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This operation makes penis thicker and longer.
Unlike traditional procedures in which the root of penis is cut to pull out the ligament, this procedure involves cutting of fascia all the way down to loosen the tightness of the cavernous body.
This procedure is performed at only 4 hospitals/clinics in Japan, including our Yamamoto Clinic (as of January 2021).
As mentioned in the blog of Dr. Takahashi, the original developer of this technique, this operation requires skilled techniques and could be performed only by expert urologists.

Dr. Yamamoto, the operator, is current clinically-coordinated professor at Tottori University hospital since 2012.
He has been specializing in andrology at university hospitals, and knows this technique as well as the management of penis and testes better than any other urologists in Japan.

Dr. Yamamoto accepts many consultations from university hospitals regarding ED and infertility. Recently, in 2019, he successfully completed the exhibition about phimosiectory at the Tottori University’s society for advancement of surgical techniques.

Mechanism of Penis Enlargement Surgery through Fascia Detachment

The penis consists of the corpus cavernosum, which is covered by a white membrane called the tunica albuginea, made of collagen fibers. In addition, this white membrane is enveloped by Buck’s fascia. This Buck’s fascia acts like a corset, constricting the tunica albuginea and the corpus cavernosum, thus limiting the length and girth of the penis. The idea is to detach this Buck’s fascia as much as possible, which limits the size of the penis. Additionally, by detaching between the corpus spongiosum and the corpus cavernosum, an increase in the size, especially in width, can be anticipated.

Mechanism of the Increase in Length

While the above explanation clarifies why the penis might become thicker, some people might question why it becomes longer. The mechanism of the increase in length due to this surgery is almost the same as the treatment method for undescended testis. Undescended testicle is a disease observed in about 1.5% of newborns. As the name suggests, it’s a disease where the testicles remain inside the body and don’t move down into the scrotum. Until the age of 6 months after birth, there’s a possibility that the testicles might naturally descend into the scrotum. However, after that period, spontaneous descent becomes unlikely, and surgical treatment is necessary. During treatment, a 2-3 cm incision is made in the lower abdomen near the groin. The blood vessels connected to the testicle (testicular artery and vein) and the surrounding tissues of the vas deferens are then detached. As a result, the length of the blood vessels and the vas deferens, which were previously restricted by surrounding tissues, are released, allowing them to extend by several centimeters. This makes it possible to place the testicles in the scrotum as usual. Similar methods are used when extending and connecting blood vessels. The mechanism behind the penis becoming longer through this surgery is quite similar. By detaching the tissues around the corpus cavernosum (like fascia and ligament fibers), the elasticity of the corpus cavernosum, which was previously restricted by the surrounding tissues, gets released. This can have a positive impact on its length.

Risks and Aftereffects of the Enlargement Surgery

There’s the possibility of experiencing pain, itchiness, bleeding, swelling, and stitches breaking open. In terms of pain, it typically isn’t very intense, but minor bleeding and swelling might persist for about 1-2 weeks after surgery. Around one month after the surgery, most discomfort usually dissapears, and one can expect to return to a lifestyle similar to that before the surgery. Basically, the penis generally takes about three months to recover completely, so some discomfort might remain for that duration.

Procedure of Detachment Surgery of Fascia of Penis (Detachment Surgery of Buck’s Fascia)

Here’s an explanation of the procedure of the surgery:

1.Anesthesia and Marking of Incision Line

The surgery is performed under local anesthesia. Firstly, anesthesia is administered at the base of the penis, and before it’s taking effect, the incision line is determined and marked. By the time marking is completed, anesthesia begins to take effect on the entire penis, and additional anesthesia is then applied along the marked incision line. Although you’ll barely feel any pain when the anesthesia is applied to the incision line due to the anesthesia effect at the base of the penis, there might be a slight pain on the opposite underside. The pain is similar to that when receiving gum anesthesia during dental treatment.

