Penile girth enhancement procedures have gained popularity in recent years, which will cause tight foreskin in uncircumcised men. Penile girth enhancement procedures, however, come with various risks and complications, some of which are not widely discussed in medical literature. One such complication is phimosis, a condition where the foreskin becomes tight and cannot be easily retracted over the glans penis after filler insertions to increase the girth of the penis. The risk of phimosis after filler insertion is higher in adults who already have mild tightness of the foreskin.

Overview of Penile Girth Enhancement Procedures

Penile girth enhancement procedures can involve a range of techniques, including dermal injections and fillers. These methods aim to increase the circumference of the penis by injecting substances such as autologous fat, silicone, hyaluronic acid (HA), and collagen into the penile shaft. Despite their growing popularity, it is crucial to understand that these procedures have not been approved by the Food and Drug Administration (FDA) in the United States, primarily due to the lack of extensive research and documented safety profiles.

Common Fillers Used in Penile Augmentation

1. Autologous Fat: This involves harvesting fat from another part of the patient's body and injecting it into the penis.

2. Silicone: A more permanent option but associated with significant complications.

3. Hyaluronic Acid (HA): HA is commonly used in cosmetic procedures and is favoured for its temporary effects and biocompatibility.

4. Collagen: Used to provide volume and structure, though it also carries risks of allergic reactions and complications.

The Risk of Phimosis with Penile Fillers

Phimosis is a condition where the foreskin becomes too tight to be pulled back over the head of the penis after uncircumcision penis filler insertions. Tight foreskin can cause pain, swelling, and difficulty with hygiene, potentially leading to balanitis. In particular, HA fillers have been noted to cause this dermatologic complication in some cases.

The mechanism behind this complication can be multifactorial:

- Excessive Filler Volume: Over-injection can lead to excessive swelling and tightness of the foreskin.

- Inflammatory Reaction: The body's response to the injected material can cause inflammation and scarring, leading to phimosis.

Improper Technique: Inaccurate placement or uneven filler distribution can create localised swelling around the foreskin, which can become tight.

- Phimosis is higher in patients who already have mild to severe phimosis. Uncircumcised men may be more prone to filler migrating to the foreskin, which becomes tight (phimosis)

Case Representation and Management

A recent case highlighted the occurrence of phimosis following HA penile girth enhancement. The patient developed significant foreskin tightness, making retraction difficult and painful. The management of this complication required a comprehensive approach:

- Prevention measures immediately after the procedure: Those who have filler recently should Keep the penis upright in supportive tight underwear for the first 7-15 days following the procedure. This is to prevent gravity and reduce the impact of walking so it does not cause the filler to migrate down towards the foreskin. If you notice excessive product around the foreskin, try to massage this back up the penile shaft towards the base of the penis before the filler settles down after 1-2 weeks.

- Medical Management: Initial treatment involved anti-inflammatory medications and topical corticosteroids to reduce swelling and inflammation. Injections to dissolve the fillers in some cases.

- Surgical Intervention – circumcision: In severe cases, surgical intervention such as a dorsal slit or circumcision may be necessary to relieve the tightness and restore normal function.

 Conclusion

 While penile girth enhancement procedures offer solutions for men seeking to increase their penile circumference, the risks and complications, including phimosis, should not be overlooked. Patients must be fully informed about the potential dangers, and surgeons must exercise caution and follow stringent protocols to minimise these risks.

Without FDA approval and comprehensive studies, the medical community must rely on case reports and ongoing research to understand and mitigate the complications associated with penile fillers. Patients considering these procedures should consult with experienced urologists and weigh the potential benefits against the risks of tight foreskin.

This blog aims to describe the under-discussed complications of penile fillers and emphasise the importance of informed decision-making and professional guidance in girth enlargement surgery.

Some clinics advise that for a patient having girth enlargement surgery, having a circumcision before can improve the aesthetic appearance of girth increase. Some clinics asked for circumcision before the girth enlargement surgery to prevent the phimosis.

 We are a specialist London circumcision centre that can deal with phimosis with filler procedures. Please ask for professional advice and treatment at our London centre.