Circumcision frenulum cosmetic-Frenulum Sparing Circumcision: Step-By-Step Approach of a Novel Technique

In males who have been circumcised, the circumcision scar refers to the scar after a circumcision has healed. In some cases, the scar can be darker-colored, and, in all cases, it will encircle the shaft of the penis. The scar, which completely encircles the shaft of the penis, is located at the boundary of the shaft skin and the inner foreskin remnant, which is the portion of the foreskin that was not removed during circumcision. In adult circumcision part of the frenulum may remain intact. The foreskin remnant is dried mucosa and can often have a different color and texture than the rest of the penile skin.

Circumcision frenulum cosmetic

Circumcision frenulum cosmetic

Circumcision frenulum cosmetic

Circumcision frenulum cosmetic

Warty lesions of the foreskin— like viral warts. However, you can request to be Circumcision frenulum cosmetic under general anesthesia for the procedure as well. The reconstructive urologists Circumcision frenulum cosmetic at University of Utah Health are csometic in both circumcision and frenuloplasty to give you the quality care you need for a successful surgery and speedy recovery. The prepuce is freed from and retracted over the glans. Lancet ;doi: Glans necrosis and failure of the prepuce to fall-off frenlum the two main complications of this technique. This is an Celinne teen obsessed Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. A randomized clinical study of circumcision with a ring device versus conventional circumcision. Sunil P. The mechanism of injury is varied and has been postulated as due to excess diathermy or by the inadvertent use of excess suture material to secure bleeding from the frenular Sissy land Circumcision frenulum cosmetic 8 ].

Mom dad and teen sex. What Does Circumcised Mean?

Choosing Circumcision is a site I pay for out of pocket because other men need it, and because without it there just isn't any first-hand experience to be found on the internet. Al R December 9, at PM. The force of a powerful erection would pull apart the wound edges resulting in wound 'dehiscence' or opening up of the wound thus making it Circumdision inadequate wound closure for a circumcision in an older child or adult. Enjoy your travels and I wish you and Circumcision frenulum cosmetic girlfriend all the very best. I suggest a week of moderate Circumcision frenulum cosmetic following circumcision. Even when medically indicated, the procedure is usually carried out on the lines of religious circumcision wherein the entire preputial skin is removed. Would you say the degree of scarring is acceptable, purely on appearance? And we hope so! But do not let your personal decision of conscience be affected by what you fear others may think, it's been all positive! But the frenulum itself feels like a tendom. I had it done when I was All rights reserved. The preservation of the frenular web is also associated with prolonged ejaculation latency time [ 17 ]. These clamps do not allow careful visualization of Circumcision frenulum cosmetic outer and inner skin surfaces of the foreskin. Bleeding points are identified frebulum cauterized with Wpie pee.

Adult male circumcision with a circular stapler versus conventional circumcision: A prospective randomized clinical trial.

  • EDIT by Choice Maker: I have a page about to frenulectomy , the removal of the frenulum, which can be done during a circumcision or afterward.
  • This seemingly simple procedure is occasionally associated with dreadful and devastating complications.
  • We do not accept insurance for these services.
  • Thank you, Juan, as always, for your tireless work and intellectual courage.

For adult circumcision, I use the sleeve resection technique in which the foreskin is removed as a single ring of tissue utilizing a scalpel.

In my opinion, this gives a symmetrical, fine incision line. In addition to a refined scar line, this technique allows the final result to be customized to the patient's specifications if he has a particular outcome in mind. Many urologists perform adult circumcisions with general anesthesia. This involves a series of injections around the base of the penis to encircle the penile circumference with the anesthetic agent. The injections are not particularly painful since the injections are just beneath the skin surface.

Only after the patient is comfortable, do I begin the procedure. For adult circumcision , I use the sleeve resection technique in which the foreskin is removed as a ring of tissue with a scalpel. In addition to a refined scar line, this technique allows the outcome to be customized to the patient's specifications if he has a particular outcome concept he wishes me to produce. This involves making an incision on the outer surface of the foreskin at the level where the edge of the glans corona is visible making an impression through the foreskin.

I then retract the foreskin and make an incision in the inner mucosal surface of the foreskin following the contour of the glans. An adult circumcision should be crafted to accommodate the dimensions of the erect penis. I simulate erect length by stretching the penis. I mark incision lines with an ink marker and then stretch the penis and move the two incision lines into proximity. I want these two points to come together without excessive tension. This will avoid uncomfortable erections. Once I have determined the correct location of the incision lines, I make the outer incision, retract the foreskin and make the inner incision and remove the foreskin as one piece of tissue.