2.Removal of Excess Foreskin (If Circumcision is Desired)

For those with phimosis, it’s highly recommended to undergo a circumcision simultaneously. The reason is that if there’s excess foreskin, swelling after surgery often intensifies, which can make the crucial compression fixation using bandage more challenging. If you hope to undertake a circumcision along with the penis enlargement surgery, the removal of excess foreskin is performed first. Since the area is anesthetized, you’ll barely feel any pain.

3.Fascia Detachment

After the foreskin removal, the enlargement surgery begins. In this surgery, the surgeon carefully detaches the fascia as much as possible using the medical scalpel. Many nerves run through this region, so utmost care is taken not to damage them during the surgery. Moreover, due to the abundance of nerves, depending on the effectiveness of the anesthesia, one might feel some pain. If any pain is felt, more anesthesia is to be administered to ensure minimal discomfort in the surgery.

4.Detaching the Adhesion of the corpus cavernosum

After removing the fascia, the next step is to apply a medical scalpel to the adhered parts of the corpus cavernosum, separating its adhesion. By doing so, space is created between the previously adhered parts of the corpus cavernosum. Together with the effect of the fascia treatment, the size increase in girth can be expected.

5.Detaching the Ligamentous Fibers at the Base

Lastly, ligament fibers attached at the base of the penis are to be removed. These ligament fibers influence the length, and detaching them along with the fascia treatment can lead to positive effects on the length of the penis.

6.Hemostasis and Suturing

Finally, we use an electric scalpel to stop the bleeding part and suture it. This is the end of the entire procedure of the surgery.

Procedure After the Surgery

Patients are required to wait for about 1 to 2 hours after the surgery.

1.Explanation of Medications and Treatment after Returning Home

You will be prescribed various medications such as painkillers, antibiotics, and ointments. Their usage will be explained to you.

2.Payment

Next, please make the payment for the surgery. Various payment methods are accepted.

Credit card	VISA
	MASTER
	JCB
	AMERICAN EXPRESS
	Diners Club
E-money	PayPay
	Rakuten Edy
	Merpay
	Apple Pay
	QUICPay
	iD
	LinePay
	WAON
Medical loan	TOMINSHINPAN

Credit card/E-money/Medical loan You can choose to pay part of the surgery fee in cash and the remainder with a credit card. We accommodate a variety of payment methods. Please do not hesitate to ask. The cost for the enlargement surgery, inclusive of medication, is 450,000 yen (tax included). If you also wish to undertake circumcision, it will also be included in the set price of 450,000 yen.

3.Check the Bleeding Condition

Bleeding check will be performed twice within about 30 minutes. During the bleeding check, instructions on how to apply the ointment and wrap the bandage will be provided. If, by the second bleeding check, there’s no sign of bleeding, you will be allowed to go home.

Flow from the Next Day after the Surgery

Below is the explanation of the flow from the next day after surgery.

1.Taking medicine, Photo Checks, Ointment Application, and Bandage Replacement

For one week after surgery, we ask patients to take antibiotics and other prescribed medications. On the next day after surgery, we will check the condition of the area where surgery is performed (e.g., bleeding, swelling) by photo. Please remove the bandage, move the foreskin towards the abdominal side, and show the sutured area as much as possible. It helps if you can provide photos of both the front and back sides. If everything looks good, you can start taking showers from the next day after surgery. Please apply the ointment and replace the bandage following the procedure that was explained after surgery. If you’re not sure about how to do this, a reference video titled “Click here (please be mindful of the volume)” is available

2.Second Check (1 Week after the surgery)

A second check will be conducted. Please remove the bandage and show the sutured area of both the front and back. If the condition is good, you can start upper body workouts one week after surgery. You will also no longer need to continue taking the prescribed medications.

