This surgical procedure has the purpose of increasing the length of the penis. Other techniques, such as supra-pubic vibro-lipo-sculpture, peno-scrotal cutaneous plasty and glans filling, can be associated to the methods that are always utilized. During the same surgical session it is also possible to perform a lipo-peno-sculpture using the anti-reabsorption technique (penile girth enhancement) with Puregraft.

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The suspensory ligament of the penis is a deep seated structure that joins the internal part of the penis to the pubic bone. Its section results in a "sliding" forward of the internal portion of the penis with consequent increase in length of the external part, the visible part. The degree of lengthening obtainable depends to a large degree on the consistency of this suspensory ligament. There is in fact a direct proportion ratio: the more developed the ligament is the greater the results in terms of increase in length. Unfortunately it is not possible to know the real consistency of each individual ligament prior to the operation because it is deeply situated (therefore not palpable) and it is mostly hidden from sight by the pubic bone (therefore not visible with ultrasound). Moreover, as in other regions of the body, there is certain variability in consistency from person to person, which renders it difficult to make a forecast prior to the operation itself. Generally speaking, the increase obtainable with this single method can vary between 2 and 4 cm, visible both in a flaccid state and to a slightly lesser degree, in erection. A forecast of the increment obtainable can be made by measuring the most superficial part of this ligament (the only visible part) using an ultra sound and comparing it with statistical data at our disposal.

Technically, the section of the suspensory ligament of the penis is quite easy and does not involve any particular difficulties. It is, however, important to pay maximum attention, especially to the section of the deepest part because of the proximity of the dorsal neurovascular structures of the penis in this region. For this purpose we have adopted a last generation computer -controlled diode laser. A laser is a very precise cutting instrument which enables the minimization of blood loss and pain, it cuts and cauterizes at the same time and shortens healing time. The use of the laser is extended to all levels of surgery, with apparent benefits in results and post-surgical healing times, which are significantly reduced in comparison to traditional methods. At this point, the description of the traditional method includes the layer by layer closure of the surgical wound and the execution of a cutaneous plasty.

The result in terms of length obtained is, however, often only partial, because frequently so called "scar retraction" of the ligament itself often occurs. This process, which is also possible in other areas of the body, causes a surgically sectioned part of the body to spontaneously "seal" in the days following the surgery, thereby nullifying the results obtained. Such a situation occurs several days after the operation with individually varying degrees of intensity as has been ascertained during re-operation procedures.

To avoid such an inconvenience the use of so called "extensors" of the penis, which have been spoken about frequently in recent years, has been recommended. These are mechanical instruments that put the penis in controlled and progressive traction. Often advertised under the mirage of astounding and unrealistic results, they have proved to be incapable of causing significant increase in length when used without surgery. Their usefulness, however, has been demonstrated when used post-surgically for the purpose of preventing post-surgical scar-retraction. Nevertheless, they cannot be worn in the first days following surgery because of the presence of the surgical scar and this limits their efficacy (they can be used after at least 30 days). This therefore imposes the use of a structure that acts as a "spacer" between the two ends of the sectioned ligament.

The most utilized method is that of placing a soft silicone spacer between the two ends of the ligament and the result is often satisfactory, but it still involves material which is foreign to the organism. We, faithful to our conviction that it is better use only materials from the organism, have designed a specific suture (periosteal fascial), in order to avoid using silicone, which allows us to invert the surface layers from deep within the two ends of the sectioned ligament, this way achieving the same result as a silicone spacer, but only using tissue from the organism. All this translates to greater safety for the patient.

This technique has allowed us to render the results obtained apparent and long lasting. The accentuation of the pubo-penile angle with the lowering of the penis, which has been described by some authors, has in our experience been of a negligible entity. This procedure has a technical duration of one hour and is performed under spinal or general anesthetic depending on its association to other methods of designer laser phalloplasty. Discharge, as with all other procedures used, occurs on the same day.

This plastic surgery method is performed at the end of the laser section of the suspensory ligament of the penis, with the purpose of permitting a contextual lengthening of the skin which covers the male organ, which would otherwise be too short.

It technically consists in performing a V-Y plasty, or in other words an incision which initially has the shape or an upside down V, which at the end of the operation becomes an upside down Y.

The use of a diode laser enables greater precision of the incision, less bleeding and reduced tissue stress, with the practical result of accelerating the healing of the wound.

At the end, aesthetic sutures using resorbable stitches, or in other words sutures that will fall off spontaneously between 15-20 days after the operation, will be performed.

In people with an abundant and evident supra-pubic adipose panniculus, the pubic skin can surpass the cutaneous insertion of the penis with the result of an organ which visually appears shorter than it really is. This condition can exist with not only overweight individuals ("sunken penis" or in extreme cases "buried penis"), but also in norma-weight individuals or even in underweight individuals and is caused by individual characteristics of adipose accumulation zones.

In such cases the procedure of choice consists in "supra-pubic vibro-lipo-sculpture", a surgical technique that enables the aspiration of pubic fat using thin cannulas endowed with a vibration mechanism which permits first the dissolving then the subsequent aspiration of then excess fat.

The vibrating method is rendered necessary by the fact that male adipose tissue has characteristics of greater consistency than that of females which is removable simply using classical lipo-sculpture. This procedure enables the flattening of the supra-pubic area, resulting in the visual increment of the length of the penis, which in reality is not directly involved in the operation. It is performed under local, spinal or general anesthetic depending on whether it is performed singularly or in association with other designer phalloplasty techniques.

Technically, two minute incisions are made in the skin at the sides of the area to be treated through which a thin cannula is inserted which, vibrating, first dissolves then subsequently sucks the excess fat. The duration of the procedure depends on the quantity of fat to be removed with an average time of about 40 minutes. At the end, a compressive bandage is applied, which can be worn without difficulty for about 20 days. Discharge occurs on the same day, both for the singular procedure and when associated with other methods.

In some cases the point of insertion of the skin of the scrotum with that of the penis is situated along the shaft of the penis itself and not at the base as normal. This anatomical condition causes a "bat wing" appearance of the skin on the posterior part of the penis, which practically translates into an imperfection which visually reduces the total length of the penis.

In order to correct this condition, a diode laser is utilized to perform a peno-scrotal cutaneous plasty using the "Z" method, which is subsequently closed with an aesthetic suture using stitches which will be absorbed within 15-20 days.

This method, which lasts a few minutes, can be performed singularly or more often within the context of designer laser phalloplasty and it results in a very evident and satisfactory aesthetic result.