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There are certain conditions that may enhance and optimize the results of Male Enhancement treatments. When a patient considers having a Penile Shaft (or Girth) Enlargement treatment several factors can have a significant impact on the results, such as if you they are uncircumcised, if they were circumcised but a lot if foreskin remains, have high retraction during the flaccid state, or even have a small glans in proportion to the penile shaft..


If a patient is uncircumcised, it is highly recommended to have a circumcision done (with minimal foreskin retained) before having a Penile Enlargement treatment.

For patients who do not want to be circumcised and have the penile shaft enlargement, only about 4 out of 10 patients will heal and shape well. The other 6 will need to have the circumcision done afterward. Having the circumcision afterward is not an issue and all heals very well.

If a patient decided not to have a circumcision and has a filler enlargement procedure, there is an increased risk of skin sores and pain due to the thin and delicate nature of the foreskin. Below are some examples of uncircumcised patients and the difficulties we face with the foreskin remaining during the penile shaft enlargement treatment. Please note that the glans (or head of the penis) and scrotal areas can be treated without issue, but not the penile shaft for the uncircumcised.

The images 1A and 1B above demonstrate a patient who has had a penile shaft enlargement treatment and is in the flaccid (soft) state, two views shown.

The image above shows the same patient with the penile shaft in the flaccid state (different view).

The image above shows the same uncircumcised patient trying to ‘manually’ pull out the glans (or head of penis). Note the thickened foreskin.

The image above 1B shows the same uncircumcised patient pulling down the shaft skin exposing the thin zone of the foreskin area. This occurs because no filler material is placed under the foreskin nor can filler occupy this space, otherwise, the foreskin will not function properly. The image 2B above shows the same uncircumcised patient in the erect state. Notice that the area under the glans, where the foreskin is located, is thinner than the rest of the shaft. This occurs because filler cannot be placed under the foreskin area, so the rest of the penile shaft, which has filler (which is not turned into permanent collagen), is enlarged.

The images above show a different uncircumcised patient in the flaccid state. He has had 1 penile enlargement treatment. Notice the difficulty in getting the glans out, and the swelling or bulging area due to some filler entering into the thin foreskin.

The images above 1C and 2 C show a different uncircumcised patient in the flaccid state. He has had 2 penile enlargement treatments and is quite large. Notice the compressed foreskin area. The foreskin has been compressed by the shaft enlargement and collagen production moving into the foreskin ‘area’…which has caused less room for the foreskin and resulted in a compressed state not allowing it to cover the glans so easily if at all.

The images above show a different uncircumcised patient in the flaccid state. He has had 1 penile enlargement treatment. Notice the difficulty in getting the glans out, and the swelling or bulging area due to some filler entering into the thin foreskin.

Those who are circumcised may need a circumcision revision (to be ‘re-circumcised’) if there is too much foreskin left from the original circumcision. How can one judge if there is too much foreskin retained from the original circumcision? Just look on the penile shaft and identify the suture or stitch line where the penile shaft skin meets the foreskin. The skin directly under the glans, or head of the penis, is the foreskin. You will notice that it is different, it is much thinner skin, and has a different color and quality. If the foreskin remnant is greater than the 1-inch in length, what should be done? It is recommended to first send photos to Loria Medical for evaluation. If the foreskin amount is greater than 1-inch (measuring from the very top of the penile shaft, just under the glans, and downwards), a Loria Medical professional may recommend having a re-circumcision to remove this excess foreskin. The ideal foreskin remnant is in the ½ to ¾ inch range. The reason for this recommendation derives from the poor quality of the foreskin remnant, which could distend or form in an unbalanced misshaped manner when the length exceeds 1-inch, unlike the skin on the rest of the penile shaft which enlarges much more evenly and in a balanced fashion.  


  When a penile shaft enlargement treatment is performed, there will be normal swelling. This swelling causes the penile shaft skin to stretch out, which is normal. However, when the foreskin swells it swells much more and balloons out because the foreskin is a very thin sheet of skin. This is significant because the foreskin area has a higher risk of malshaping. The foreskin area will form collagen underneath it, like the rest of the shaft area, but may form with an inappropriate balance. This may cause asymmetry to the penile shaft. This bulging foreskin area can be controlled and formed to balance with the rest of the penile shaft, but not in all cases. If the foreskin bulges or shapes differently than the rest of the penile shaft, will I still be able to function sexually? Absolutely. The bulge may actually cause more sexual stimulation, but most patients want the penile shaft to ‘look’ cosmetically pleasing. In most cases, the ‘bulging area’ may be more stimulated during intercourse and functionally it will be better, but cosmetically it will not. Below are some examples of circumcised patients having had a penile shaft enlargement treatment and the difficulties we face when a lot of the foreskin remains (after the original circumcision).

The images above are patients in the flaccid state post a penile enlargement treatment, who also are circumcised with the recommended minimal circumcised foreskin remaining. Note the excellent balance and symmetry of the penile shaft, and the good proportional balance with the glans (or head of the penis).

The images above demonstrate circumcised patients in the flaccid state who have had a penile shaft enlargement treatment. Note the minor bulging area just under the glans (or head of the penis). The results were excellent, and this small bulge is presented here to show how the extra foreskin can cause shape irregularities. The underside view shows excellent balance with minimal ‘bulging’. The patients above were very happy with their results.

The images above demonstrate circumcised patients in the flaccid state who have had a penile shaft enlargement treatment. One image shows the skin pulled back, and the other in its natural flaccid state. Note the ‘turtling’ effect due to the high flaccid recoil or pull from the penile shaft. This ‘shrinkage’ or retractile force can cause this effect. This can be remedied by placing a flaccid insert under the penile shaft skin.