Bleeding points are identified and cauterized with electrocautery. The frenulum is then removed if the patient desires this to be done. I then close the wound with fine sutures, placed in a very precise manner so that suture marks and tunnels will not occur, and finally apply a compression bandage to the surgical site.

As mentioned in the initial paragraph, the outcome may be customized to patient preference. Since the incision on the outer surface of the foreskin is made separately from the incision on the inner, or mucosal, surface of the foreskin, these incisions can be made at different distances from the tip of the foreskin. The effect of this is that the incision line may be moved closer to the edge of the glans or further down the shaft.

This is a separate issue from the overall tightness of the skin on the penis. The tightness has to do with the overall length of foreskin removed. I also perform revision procedures for men who wish to have their circumcisions appear different from their current status. They may wish to have the overall fit of the skin on the penis to be made tighter, the frenulum removed, cosmetic appearance of the scar line improved, or symmetry of the skin improved. In performing a revision procedure, I make an incision on each side of the previous scar and remove it along with as much additional skin as the patient desires.

The wound closure is the same as for initial circumcisions. Phone - Call Us Now Patient 1 - Circumcision Revision Surgery. Patient 2 - Initial circumcision for a man in his mid 20's. Patient 4 - Initial circumcision for a man in his early thirties. Patient 5 - Initial circumcision for a gentleman in his late forties. Patient 6 - Circumcision revision pre-revision photos not available for a gentleman in his early forties.

Patient 7 - Initial circumcision for a gentleman in his early thirties. Patient 8 - Initial circumcision for a gentleman in his late twentiesl. Patient 9 - Circumcision revision for a man in his forties. Patient Patient 20 - Scrotal Recession. Circumcision Surgery - Before And After Pictures For adult circumcision, I use the sleeve resection technique in which the foreskin is removed as a single ring of tissue utilizing a scalpel.

Which Circumcision Technique We Use? All rights reserved. Schedule A Consultation or Procedure Please fill out the form below with a requested appointment date.

To be honest, I'm not really in a rush to get things started again on that front. I might have a better view tomorrow. You men that should know better discussing the mutilatoin of your boys. Frenulectomy is the removal of the frenulum, and is often done at the same time as a circumcision. Penile Implant Case Studies. How long will I need to stay and do you recommend any hotels nearby?

Circumcision frenulum cosmetic

Circumcision frenulum cosmetic. Phimosis Gallery:

Producing an outcome of a circumcision procedure which suits the aesthetic preferences of a patient when the penis is flaccid and allows for a comfortable erection is my goal with each procedure I perform.

Removing the proper amount of skin is an important aspect of achieving this. I mark the skin incision lines on both the outer surface of the foreskin as well as on the mucosal inner surface and then stretch the penis while using a forceps to move these incision points together.

This provides an accurate assessment that incisions made along these two lines will result in a final outcome which will accommodate a full erection. I have tried using erection induced by injection of medication into the penis to compare to the method of stretching.

The method of stretching I use is superior for three reasons in my experience. Second, once the erection is induced it is not possible to go back and forth comparing the incision points between erect and flaccid states the way I am able to compare stretched and unstretched locations of the incision points. These clamps do not allow careful visualization of both outer and inner skin surfaces of the foreskin.

It is difficult, if not impossible to ascertain that the proper amount of skin is being pulled though the clamp before crushing the skin. I have dealt with some men who have attempted self circumcision using this device and have removed inadequate or excessive amounts of skin.

An adult circumcision has to be very carefully crafted to result in a nice cosmetic as well as functional result. It is a big mistake for a man to attempt self circumcision using one of these devices. Lasers are great for use in some types of surgical procedures. For circumcision, a laser offers no benefit and potential problems. A laser cuts, nothing else. The surgeon can not control the depth of the cut with a laser.

As circumcision is concerned, it is important that the surgeon be able to control the depth of a cut to a very fine degree. Too much depth of cut and injury to the urethra or erectile bodies could result.

I use a stainless steel scalpel for circumcision. Neonatal circumcision is performed utilizing one of a number of clamp devices which remove the redundant foreskin, stop bleeding arteries and veins by crushing them, and bond the skin edges without the need for sutures.

Each one of these creates a pressure bond to hold together the skin edges so that their is no need for sutures. These devices provide an adequate wound closure for infants because they do not have powerful enough erections to pull apart the skin edges.

The bond created by these clamps at the skin edges consists of the clamp crushing the two opposing skin edges together. The force of a powerful erection would pull apart the wound edges resulting in wound 'dehiscence' or opening up of the wound thus making it an inadequate wound closure for a circumcision in an older child or adult.

