What surgical options are available for permanent penis enlargement and what are their risks?

1. Surgical lengthening: suspensory (ligament) release and soft‑tissue rearrangement

The most commonly described lengthening surgery severs the suspensory ligament that anchors the penis to the pubic bone to allow more shaft to project externally; surgeons often pair this with removal of suprapubic fat or repositioning of penile skin for greater visible length ^{[2] [6]}. Reported average gains are modest—often only a few centimeters of flaccid or visible length—and the procedure can destabilize the erect angle, increasing the risk of post‑operative erectile dysfunction, scarring, and cosmetic dissatisfaction ^{[7] [2] [5]}.

2. Girth enhancement: fat grafting and injectable fillers

Girth procedures include autologous fat transfer (harvesting a patient’s fat and injecting it under penile skin) and injectable dermal fillers such as hyaluronic acid; fat grafting can provide more durable bulk but can resorb unevenly, cause nodules, or lead to deformity, whereas some fillers are temporary and require repeat treatments ^{[6] [8] [1]}. Permanent or non‑medical filler materials (silicone, paraffin) have been repeatedly associated with severe complications—chronic inflammation, infection, hard masses, penile deformity and even loss of function—prompting strong professional warnings ^{[3] [9]}.

3. Subcutaneous implants and the Penuma device

Soft silicone subcutaneous implants, most notably the Penuma® implant, are marketed to increase girth and aesthetic appearance; Penuma is the only device noted in the reporting with FDA clearance for commercial sale but is not without controversy, and its long‑term comparative safety profile remains limited ^{[10] [11]}. Implant procedures can produce satisfactory cosmetic outcomes for some men but carry risks of infection, capsule formation, implant removal, scarring and altered sensation; marketing claims should be weighed against limited independent long‑term data ^{[2] [11]}.

4. Complex reconstructive surgeries: buried penis, micropenis and combination approaches

When enlargement is medically indicated—true micropenis or severe buried penis—surgeons may undertake more complex phalloplasty or reconstructive approaches combining ligament release, skin grafting, fat pad reduction, and staged tissue grafts; these operations can restore function and appearance when anatomy or disease causes functional impairment ^{[5] [6]}. Such reconstructions are more accepted in specialty urology/plastic settings but still carry the general risks of major surgery and may require multiple procedures and long rehabilitation ^{[5] [1]}.

5. Frequency and severity of complications: what the literature shows

Systematic reviews and case series emphasize that complication rates are nontrivial and that severe disabling outcomes—penile deformity, shortening, chronic edema, non‑healing wounds, loss of sexual function and need for corrective surgery including grafting—are documented, particularly after non‑standardized or illicit procedures ^{[1] [3]}. Patient satisfaction is variable and often linked to realistic expectations and psychological state; experts warn that many men seeking enlargement have normal anatomy or body‑image disorders, making surgery clinically inappropriate ^{[11] [4]}.

6. Practical guidance: informed consent, alternatives and realistic expectations

Because benefits are modest for many cosmetic cases and risks can be permanent, clinicians advise thorough evaluation (including psychological screening), detailed informed consent, and exploration of safer alternatives (traction devices, temporary fillers, counseling) before irreversible surgery; marketing materials may overstate outcomes, so independent medical review and specialist referral are essential ^{[2] [12] [4]}. The literature underscores that outside of clear medical indications, many professionals do not recommend surgery given the balance of uncertain benefit and real harm ^{[4] [3]}.