  Another condition that enhances and improves the results of a penile shaft enlargement treatment is the flaccid length. The flaccid length of the penis is the length when the penis is ‘soft’ or non-erect. If one has a longer flaccid length, the results are generally better. Why is this? During the filler treatment, the permanent filler material is placed into the penile shaft (subcutaneously) we then place a gauze wrap to keep the penile shaft extended out as long as possible. The reason for this ‘soft gauze cast’ holding the penile shaft out, like in its erect state, is that we want the filler material to stimulate collagen in a proportionate and even manner along the entire length of the penile shaft. The penile shaft has the tendency to pull and shrink back, this pulling force must be counterbalanced and prevented. Why is this important? If the penile retraction force is very strong (those whose flaccid length is less than 3 inches, or less than 50% of the erect length), this may cause a shift in the filler location and possibly cause what is called a ‘turtling’ affect. To help prevent this, we stabilize the penile shaft after the treatment by wrapping it with stretch gauze to prevent the penis from contracting into a short flaccid state. The ‘soft gauze cast, or gauze wrap, is there to prevent the penis from contracting into its short flaccid state. This will help the filler material remain evenly distributed throughout the penile shaft. Please refer to the images below and images 1-7 above which demonstrate many patients with longer flaccid states.

The patient in the images above demonstrates significant length in the flaccid state. The flaccid pre-procedure circumference is noted.

The images above demonstrate the post-procedure results, flaccid, and erect. The gains were greater than average, but notice the symmetry and balance of the entire penile shaft.

By keeping the penile flaccid length to its maximum, which the gauze wrap assists with, the filler will stimulate collagen production, and this collagen will distribute more evenly throughout the penile shaft. Even though there is a gauze wrap on the penile shaft to help prevent this flaccid pulling, the gauze wrap is not always successful and the flaccid pull might be too strong and causes two things to happen: The first is the strong flaccid pulling force can actually push some of the filler out of the penile shaft and into the pubic and scrotal areas. This is not dangerous, but the idea is to keep the filler in the penile shaft so the enlargement can be maximized. Secondly, when the flaccid pullback is strong it may cause an uneven distribution of filler material and subsequent collagen formation. It may cause the foreskin area to bulge more. If there is more foreskin leftover from the circumcision, then a bulging may potentially develop, which ultimately results in the ‘turtling’ effect. Does this affect intercourse and function? No, absolutely not. It is all cosmetic and does not have a functional impact. It is only a temporary issue if the head of the penis, or glans, is submerged under the bulging skin of the penile shaft during the flaccid state. When the penis becomes erect, the glans comes out and will look better and proportioned. The issue is a cosmetic problem, not a functional problem. Is it possible to correct this flaccid shortening issue (the high retraction of the shaft)? Yes. Loria Medical is working on a penile sleeve lengthening device designed to be inserted directly under the skin and concealed by your new collagen. The Flaccid Insert or penile sleeve device prosthesis is a thin medical-grade soft silicone rubber sleeve that is intended to maintain the penile shaft stretched out, gently, constantly, and consistently extending the penis forward subsequently elongating the tissues over time. This soft silicone implant prosthesis (which is the same material used in the latest designs of breast implants) once in place will prevent the penis from retracting, acting as an internal ‘splint’. This implant could permanently remain under the penile shaft skin and could be incorporated within the new collagen production. This penile sleeve device is highly recommended and will improve and optimize results for those who are looking for additional lengthen or to help prevent the high retraction (‘turtling’) of the glans.


  The glans, or head of the penis, can be modestly enlarged. The reason for modest gains, fair in comparison to the gains obtained with the shaft and scrotal enhancement, is due to the actual anatomy of the glans itself. That will not allow a lot of filler to be placed, and that is the reason why it could take several treatments to enlarge the glans to a significant size. Who is the best candidate? This varies greatly between each person, as all patients have a particular anatomy, and not until the first glans treatment is performed will we know how much gains around the glans a patient can get. When the procedure is being done, Your Loria Medical Physician will begin injecting the filler material and will evaluate how much filler the glans will allow in. The amount of filler formula to be injected will be proportional to the amount of space available in the glans, and whatever space is available will be filled. There is nothing that can be done to assist in getting more filler to ‘fit’ in the glans. The natural available space is the limiting factor. Keep in mind that the glans can be treated several times, which gives us the opportunity to build it up over time. There are no particular set of conditions that could be altered in favor of greater results regarding this procedure. Loria Medical always encourage its patients to have at least one glans enhancement done. If the response to the glans treatment is poor, further treatments might not be recommended. To see before and after images of glans treatments, please go to the Photo Gallery.


  Scrotal enhancement treatments are typically performed for those who desire a larger/fuller scrotal appearance or have a scrotum that constantly pulls/contracts which makes the patient feel very uncomfortable or may even be painful. The filler formula will induce collagen formation between the muscular fibers producing such contraction, preventing this from happening to an uncomfortable degree. Another consideration for scrotal treatment is on the other side of the spectrum, for one who has a very loose scrotal sac which could also be uncomfortable. By adding the filler formula material, the scrotal sac will ‘tighten up’ due to the extra girth of the skin and become firmer. By adding a permanent filler to the scrotal skin, it will cause the whole scrotal area to enlarge, help prevent scrotal contraction, and help ‘tighten up’ on the loose appearing scrotal sac. There are no particular conditions that will increase the chance for better results. Scrotums vary greatly in size, shape, and in skin quality. To see before and after images of Scrotal treatments, please go to the Photo Gallery.



Dr. Victor Loria, D.O. leads the practice of Loria Medical with locations in Orlando and Miami Florida. For more than 30 years, Dr. Loria has performed cosmetic, dermatologic surgery and other procedures including hair restoration, laser surgery, and permanent cosmetic filler on both men and women.





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