3.Third Check (2 Weeks after the surgery)

A third check will be conducted. As before, please remove the bandage and show the sutured area from both the front and back. If the condition is good, you will no longer need the bandage, and you can start lower body workouts and engage in sexual activities. Two weeks after surgery, the stitches might still be present. If they are bothering you, you can cut off the thread ends, apply ointment to make it slippery, and then remove the stitches. After this, there’s typically no need for further contact unless any issues occur.

FAQ

Below are the frequently asked questions.

What is the efficacy rate?

It’s around 70-80%. Middle-aged individuals and older who find it easier to stretch the penis and those who have not undergone surgeries like circumcision tend to have better results. Meanwhile, younger individuals in their early 20s, those who have previously undergone circumcision or similar surgeries, and those who feel strong resistance when stretching the penis tend to experience less effective results.

Can you explain how the pain feels during surgery?

The surgery is performed using local anesthesia. Therefore, there will be some pain when the needle is inserted several times when performing the first local anesthesia. The injection areas are near the base of the penis (close to the pubic bone) and around the corona of glans penis, where the incision is performed. Generally, once the base of the penis is anesthetized, most patients feel little or no pain during the application of anesthesia around the corona of glans penis. If you feel any sensation or pain during the surgery, additional anesthesia will be administered to ensure the procedure is as painless as possible.

Can you explain the pain after the surgery?

About 30 minutes after the surgery, you might experience a stinging sensation similar to a sunburn. However, this pain usually disappears within an hour. Many patients even go sightseeing or enjoy a meal before heading home after the surgery. We’ll also prescribe painkillers, so if you feel any discomfort, please take them as instructed.

Will there be any change in penis sensitivity?

In general, there is no change. However, if the surgery is done along with circumcision, there will be a change in sensitivity due to the removal of excess foreskin. After the surgery, as you become accustomed to the new sensitivity through sexual activities, either by yourself or with a partner, you’ll find that you can ejaculate similarly to how you did before the surgery.

Will the erection become softer or change its angle?

The hardness of an erection is determined by the corpus cavernosum. We don’t directly operate on the corpus cavernosum, so there’s no possibility of getting soft. The angle of the erection is determined by ligaments deep within the penis and the volume of blood flowing into the corpus cavernosum. Similarly, we don’t perform the surgery on those that have a directly impact on the erection’s angle. Therefore, there is no possibility of change in erection angle after surgery. In fact, due to treatment made to the fascia near the base, the corpus cavernosum may become bigger more easily, which could potentially increase the erection angle.

Can I undertake surgery to enlarge the glans penis, insert a silicone ball, and have the penis enlargement surgery at the same time?

It’s possible, but not recommended. This is because the operation area for glans penis enlargement surgery and the incision area of penis enlargement surgery are very close, increasing the risk of necrosis in the foreskin in between. Regarding the silicone ball, the depth at which the fascia is detached and the depth at which the silicone ball is placed is different. This could result in the silicone ball not being placed properly or stitches breaking open more easily, so it’s not recommended.

Is it possible to keep the surgery a secret from my family?

Many patients undertake the surgery without notifying their families. At home, we kindly ask that you replace the bandage yourself. The bandage might have some blood on it for a while, so it is better to consider how you’ll dispose of it. In addition, wrapping the bandage might create an unusual bulge in the groin area, so it might be a good idea to have slightly larger underwear ready. We also provide medicine and bandages for replacement, so consider in advance where to store them after the surgery.

How long does it take from entering the clinic to leaving?

If everything goes smoothly, including consultation, surgery, and bleeding checks, it usually takes around 3 hours.

Will the surgery cost change from 450,000 yen (including tax)?

No, it won’t change. The cost is 450,000 yen, including all medications for training and the like. Even if you wish to have circumcision at the same time, the price remains 450,000 yen.

I have diabetes. Can I still undertake the surgery?

Yes, it’s possible.

Can I have corrections from other clinics done simultaneously?

Please consult with us through our men-only Tel. in advance. We’ll consider whether it’s possible and get back to you. Generally, corrections for deformity+ enlargement surgery after surgical treatment of phimosis are often feasible.