Adults require a suture closure stitches to provide a secure enough closure to allow the wound to remain intact despite the force of erections. Also, it should be mentioned that careful suture closure leads to a much finer scar once the healing is complete. Sutures guide the healing edges of the wound close together so that the end result is a very fine line.

I have performed some circumcisions in which I did not suture stitch the wound. Neonatal circumcisions are done with minimal local anesthesia or no anesthesia. Using a clamp device, a neonatal circumcision is a quick, five minute procedure.

Many urologists perform adult circumcisions with general anesthesia. This involves a series of injections around the base of the penis to encircle the penile circumference with the anesthetic agent.

The injections are not particularly painful since the injections are just beneath the skin surface. I use the sleeve resection technique in which I remove the redundant foreskin with a scalpel. This involves making an incision on the outer surface of the foreskin at the level where the edge of the glans corona is visible making an impression through the foreskin.

I then retract the foreskin and make an incision in the inner mucosal surface of the foreskin following the contour of the glans. An adult circumcision should be crafted to accommodate the dimensions of the erect penis. I simulate erect length by stretching the penis. I mark incision lines with an ink marker and then stretch the penis and move the two incision lines into proximity. I want these two points to come together without excessive tension. This will avoid uncomfortable erections.

Once I have determined the correct location of the incision lines, I make the outer incision, retract the foreskin and make the inner incision and remove the foreskin as one piece of tissue. Bleeding points are identified and cauterized with electrocautery. The frenulum is then removed if the patient desires this to be done.

I then close the wound with fine sutures, placed in a very precise manner so that suture marks and tunnels will not occur, and finally apply a compression bandage to the surgical site. Typical outcome images can be viewed on the circumcisioncenter. Yes, it is important to have a consultation visit.

The consultation is included and the time required is approximately 30 minutes. Both the consultation and procedure may be performed during the same office visit, requiring an overall time of one and a half hours. Yes, we gladly treat patients from any country. Travel information can be found here. If I had my wish, all my patients would remain in Atlanta for several weeks to allow complete wound healing.

The majority of my patients travel out of Atlanta within 48 hours of the procedure and have no problems. I suggest a week of moderate activity following circumcision. Sedentary activity and travel is possible the same day.

I treat any circumcision procedure with an equal concern for the attention to detail with surgical technique. Sparing the frenulum as in our technique circumvents some of the complications associated with circumcision. Frenular artery bleed that usually requires a re-operation is eliminated [ 7 , 8 ].

Absence of a suture line on a transected frenulum avoids painful postoperative erections. One of the recognized complications is removal of excess skin, especially on the ventral aspect. This often leads to painful chordee and in worst cases, the scrotal skin is drawn upwards during an erection, leading to uncomfortable and unpleasant sexual intercourse. In our technique, as the ventral aspect of the skin is untouched, such an eventuality is avoided.

Another rare complication reported in the literature is the occurrence of urethro-cutaneous fistula [ 7 — 11 ]. The mechanism of injury is varied and has been postulated as due to excess diathermy or by the inadvertent use of excess suture material to secure bleeding from the frenular vessels [ 8 ]. Our technique eliminates any risk to the underlying urethra. Meatal stenosis is a recognized complication of circumcision, especially involving neonates.

However, meatal stenosis is also reported in adults and Persad et al. Our technique preserves the frenular artery and we have not seen any case of meatal stenosis in our series. Partial preputial preservation as described herein requires a broad sleeve of circum-coronal mucosa to be retained, to allow the skin to ride over the coronal margin. There are reports describing circumferential lymphoedema of this sleeve in operations involving penile degloving, possibly as a consequence of severing of its lymphatic continuity with the skin of the shaft [ 13 ].

We have indeed observed a similar situation after conventional frenulum-dividing circumcision as well, leading to a persistent woody ring around the corona that mars cosmesis. Several publications have highlighted important functional aspects of the frenulum and prepuce [ 14 , 15 ].

The frenulum has also been implicated in arousal and erectile properties with studies suggesting erectile dysfunction is patients wherein it has been altered by circumcision [ 16 ].

Indeed, the study by Sorrells et al. The preservation of the frenular web is also associated with prolonged ejaculation latency time [ 17 ]. In patients with spinal cord injury, vibratory stimulation applied to the frenulum of the penis produced ejaculates sufficient for intrauterine insemination [ 18 ]. By sparing this important structure in our technique, these unique qualities that the frenulum possesses are protected.

