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Widening is accomplished through liposuction, which involves extracting fat cells from a patient's abdomen, or elsewhere, and injecting the fat cells into the sides of the penis. One drawback is that often the 30 to 50 percent increase in girth is diminished when those fat cells are reabsorbed. But Tilden says recent work with "dermal graft augmentation" adds tissue to the sides of the penis, thereby preventing the need for "refills" of fat through liposuction.
Despite the refinement of technique, Nadig thinks the whole procedure has less than pleasing results, even if you only consider the visual aspects.
"Cosmetically, the 'after' pictures I've seen were not attractive, nor did they resemble the normal penis," he says, pointing out that the hair-bearing skin produces a "fur collar" effect. And since the head of the penis is not enlarged, the widening makes it resemble a puff adder, a snake that's bigger around the middle than at either end. Worst of all, there may be scarring and "the penis may end up being shorter."
As with any surgery, there is a risk of infection. A more dangerous and possibly fatal complication of the liposuction is that the injection of fat cells could trigger an embolism, a blood clot caused by globules of fat obstructing blood vessels.
Those selling penile enlargement and the doctors who question the surgery agree that it's basically a "feel good" procedure to bolster self-image and has little or no effect on sexual performance. And considering the money and time involved, the patient wouldn't be the only party left feeling good. At $5,900 for an outpatient procedure that takes an hour or two, there is a terrific profit motive for both the company marketing the surgery and the surgeon.
As for truth in advertising, surgeons mostly concede that the penis can be lengthened an inch or two by the operation. But it's unclear if that extension is maintained when the penis is erect. Surgicare marketing man Schoemen admits as much. "You're going to see more of a change in the flaccid state than the erect state," he says.
Size might count for self-image but has little to do with sexual performance or satisfaction, notes Dr. Connie Moore, an associate professor of psychiatry at Baylor College of Medicine.
"There are many men out there who if they could snap their fingers and have a larger penis, they would do so," she says.
That would certainly be cheaper than going under Dr. Ringer's scalpel. But Moore, a sex therapist and director of the Veterans Administration Sleep Clinic, says men have unrealistic ideas about penis size, since usually the only erections they've seen are in pornographic movies. The men in those movies are selected for their body type and penis size and provide a "skewed view" of things.
She isn't surprised some men are drawn to the surgery. Too often men are overly concerned by the size of the penis in its flaccid state, which can be deceptive. "In a locker room, they may not realize when you're flaccid and look a little smaller than somebody else down the row, that when erect, your erection may be just as large as his."
Moore says she's worked with men "who thought they could not get in a sexual situation because they felt so small. They felt they couldn't satisfy a woman." But she suggests psychotherapy, not surgery, is the answer for those tortured souls.
"With most men it's less extreme," she adds. "They're not pathological about feeling small -- they just think having another inch or two sounds good."
And it sounds good to lots of men. Estimates are that anywhere from 2,000 to 4,000 men nationwide have had some type of penile enlargement surgery. Surgicare performs about 200 a month nationally, and the Houston office -- one of the company's three regional surgical centers -- fields from 25 to 100 calls of inquiry daily from Texas and nearby states.
Age, by the way, is no deterrent to surgically induced happiness, at least according to Jason Schoemen. Surgicare's oldest local candidate was a 92-year-old man who, Schoemen claims, "wanted to die happy.