Compared to five years ago, we weren’t doing any of these procedures. Since then, the procedures have increased in demand exponentially, to where we’re probably doing twenty to thirty procedures per month, since around 2024. We’ve actually seen a lot of patients traveling for these procedures from other states and around the country.
I want to talk about it the way I would with a colleague, because the demand is telling us something. So here is the candid version.
Who Is the Typical Patient
The typical patient is actually anything you can imagine. There are really no stereotypes in terms of who’s seeking these procedures. There’s a wide range of ages and a wide range of races. You would think that a lot of men would consider themselves small, and that’s why they’re obtaining these procedures, but actually, a lot of men are already well-endowed, and they’re just looking for enhancements. I can see that the age between thirty and fifty is the most common, but again, we see all types of patients.
What They Are Asking For
They’re asking for several different kinds of procedures. The most common is size enhancement, which is usually done with fillers. The most common fillers, which give the most volume in the penis, are Voluma and VoluX. These fillers are going to increase girth and can increase length up to half an inch, but that’s not the main objective or how it physically works.
Men who want to enhance sensation or who have erectile dysfunction are getting the P-Shot, which is essentially PRP, platelet-rich plasma derived from your own blood, which is injected into the cavernous bodies of the penis and the crown to increase sensation, libido, and erection strength.
Recently, we’ve seen an increased demand for Bocox, which is botulinum toxin injected into the cavernous bodies of the penis. This creates vasodilation, which creates a larger erection. It usually increases length by half an inch to one inch, creates a stronger erection, and is used in normal patients as well as for erectile dysfunction.
Some men are looking for a descended testicle look, where the testicles hang more pronounced, and smoother scrotal skin, and to avoid the scrotal shrinkage that we sometimes see with changes in temperature. These men are good candidates for Scrotox, which is Botox injections into the dartos muscle and the scrotal skin.
The Part I Make Sure Everyone Hears
It is very important to know that Scrotox can cause sterility, because really, those muscles we have are for temperature control of the testicles and the spermatic cord. A patient who would not be a candidate for Scrotox is one who would still want to have a family, as the procedure can make a male sterile.
It’s also important to understand that all of these treatments are off-label. Even though the products are FDA-approved, we are using them in an off-label nature, with the patient’s consent and understanding of the risks and complications.
What Is Really Driving It
I think, essentially, it’s increased self-esteem in sexual encounters and increased performance. Some of the procedures are more about appearance, such as the Scrotox for smoother skin and more descended testicles. Some men actually come for injections to increase the testicle or scrotal size, so that’s more about appearance. I think length and girth are a combination of appearance and sexual confidence. And I think erectile strength is more about sexual confidence and performance.
The Misconceptions Men Walk In With
One of the biggest misconceptions men have when considering these procedures is that the procedure will considerably lengthen the penis. As I’ve discussed before, these procedures really don’t create a lot of length. If anything, it’s half an inch maximum, or one inch. But they do seem to create a lengthening effect at rest, when the penis is not erect, and they mostly create an increase in girth.
The other misconception is that these results are permanent, where, for example, fillers can last one to two years, and Botox usually lasts three to six months.
And then I think the biggest misconception of them all is that bigger is always better, and that’s not necessarily the case. Sometimes the quality of the erection is more important than the size.
Where the Risk Lives
There are many risks and complications. It’s extremely important that you go to a board-certified physician to obtain these enhancement procedures, that the facility is using FDA-approved botulinum toxin and fillers, and that these procedures are performed in sterile environments. This is certainly not a procedure where you would want to bargain or look for the least expensive provider, if that means cutting back on safety and quality products.
The main risks, especially with the penile fillers, would be some areas of contour deformities, which can always be touched up later. Sometimes there could be nodules that are palpable, which can also be dissolved if necessary. It’s very important that the product be injected in the right plane. If it’s injected too superficially, then the nodules and irregularities will be more apparent. They can even create edema in non-circumcised men, which can interfere with intercourse and even regular voiding. The most dangerous complication would be an infection in this area, which is avoidable with the right sterile technique and postoperative care.
The Bigger Picture
I think this is part of a broader male aesthetics trend. We are seeing men more frequently in our clinics for cosmetic procedures, hair restoration, hormone replacement, weight loss therapies, peptides, and wellness IV drips. I think men are getting more comfortable with these treatments. I think a lot of it has to do with finding the right provider that they’re comfortable with and that they can trust.
So many men are curious but embarrassed to ask about these treatments. A lot of them do research online. We even have a chatbot that can talk to them, and at least they seem to think it’s a little bit more private. But what I would say is that these are actually very common procedures that most men know about and have even researched for themselves, that we just don’t talk about. Clinics that perform this on a regular basis understand the needs of men and usually cater to them in a very respectful and private way, where they’ll feel understood and not judged.
The Credential Behind the Opinion
I am double board-certified by the American Board of Plastic Surgery and the American Board of Surgery, an American College of Surgeons Fellow, Mayo Clinic plastic surgery fellowship trained, and a Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center Paul L. Foster School of Medicine. Castle Connolly Top Doctor for thirteen consecutive years. I write about this candidly because the field is growing faster than the honest conversation around it.
Ready to Talk?
If you are a man weighing any of this, or a colleague trying to build this part of a practice the right way, the principles are the same: honesty up front, sterile technique, FDA-approved products, and realistic expectations.
For the patient-facing clinical guide, see the companion post on agulloplasticsurgery.com. For the MedSpa and men’s wellness side, see the version on swplasticsurgery.com.
Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. #StayBeautiful.
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