytes with b1 receptors (arms, chest), allowing for better long-term maintenance of the graft.
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GRAFT PLACEMENT
We use a cannula with a 1.2 mm diameter. The cannula is mounted on a 10 ml syringe, placed in a specially designed device, similar to a gun, where the ratchets of the barrel allow for gentle and even pressure, ensuring a harmonious and uniform distribution of the graft and good control of its contours.
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The two entry points are located on the ventral and distal parts of the penis, in the preputial skin or the balanopreputial groove. We choose the entry points in the balanopreputial groove, just below the glans, as this is the natural anatomical plane, and the procedure is easier than with a peno-pubic approach. The graft is placed up to the base of the penis, at its pubic angle; it must be deposited in parallel layers in each histological layer, between the skin and the tunica albuginea, while preserving the integrity of the dartos and Buck's fascia.
The deposition involves seeding subcutaneous fat islands, in equal amounts, averaging 0.5 cm³, placed in overlapping layers along a flaccid penis, ensuring the integrity of these envelopes. It is important not to inject too large quantities of fat at once to limit the occurrence of cytosteatonecrosis, which could have an unsightly and uncomfortable effect for the patient. The usual amount grafted is 50 to 70 cm³. In subsequent sessions, 70% of the previous graft is used. It is also crucial not to place the fat too superficially to avoid any risk of necrosis.
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POSSIBLE COMPLICATIONS
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Irregularities in the insertion of the graft
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Cosmetic problems related to these irregularities
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Rejection of the fat graft
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Frequent swelling (27 % of cases) with no ensuing problems. Uncircumcised patients must be informed of the possibility that swelling could prevent them from easily moving the foreskin for three to five weeks.
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Separation of the scar tissue (10 % of cases) that heals in a few days
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Cutaneous necrosis, extremely rare
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Infections where the patient suffers no adverse consequences
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Fibrosis, calcification, or fatty cysts
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Granulomas caused by cytosteatonecrosis
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HOW DOES THE PLATELET-RICH PLASMA (PRP) INJECTION SESSION WORK?The platelet-rich plasma (PRP) injection session for the treatment of baldness begins with a consultation to discuss medical history and expectations. Next, a blood sample is taken, centrifuged to isolate the PRP, which contains growth factors. Before the injections, the scalp is prepared, sometimes anesthetized, and then the PRP is injected directly into the areas to be treated. After the injections, scalp stimulation may be performed. The session ends, and post-treatment instructions are provided to maximize results. Multiple sessions may be necessary for lasting effects.
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HOW MANY PRP INJECTION SESSIONS WILL I NEED?The number of PRP injection sessions needed for baldness treatment can vary depending on several factors, including the severity of hair loss, individual response to treatment, and the patient's specific goals. In general, multiple sessions spaced over a period of several months may be recommended to achieve optimal results. Typically, an initial regimen might include several sessions close together over the first few months, followed by maintenance sessions at more spaced intervals. Dr. Danino recommends one session monthly for the first few months, followed by maintenance sessions every three to six months.
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WHAT ARE THE RISKS OF BALDNESS TREATMENT WITH PLASMA INJECTIONS?Platelet-rich plasma (PRP) injections for baldness treatment are generally considered safe because the PRP is derived from the patient’s own blood, reducing the risk of allergic reactions. However, as with any medical procedure, there are some potential risks associated with PRP scalp injections. Some of these risks include: Injection site discomfort: Temporary redness, swelling, or tenderness may occur in the scalp after injections. Infection: Although rare, there is a risk of infection at the injection site. Health care professionals take steps to minimize this risk by following aseptic protocols. Bleeding: Minor bleeding may occur at the injection site, especially in people who bleed easily. Unsatisfactory Results: Treatment results may vary from person to person, and PRP is not guaranteed to be effective for all individuals.
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HOW LONG DOES PRP INJECTION TREATMENT LAST?The duration of a PRP injection session for baldness treatment can vary depending on several factors, such as the method used by Dr. Danino and the area of the scalp being treated. In general, a PRP session can take about 30 minutes to an hour. The process involves drawing blood from the patient, centrifuging it to isolate the platelet-rich plasma, and finally, injecting this plasma into the scalp. The total number of sessions required will depend on the treatment protocol recommended by Dr. Danino and the patient's individual response to PRP.
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CAN WE RETURN TO OUR USUAL ACTIVITIES AFTER A PRP SCALP TREATMENT?Generally, most people can resume their normal activities after a PRP scalp injection session. Although the procedure is considered minimally invasive, some individuals may experience temporary mild redness, swelling, or sensitivity in the scalp. These side effects are usually transient and resolve within a few hours of treatment. Dr. Danino recommends limiting strenuous physical activity to avoid sweating, and sun exposure. Wait 24 hours before washing your hair.
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WHY ARE PLASMA INJECTIONS A GOOD SOLUTION?Platelet-rich plasma (PRP) injections are considered a promising treatment option for baldness due to several potential benefits: Natural Approach: PRP is derived from the patient's own blood, reducing the risk of allergies or serious side effects. It uses the body's own healing mechanisms to stimulate hair growth. Growth Factors: PRP contains growth factors, proteins and other bioactive components that can promote cell regeneration, stimulate vascularization and strengthen hair follicles. Non-Surgical Procedure: PRP injections are less invasive than some other hair treatment options, such as hair transplant surgery, which generally means less recovery time and side effects. Potential to slow hair loss: PRP may help slow the progression of hair loss in some people by strengthening existing follicles. Versatile Treatment: PRP can be used as a stand-alone treatment or in combination with other treatment options, providing a versatile approach to meet individual needs.
Before/After Results of Penoplasty - Lengthening and/or Thickening of the Penis
It is important to note that the examples of surgery performed by Dr. Alain Danino are provided for informational and educational purposes only. These illustrative cases are intended to offer information about the surgical procedures performed but should not be considered as a guarantee or assurance of the surgical outcomes that potential patients may achieve.
