Dr Auroy answers your main questions

To date, the most suitable product is hyaluronic acid (supplied in syringes). Besides being harmless, it needs to be firm, volumising and to last as long as possible.

This is where one must be wary of hyaluronic acids that are too "thick" (heavily cross-linked or very highly concentrated), which can readily cause hard lumps. The same problem arises when they are injected in the face, the hands or the décolletage. The right balance must therefore be sought: a fluid hyaluronic acid that holds well, with a good volumising effect and slow degradation. Not all hyaluronic acids meet these requirements.

The best principle to bear in mind in the aesthetic approach to the penis is this: proceed in stages, gradually and durably, as for the face. We inject hyaluronic acids of different viscosities for lengthening and girth enhancement of the penis, and for girth enhancement of the glans.

A sound plan is to carry out one injection, then see the patient again within the year. In most cases a second injection is strongly advised: it may be of a smaller volume, but I recommend injecting the same volume as at the first procedure. This favours a more harmonious and more durable result.

Resorption of the product in the penis is exceedingly slow.

It depends on the patient's starting anatomy and on how “realistic” the request is. Glans girth? Penile lengthening? Penile girth? One should not aim for too much at the outset, and should proceed in stages. The skin cannot accept excessive volumes of product in 45 minutes. A volume of 10 to 15 ml on average is a sound starting point, after which the situation is reassessed.

At the practice, the procedure takes 45 min to 1 h depending on the case. The appointment may last up to 1 h 30 with all the necessary explanations, in particular the post-injection instructions. The procedure is atraumatic and painless thanks to anaesthetic cream applied beforehand. All information for before and after the procedure is given to the patient. A review is carried out at 1 month. If needed, hyaluronic acid can be added or removed.

It is straightforward, comparable to what follows a hyaluronic acid injection in facial or body aesthetics.

• Discomfort, or rather an unpleasant sensation (sometimes burning or stinging, specific to the penis).
• Swelling, bruising or haematoma.

It is advisable, indeed essential, to abstain from sexual intercourse for one week (it may be uncomfortable at first), and ideally for two weeks.

• It is immediate and settles progressively over the course of a month, as the swelling subsides and massage refines the result.
• Depending on individual anatomy and the volume injected, the volumising effect can be substantial, firm and convincing.
• On average, a gain of 2 to 5 cm in girth is expected.
• The penis is heavier and more prominent both flaccid and erect (greater confidence, a fuller appearance in underwear, and increased sensation during intercourse).
• The injected glans can regain a volume proportionate to that of the penis rather than appearing set back; above all it remains prominent when erect.

As regards lengthening, however, one point must be made clear:

• Penoplasty projects the penis downwards and forwards when flaccid, thereby increasing its length by 1 to 3 cm through projection.
• The result is a more prominent appearance overall.

There is, however, no gain when erect: the penis does not become longer than it was to begin with (or only marginally). On this point, it is worth recalling that studies on sensation during sexual intercourse are unanimous: girth and thickness matter more than length.

The first appointment is above all a medical discussion. Dr Auroy listens to the request, assesses the starting anatomy and makes sure the request is realistic. It is also the moment to rule out any unrealistic expectations, or situations that would not fall within this approach. No decision is taken in haste.

A physical examination is carried out flaccid and, where possible, erect, in order to assess as accurately as possible the volume to be injected.

Yes. The consultation takes place at the practice, under medical confidentiality, like any aesthetic dermatology procedure. Discretion is central to the practice.

Any adult man wishing to gain girth or flaccid length, whatever his starting build, provided the request is realistic and no medical contraindication is identified in consultation. Cases of micropenis, which are extremely rare, fall within the surgical field.

Patients' motivations vary widely.

• A lack of self-assurance in the young adult.
• An active sex life, with a wish to enhance pleasure.
• Locker-room self-consciousness in sportsmen or when playing team sports.
• Regaining confidence after a separation or divorce.

Hyaluronic acid is indeed a resorbable product, but when injected specifically into the penis between two fascial layers, its resorption becomes very slow, owing to the absence of enzymatic breakdown at that site. It is considered that after two correctly performed procedures, loss becomes minimal and the result may be regarded as permanent (to 80%).

Should the patient wish, however, the result can be entirely reversed by injecting the antidote: hyaluronidase.