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Everything you want to know about penis surgery

Tom Rasmussen goes balls deep with the inventor of the penoplastic procedure, Dr Roberto Viel

The world is obsessed with penis size. The number of times we’ve all, over brunch, zoomed in on the crotch of a celebrity wearing grey sweatpants or giggled over a cosmo at the size of a new squeeze’s squeeze. Why? Because we’re all Hannahs. Sorry. Wrong show! We’re all Samanthas!

But in truth, the world of worry which surrounds the size of one's own penis is a pretty real thing, at least for those years in which we become aware that we have one. Arguably penis size is something all of us with a penis have at some point felt concerned about. According to the International Society of Aesthetic Plastic Surgery, over 45,000 penis enhancement procedures took place between 2013 and 2017. Basically, penis enlargements are a thing — and they’re on the rise.

We decided to get to the shaft of the matter, go balls deep if that’s your thing, and interview the man who has spent nearly thirty years minimising insecurities by maximising people’s penises.

Dr Roberto Viel introduced the practice of ‘penoplasty’ to the UK back in 1990. And here he is to answer loads of questions about what it is, what it does, and what it means.

How and why did you want to become a surgeon?
Dr Viel: I started my studies in Milan, I graduated in the eighties and then I did my residency in the department of plastic and maxillofacial surgery and basically as soon as I finished with the residency I started to work as a cosmetic surgeon. I went straight into private practice, focusing on aesthetic plastic surgery in the surgical and non-surgical. And at the end of 1990, together with my twin brother, we opened this office here in London. So I’ve been here, doing this job, since 1990. It seems like yesterday — time flies. I’m lucky enough to travel the world for my job and see interesting cases.

Can you tell me what led you to pioneer the technique of penoplasty?
Dr Viel: Penoplasty — in 1990 I had a request from a female patient asking if there was a possibility to make the penis larger because her boyfriend needed that. So at the time, as a young surgeon, I found it an interesting question, a challenging one and when I was doing my investigation and research I came across somebody in the States that was using fat to increase the circumference of the shaft of the penis. There were also some pioneers of fat transfer that said it was possible and so that’s why first I went to see this surgery in Miami, and see the way it was happening, and it went from there. At the time I was using fat to graft to the face so to utilise a similar technique for the penis was the way forward. Then the technique has developed, improved, we made some changes on the way — but that’s the whole idea. To increase the circumference of the shaft of the penis in doing a fat graft.

Why fat?
Dr Viel: We use fat because fat is the best material, in my opinion, it’s a part of the patient’s own body, there’s no risk of rejection, no risk of major complication or problems and it’s predictable in what we can achieve. Yes, there’s some fat absorption — that’s why that has to be explained to the patient, that absorption can sometimes happen, that small lumps can sometimes happen — but they’re treatable — but if the technique is done correctly it is a very satisfactory method of enlarging the penis.

Have you ever used anything else?
Dr Viel: I tried in the past to use fillers because it seems to be a good, quick alternative, but I wasn’t happy with the fillers because they move too much on the shaft of the penis, and some of the fillers that are more permanent would give hard lumps and cysts that are difficult to treat, so filler was not in my experience very successful. That’s why I stayed with fat. To compensate and to reduce the fat absorption, nowadays we mix the fat with platelets to reduce the absorption. Or even better — enrich the fat with mesenchymal stem cells and this way we have the best result because absorption is minimal and there is more new fat.

When you say absorption, what do you mean?
Dr Viel: The fat that you put in — can be into the penis, the hands, the face, the breasts, the buttocks — there is always some loss of the fat that you put there because the fat graft — to survive — needs a proper blood supply for the lipocyte to survive and become living fat cells. So, if you put too much fat not all of the fat can receive the blood supply to survive so will be absorbed by the body. So the average absorption is about 30/40/50%.

When you’re doing the procedure do you plan for the absorption?
Dr Viel: It’s not to plan, but we know what will be more or less the rate of absorption, so when I do this surgery I collect more fat than I need, and we’ll cryopreserve that fat. We freeze it and we’ll use the frozen fat as scaffolding to increase the girth of the shaft of the penis every few months until we reach the final result.

So it’s a procedure over some months?
Dr Viel: Yes.

