There are four main circumcision styles (high/low and loose/tight) depending on how much inner and outer foreskin is removed. Discussing these with a urologist and considering your anatomy and foreskin problems is vital for choosing the best option and achieving a successful outcome.

The high/low style is a way of stating how much inner skin is removed. The loose/tight style is a way of stating how much outer skin is removed. These styles are almost independent; hence, there are four circumcision styles:

• Low and Loose

• Low and Tight

• High and Loose

• High and Tight

Dr Khan can discuss the characteristics of high- and low-cut, tight- and loose-cut types or styles of circumcision.

 1.     High and low “cut” circumcision

This concept is due to the scar line from the groove (sulcus) of the head of the penis (corona of the glans) and also depends upon how much inner skin, called mucosal skin, is removed. High “cut” means excess outer skin along with the shaft of the penile skin is cut, leaving long inner skin. Low “cut” means to cut more inner skin so that the scar line is very close to the groove of the head of the penis. Some men think entirely the opposite of this concept. They may think a “cut” or scar line is taken to the base of the penis.  These high or low styles are not possible in all men. Put a scar line in the middle of the shaft or close to the base of the penis is not recommended as it leaves too long inner skin, which can swell up due to lymphatic drainage (lymphedema) and also, over time, the inner skin stretches to become a loose fold of skin which gives unsatisfactory results in the long term. This also involves cutting too much shaft of the penile skin.

2.     Tight versus loose circumcision

This might depend upon many factors, such as how much total foreskin is removed, the mobility of penile shaft skin and attachment of the skin at the base of the penis toward the abdomen (penoscrotal junction). Tightness of skin around the penis is sometimes not possible, no matter how much foreskin is removed during the circumcision. This is due to the loose attachment of skin at the base of the penis to the body at the penoscrotal junction. Congenital reasons or the ageing process might cause this. Tight circumcision should not be confused with the quality of erection, which depends upon many factors. The erection is not affected by circumcision. Loose circumcision may also be similar to partial circumcision. These concepts should be taken according to the flaccid and erect state of the penis. Tight circumcision is not possible for those who have a considerable difference in size between fully flaccid and fully erect penis. They may have a painful erection during sexual activity in the first 3-6 months if a tight circumcision is performed.

American Urologist Dr Eid described on his website about “Cosmetic Circumcision”, where he cut the sleeve of skin at the base of the penis leaving the whole inner skin INTACT. 

However, in Dr Eid's experience, great care has been taken so that during an erection, the penis has an excellent cosmetic appearance. For that reason, before the removal of skin, an artificial erection is induced in all patients to determine the amount of skin to be excised precisely. In addition to experiencing improved hygiene and self-esteem after having a cosmetic circumcision, patients are delighted with the appearance of their penis.

In Dr Khan's view, this can be done in a very selective number of patients. There are the following conditions required to achieve good outcomes: 

1. The peno-scrotal junction has to be fixed  

2. There must be loose foreskin which can retract behind the head of the penis  

3. There must not be a buried penis  

4. There is no pathological phimosis (tight foreskin)  

5. There should not be Balanitis (BXO phimosis) or scarring

6. It needs to have general anaesthesia for getting an artificial erection to see for adequate removal of skin from the base of the penis 

Ref:

1. http://www.circlist.com/styles/page1.html#terminology

2. https://www.urologicalcare.com/cosmetic-penile-surgery/cosmetic-circumcision/