Plastic Surgery
Dr. Barry Eppley

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Double Board-Certified Plastic
Surgeon Dr. Barry Eppley

Posts Tagged ‘suprapubic liposuction’

Case Study: Suprapubic Mound Liposuction and Lift For Uncovering the Buried Penis

Monday, July 4th, 2011

Background:Penile length or show is an important feature of a man’s body image. While there can be debate as to how much penile length is normal or of importance, all would agree that some penile show is needed. When little to no penis is seen, this can impact a man’s self-image severely as well as inhibit its sexual capability.

There are a variety of conditions that can cause a hidden or concealed penis which merit a full urologic work-up and evaluation. The overlying soft tissues, including the suprapubic mound and the lower part of the abdomen, can either cause or magnify other medical causes of the buried penis condition. Shrinking the size of all tissues that surround the penis may help increase the amount of shaft length seen in the non-erect state.

Case Study:A 34 year-old male was seen with the desire to have greater penile exposure. Despite some significant weight loss, he was unable to still see his penis. While it became more evident when erect, it was nearly complete buried when not. This was a major source of embarrassment for him.

On examination, there was a moderate-sized suprapubic mound around the penis of which only the very tip of it could be seen. On pressing down around the mound, greater shaft length appeared. There did not appear to be any tethering or restriction of the penile skin. There was also a hood of suprapubic skin excess from the lower abdomen which pushed down onto and almost over the buried location of the penis.

The first step in the surgical treatment of his buried penis was liposuction of the suprapubic mound. Using the Smartlipo probe at 30 watts, the suprapubic mound and lower abdomen was initially treated with7,500 joules of energy. Then a 4mm cannula was used to aspirate a total of 275cc of fatty aspirate creating a visible reduction of size of the mound. Because of the size of the lower abdominal area, a suprapubic lift was done removing 8” of skin and fat vertically and 22” horizontally across the lower abdomen. This was excised down to the abdominal fascia in a wedge fashion and removed. A drain was inserted and a compressive dressing was applied. This was done as an outpatient under general anesthesia.

The drain was removed one week later. He wore lower abdominal compression for three weeks after surgery. At that time, the largest amount of swelling had gone down and the benefits of the procedure could be seen. Swelling continued to go down and a final result was reached by eight weeks after surgery. Penile show was much improved and the shape of the lower abdomen and suprapubic mound was significantly flatter. He felt he got an ‘extra’ 3 inches of visible penile length and his self-confidence skyrocketed…to quote him directly.Final results will take a full 3 months to appreciate until the suprapubic mound area again feels soft with normal skin sensation.

Case Highlights:

1) One of the contributing causes of a buried penis is a large enveloping suprapubic mound of fat and a suprapubic and lower abdominal skin overhang. Penile length can be severely shortened when buried by overlying and surrounding soft tissues.

2) Liposuction of the suprapubic area can help increase penile show by reduction of an obscuring fatty mound.

3)Suprapubic liposuction for the buried penis may be combined with excision of lower abdominal skin and fat to simultaneously create a suprapubic lift as well. Fat reduction and skin lifting combine for the best exposure of penile length.

Dr. Barry Eppley

Indianapolis, Indiana

Suprapubic Liposuction in Lengthening of the Buried Penis

Saturday, October 18th, 2008

A buried or hidden penis is an uncommon condition of young male children and teenagers. There are numerous reasons for a buried penis including  scar retraction from a prior circumcision, childhood obesity, and a congenitally small or short penis. Regardless of the cause, a concealed penis is a potential problem for an unobstructed urinary stream as well as a source of social embarrassment.

In some patients, a suprapubic fat pad is present that can completely mask a penis on its own or, at the least, exacerbates an already partially buried penis. Obesity and the size of the mound often have a logarithmic relationship and any degree of being overweight makes concealment of the penis worse.

Numerous procedures are available to expose and lengthen the penis to make it more visible above the surface of the skin. The primary procedure is release and lengthening of the retracted penile shaft. Often, however, the enlarged suprapubic mound obscures the effect of penile lengthening making it less visible than it otherwise might be. In these cases, reduction of the suprapubic mound through liposuction is of invaluable assistance in maximizing the effect of penile lengthening.

I have performed over 100 suprapubic liposuction cases in buried penis patients, of which over 90% have been in children and teenagers. This procedure is always performed with a pediatric urologist of which I have been fortunate to have worked with some of the finest. The pediatric urologist first performs the release of the penis at which time I enter the case. Larger suprapubic mounds are first infiltrated with a tumescent solution but smaller ones are injected with a lidocaine and epinephrine solution only. Through small stab incisions in the groin creases, small caliber cannulas are used to aggressively suction the mound from the underside of the dermis to the base of the penis removing as much fat as possible. The pediatric urologist then returns to complete the procedure, finally securing the skin to the base of the penis. At the conclusion of the procedure, I like to apply compression which the patient will wear for one week after surgery.

The combination of penile lengthening and suprapubic liposuction is very effective for the correction of the buried penis deformity.  Suprapubic liposuction adds little time and virtually no risk to the procedure. Families should be aware that the suprapubic liposuction is not covered by medical insurance even though the urologic portion may be eligible for benefits.

Dr. Barry Eppley

Indianapolis, Indiana

Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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