Does the procedure only expand the girth?
Dr Viel: There are two different procedures: penoplasty is a combination of girth and length — most of the time I do both. But sometimes there are patients that want only the girth and patients that want only the length. But most of the time both. So for the girth it’s a fat graft, and for the length it’s a different procedure which involves cutting the suspensory ligament at the base of the penis. If I release this ligament, if I cut this ligament, the penis drops out more and when it’s flaccid it will be longer, by about an inch and a quarter. But when there is an erection there is not an increase in length because the penis is already stretched to the maximum limit.

Is it an invasive procedure?
Dr Viel: Yes, it’s an invasive procedure. Because I need to collect fat with a technique called liposuction, and then re-inject the fat at the base of the penis with a small opening with a thin cannula. So it’s not very invasive, but it’s still an invasive procedure. It’s a day case procedure which can be done under local anaesthetic with or without sedation. There is no need for general anaesthetic. 

Once healed, does it change sexual performance in any way?
Dr Viel: This procedure will improve the sex life because it will improve the self-confidence of the patient. So the patient usually feels more confident with sex, which should reflect in a better sex life.

Is there a specific type of client for this type of procedure?
Dr Viel: No, I have seen every aspect of life. I’ve seen from the young boy to the seventy plus man. I’ve seen from the unemployed to the successful businessman, to the professional — every aspect of life.

And in terms of pre-procedure penis size, does that range as well? Can it be someone with a very big penis or a very small penis?
Dr Viel: To see a real micropenis is very rare — I’ve seen a few times, but not very often. Otherwise, the majority is what we may conceive as an average sized penis, but what is average in a textbook is not average in the mind of the majority of the patients. Sometimes it’s smaller than the average, and sometimes it’s larger. I’ve seen everything.

Once you’ve done the procedure once and it’s working and has a good blood supply is there a limit to how many times you can graft?
Dr Viel: For lengthening it’s only once — when you cut the ligament you cut the ligament. And you can increase further after the surgery if you use a medical device that will stretch the penis — a penile extender. So once you cut the ligament and you use an extender you can gain more in length. For the girth, you can repeat the graft a few times.

Is penile stretching dangerous?
Dr Viel: No.

What misconceptions have you experienced throughout your career regarding penoplasty?
Dr Viel:
I have to say that nowadays it’s more accepted, and more surgeons are doing it – it’s a part of our life. But for many years at the beginning it was seen as something to laugh about. But we shouldn’t perceive it this way. There are a lot of men that suffer from because the size of the penis is important to them. I have seen several cases of men who can’t live a normal life and they avoid going to the gym, to the beach, to the pool, because they are so concerned about the size of their penis. The size of the penis has a strong influence on the psychology of a man.

Do you ever worry that by offering a service which enlarges the penis, you’re re-enforcing stigma around having a smaller penis?
Dr Viel: No. Absolutely not. We’re here to help the people and that’s what we do. It goes back to self-esteem and confidence. There are lots of people with small penises who are happy, but if you’re not happy why not help. We’re here to help each other. I know in my profession I don’t save lives, but I want to improve the quality of life.

Has the popularity of the procedure increased or decreased?
Dr Viel: It’s always steadily going up — even during recessions.

Can you think of any remarkable cases?
Dr Viel: When a patient comes back and says thank you very much, you changed my life.

Do more men want to increase length or girth more often?
Dr Viel: I do both most often.

What’s the healing time?
Dr Viel: Five, six weeks. No sex.

How do you think the procedure will evolve?
Dr Viel: There is not much to change for the lengthening. For the girth, if we can enrich the fat graft to have minimal absorption and minimal production of small lumps that would be ideal. That’s why I personally think to develop the use of mesenchymal stem cells to reduce absorption would be ideal. Less absorption, fewer top-ups.

In terms of top-ups — is that something every patient has to have?
Dr Viel: At the moment that’s part of my protocol, yes. It’s a quick procedure, takes ten/fifteen minutes, and doesn’t impact the routine of the patient. I usually do that three or four times for each patient.

In terms of the longevity of the procedure?
Dr Viel: It will last. But you need to keep your weight constant, if you lose fat, you may lose fat from the penis.

Is it reversible?
Dr Viel: The ligament – in a way you can reattach something, yes. To remove the fat, in theory, is possible but it’s much more aggressive than to input fat. But in theory, it’s possible.

And finally, do you enjoy it?
Dr Viel: Yes, it’s a nice, smooth operation that gives me pleasure to do, to help the man.