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The male scrotum is an infrequently addressed aesthetic area in both the medical literature and in clinical practice. Men can be bothered by the shape of their scrotum for two primary reasons, scrotal laxity/sag and lack of adequate scrotal volume. (due to small testicular size)  Scrotal laxity is typically seen as excessive and low hanging redundant scrotal skin. Besides its appearance it can cause functional issues such as discomfort from clothes irritation and chafing of the thighs or the scrotal skin itself. Scrotal laxity can also be associated with skin webbing between it and the penis.

While the threshold for considering scrotoplasty surgery is up to the individual, a low hanging scrotum can be defined as one where the lower end of the skin hangs below the tip of the penis in the upright position. Certainly if it hangs a few cms lower significant laxity is present as in most men the revers relationship exists.

In the October 2020 issue of the journal. Aesthetic Plastic Surgery an article was published on this topic entitled ‘Aesthetic Scrotoplasty: Systematic Review and a Proposed Treatment Algorithm for the Management of Bothersome Scrotum in Adults’. In this paper the authors perform a literature review on this topic and its surgical treatment. In searching this male genital rejuvenation area terms such as scrotoplasty, penoscrotal webbing, scrotal lifting, scrotopexy and scrotal tuck were used. A management algorithm and surgical technique is proposed along with the results from the eleven (11) articles that qualified for this review.

As their literature review has shown aesthetic scrotoplasty/scrotal rejuvenation and their surgical techniques are few. They basically break down into different techniques for improvement in scrotal laxity and reduction/elimination of penile-scrotal webbing. The techniques to do these procedures are fairly similar as the excision of extra skin can only vary is much and the elimination of webbing follows basic contracture scar release principles.

Scrotal enhancement was not specifically discussed/reviews in this paper which refers to volumetric augmentation of the size of the scrotum. This is done through either testicle implants or fat injections of which the former is far more effective if one can tolerate the concept of an indwelling implant inside the scrotum.

Dr. Barry Eppley

Indianapolis, Indiana

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