Great Lengths

If you answer those ads on the sports pages, maybe what you really need is a shrink

Jason Schoemen doesn't like to keep his appointments waiting. He assumes their anxiety levels are spiked high enough by the time they reach the front desk of Surgicare for Men's office near the Galleria. They've been driven there by perhaps that most primal of male concerns. They've come to inquire about having their penises enlarged.

Their path to Schoemen's door begins in the sports pages of the Post or Chronicle, where advertisements for Surgicare for Men frequently appear, tucked among the box scores and other ads for gun stores and topless bars. Callers to the number in the ad usually get a recorded message assuring them confidentiality and directing them to leave a message because "all medical staff are currently with patients." That's curious, since the entire office "staff" consists of Schoemen, the 20-ish, quick-talking marketing man for Surgicare for Men. He returns the calls and makes appointments for a "free consultation."

Prospective patients are greeted by a busy brunette who also fields a barrage of calls for the businesses that share the fifth-floor suite with Surgicare for Men, including Optimal Energy Inc. and Injury Management Organization Inc. "It's hard to remember what to say," the secretary admits, since each blinking button is linked to a different greeting for a different business.

Schoemen ushers potential customers back to an office sparsely adorned with three framed certificates on a wall, a bookshelf, three chairs and a desk. Screenings take anywhere from 15 to 30 minutes "depending on how many questions they have," he explains.

Schoemen describes the penile enlargement procedure and its cost -- $3,900 for widening or lengthening; $5,900 for both latitudinal and longitudinal enhancement -- and displays "before and after" photos of (apparently) satisfied customers. Easy credit terms are discussed; those who'd like to secure a loan for the cosmetic surgery (not covered by medical insurance plans) are referred to a finance company. The procedure, candidates for enlargement are told, is performed at the Northwest Freeway "surgery center" of Dr. B.R. Ringer, a local osteopath (who did not return calls for this story).

Surgicare's ad in the Post -- with the come-on that "Dreams Do Come True" -- promises an average increase of one to two inches in length, a 30 percent to 50 percent increase in width and, somewhat cryptically, "self-improvement." Surgicare for Men also advertises in Penthouse and the bodybuilding publications Muscular Development and Iron Man.

The other penile lengthening and enlargement enterprise that advertises in the local sports pages markets the services of a Dr. H.R. Safford III, who offers "over 20 years of surgical experience on males" (the cosmetic use of penile surgery, however, began only about three years ago). Safford, who lives in Denver, is described in the "for men only" ad as "the only M.D. board-certified urologist performing this surgery in Texas."

That distinguishes him from Dr. Ringer, who doesn't have an "M.D." after his name but is a doctor of osteopathy, a discipline that requires slightly different training but is recognized as a standard system of medical and surgical care. The ad does beg at least one question: if Safford is the only board certified urologist performing this surgery in Texas, is there a reason why other traditionally accredited surgeons aren't doing it?

Yes sir, there is.
Mainstream urologists say the procedure can be risky and note that there have been no studies published on its effects.

And it isn't necessary, they say.
Dr. Perry Nadig, a clinical professor of urologic surgery at the University of Texas Health Science Center at San Antonio, has blunt advice for anyone thinking of having penile enlargement surgery: don't.

"First of all, why would someone want to have it done?" he says. "If you have a self-image problem, you don't go to a cosmetic surgeon, you go to a psychiatrist."

But Ed Tilden, the marketing boss for Surgicare for Men in Newport Beach, California, says that if women can have cosmetic surgery, why can't men? "Twenty years ago when women came in and said they wanted face-lifts and breast enlargements, no one told them to go see a psychiatrist. What's wrong with a man trying to improve himself?"

Nadig is distressed by the widespread marketing of the surgery, especially the advertising "for an experimental procedure, and that's what this is. I feel very uncomfortable because the patients need to have full disclosure. They need to know it's an unproven procedure of unproven safety and efficacy." Nadig is virtually quoting the American Urological Association's two-sentence policy statement on penile enlargement, which notes that no scientific study has been done to support the ads' claims. Conversely, none has been published to debunk them, which is no surprise to Nadig. "It's hard if you're trying to prove a negative. If you don't think something is going to help a patient, you don't want to do it to them."

Surgicare's Tilden doesn't dispute the lack of studies, but he says that's because the surgery is relatively new. Previously, the procedure was done only to correct rare cases of microphallus -- an abnormally small penis -- or after penile damage due to trauma.

So how's it done?
The lengthening of the penis is achieved by cutting the suspensory ligament at the root of the penis, thus advancing the appendage from underneath the pubic bone, usually for about one to two inches. That decreases the stability of the penis and sometimes results in loss of elevation on an erection. It also requires the use of hair-bearing skin at the base of the penis.

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.

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