It was late when the young man got to the ER. He undid his trousers to show the doctor on call what the problem was, and boy, did he have a problem. His penis tissue was swiftly turning necrotic; it looked mangled. He had recently tried one of the latest cosmetic treatment trends: dermal penile filler, injected into the penis to boost girth. It’s usually a relatively safe, simple procedure, but he was one of the unlucky ones.
What, exactly, is dermal penile filler? Well, it’s not dissimilar to the way injectable dermal fillers are used to add volume to areas of the face. “Imagine for a second that your penis is essentially a blood chamber: when it fills, you get an erection. Then, you have a layer of skin wrapped around it. In between these two structures is a potential space that allows a skilled physician with proper training to inject appropriate amounts of filler inside of it to increase girth,” explained Dr. Jack Chang, a physician who is clinical lead at Pollock Clinics in western Canada.
Average penis circumference is about 3.7 inches when flaccid and 4.6 inches when erect, according to a 2014 review of 17 studies including more than 15,000 people. Chang said treatment with dermal fillers can increase thickness by one to two inches.
Chang’s clinic has been focused on no-scalpel vasectomy for many years, but added dermal fillers to the menu in the past two years due to popular demand. Now, they do five to 10 procedures a week, and the number has been growing. But men looking to enlarge their penis is nothing new. “Before dermal fillers were available, some men even used venomous snake bites that would cause their penis to swell to enhance their appearance,” Chang said.
In Toronto, plastic surgeon Dr. Cory Torgerson offers a non-surgical penis enhancement named The Big Shot at his Sovereign Male clinic. The treatment utilizes an injectable platelet-rich gel matrix; it’s a mixture of hyaluronic acid filler combined with platelet-rich plasma. The Big Shot is a fast-growing part of Sovereign Male’s bottom line, making up the majority of its procedures. Torgerson said filler is appealing to clients because it takes only 30 minutes and has minimal downtime. Plus it’s completely dissolvable and results are instant and last two to four years.
These doctors have seen the effect the procedures can have on men’s self-esteem and sexual confidence. “I have had men literally burst out in tears because they finally feel more comfortable about who they are,” said Chang. Torgerson has also seen tears of joy. “The boost in self-assurance increases both mental health and sexual well-being,” he said. “Feedback such as ‘game-changer’ and ‘super-cool’ are common. Patients who have had a disfiguring circumcision as a young child find it ‘life-changing.’”
Despite their popularity, penile injectables are divisive among the urology community. Some doctors are concerned about the number of non-urologists and even non-doctors performing procedures on such a complex organ. (The young man at the ER, for example, had his penile procedure done by an ear, nose and throat doctor.)
“[The penis] changes its characteristics: it can be flaccid or erect, it’s rich in vasculature, it has nerves, multiple layers,” said Dr. Dean Elterman, urologic surgeon at University Health Network and associate professor of urology at the University of Toronto. “It’s not just a thing you look at; there’s a physical component, so having a thorough understanding of the function and the anatomy is critical when doing a procedure on the penis.”
Michael, a 41-year-old porn performer from Montreal, previously measured 4.9 inches girth when erect. “I was insecure about my penis thickness. I was not proud of it,” he said. Last year, he flew to Dallas to get PhalloFill, a procedure using hyaluronic acid fillers, done by its founder, William Moore. Moore is not a urologist or a doctor but a cosmetic practitioner; he is the president of the Texas Med Spa Association and a certified injector of 20 years.
Michael had his first treatment in June 2022, then travelled back to Dallas in August to get more filler for a thicker result. “Go big or go home,” Michael said. “The procedure is surprisingly painless and went very smoothly.” He said he had some minor bruises for the first few days, but they were all gone three days later.
Today, Michael’s penis circumference is 5.7 inches. “Now, of course, there are providers in Canada I could go to if I wanted to get more filler in the future, which I plan on doing,” he said. “The best part for me is that my penis looks big and heavy even when it's soft. I now fill my swimsuits very nicely.”
According to the PhalloFill website, a single treatment, which adds about ¼ to 1/3 inch and consists of four to six units of filler, ranges between $2,800 and $4,350 USD; a 20-unit package adding about 1 inch over three or four treatments hovers near $10,000.
Last summer, Dallas was the only place Michael could get PhalloFill done, but now there are over 15 North American locations offering the procedure, administered mostly by board-certified urologists or dermatologists and some certified injectors (certification requirements vary by state or province). As of this past August, it’s offered in Montreal by certified urologist Dr. Kevin Zorn.
In Canada, urologists tend not to go into the penile enhancement space. “It may be because most of us in the urologic community have our reservations,” Elterman said. “So it falls on other surgeons to do it and there’s a market for it and I think that’s fine, but there is a word of caution.” That is, that other doctors — or non-doctors — likely don’t have years of experience of dealing with this specific anatomy. “If you’re doing a surgery, you should be able to do it not only when things go right, but also when things go wrong,” he said. “When there are complications, who will manage those complications? That is a critical element.”
Complication was the fate the young man at the ER suffered. He texted the doctor who had performed the procedure to say that he had gone to emergency, and the doctor proceeded to encourage the man to sign out of the hospital and come be treated at his own clinic. So he signed out and left, AMA (against medical advice).
Shame, too, may prohibit someone from seeking appropriate medical treatment when procedures go wrong. According to Elterman, improperly dispensed dermal fillers can result in injury to blood vessels and nerves, abnormal sensation, and pain with erections and intercourse. It can also cause deformity, infection, bleeding and loss of function.
Still, Elterman said that the procedure is generally safe if performed properly. Patients should do due diligence and research the background, training and experience of the doctor providing the service, and find out what happens if there is a complication. “They should know, where should they go? The closest ER? Does the surgeon have the necessary knowledge and skills and equipment to manage any issues?”
Chang adds infections and allergic reactions to the list of potential risks to consider. “Unevenness due to filler spreading around amongst skin fibres can also cause some esthetic concerns,” he said. “Seeing an experienced provider is crucial. It’s important to see someone who has experience doing this on a regular basis. It’s also important to consider how accessible the provider is to respond to complications expediently.”
Torgerson recommends going to a clinic that specializes in the exact treatment a patient is seeking. “A patient should feel confident after a proper consultation that they are a good candidate for the procedure and that their expectations are reasonable,” he said. “There should be clear aftercare instructions and ample opportunity for followup appointments.”
The demand will continue to swell, Elterman predicts. We’re in “the golden age of non-surgical phalloplasty,” as Chang puts it. And more social acceptance may be around the corner. “Just as it is widely accepted that volume enhancements in a woman’s chest can improve her self-esteem, the same can be applied for men,” said Torgerson.
But while the market will continue to meet the demand, not everybody will be satisfied with the outcomes. “The majority of [people who have this procedure] have normal penises, so this is all elective cosmetic surgery,” Elterman said. “My experience with men’s penis concerns is it’s very difficult to make them happy.”
Ladies take note: Not every man can deliver 8 of pure meat like me.