Our technique, involves preservation of significant amount of prepuce in addition to sparing the frenulum. While re-emphasizing the role of the prepuce in sexual arousal due to its neuro-sensitivity as in the case of the frenulum, preservation of glanular surface moisture and hence its sensitivity may be an additional factor. Mechanical factors at play during coitus: a Single frictional interface 1 during coitus with the entire prepuce excised; b Two frictional interfaces 1 and 2 with partial preputial preservation.

We describe a step-by-step approach to our technique of frenulum-sparing circumcision. The technique is easy to perform and reduces likely hood of certain complications that could result in not only post-surgical morbidity but also functional and cosmetic dissatisfaction for the patient. The postulated theoretical beneficial effects of the technique on sexual function however need to be further studied. National Center for Biotechnology Information , U. J Clin Diagn Res.

Published online Dec 1. Find articles by Sunil Purshotham Shenoy. Find articles by Prashanth Kallaje Marla. Find articles by Pritham Sharma. Find articles by Narayana Bhat. Find articles by Amrith Raj Rao. Author information Article notes Copyright and License information Disclaimer. Corresponding author. Sunil P. Shenoy, Head, Department of Urology, A. E-mail: moc. This article has been cited by other articles in PMC. Materials and Methods An initial dorsal slit, three fourths of the way up to the corona is extended laterally and obliquely on either side, to meet the preputial edge, mm from the frenulum.

Conclusion The frenulum-sparing technique of circumcision is a promising modification to the various existing techniques. Keywords: Complications, Frenular artery, Prepuce, Phimosis. Open in a separate window. Discussion In our technique, we remove the phimotic foreskin but avoid disturbing the frenulum and its adjoining web. Conclusion We describe a step-by-step approach to our technique of frenulum-sparing circumcision.

Epidemiology of complications of male circumcision in Ibadan, Nigeria. BMC Urol. Complications of circumcision in male neonates, infants and children: a systematic review. Circumcision: a consideration of some of the controversy. Journal of child health care. Circumcision of the newborn; an appraisal of its present status. Obstetrics and gynecology.

Frenulum breve - A guide to Circumcision

Request an Appointment. Refer a Patient. Circumcision is a surgical procedure that removes the skin that covers the tip of the penis — the foreskin. This means some men may choose to get circumcised in adulthood or never at all. Some men are concerned about the cosmetics and sensation of the penis after their circumcision. The reconstructive urologists here at University of Utah Health are experts in both circumcision and frenuloplasty to give you the quality care you need for a successful surgery and speedy recovery.

Aside from cosmetic, social, and cultural reasons, uncircumcised men may also need to get their foreskin removed for various health reasons such as:. But the organization does list some medical benefits that support performing the procedure. These include:. There are a few different circumcision techniques. For newborns, doctors typically use a clamp. As the foreskin is pushed from the head of the penis, the doctor will clamp it with a metal or plastic ring-like device to protect the head of the penis while they remove the foreskin.

Your doctor will perform the circumcision under a local anesthetic that is injected near the base of the penis. However, you can request to be put under general anesthesia for the procedure as well. The doctor will make an incision just below the head of the penis and remove the whole foreskin with a scalpel or surgical scissors. They will then close the incision with dissolvable stitches that attach the skin of your penis to below the head.

The stitches usually disappear within two to three weeks. Your doctor may use the dorsal slit technique if you are suffering from phimosis or paraphimosis. The dorsal slit procedure removes a specific amount of foreskin with scissors; then the doctor will perform the remainder of the circumcision at a later time.

Next in the procedure, we stitch back together the part of the foreskin that has been cut using or absorbable sutures. We keep any excessive bleeding under control with direct pressure and electrocautery. Your doctor may apply petroleum jelly to your incision and wrap the stitched area in sterile gauze to keep it protected for the first 24 hours.

For patients suffering from acute paraphimosis, your doctor may try to decrease the swelling with their hands before proceeding with surgery. They may apply a gentle, steady pressure on the foreskin to decrease the swelling. The doctor will then use his or her fingers to push on the head of the penis and pull on the foreskin in an effort to further reduce the paraphimosis. Also, circumcision does not shorten the penis. If you have scarring from a previous circumcision, we can also repair it successfully.

However, as with any surgery, you can experience some unwanted side effects and risks after your circumcision. These may include:. This procedure is a variation of a circumcision that doctors try first on patients with a tight frenulum the tissue between the head of the penis and the underside of the penis.

This can cause pain or bending during an erection. If this is the case, your doctor may perform a frenuloplasty to change length of the frenulum of the penis and ease the restriction. The procedure can be done under a local anesthetic or general anesthetic, whichever you prefer. Your doctor will start by dividing the skin with a horizontal incision near the top of the frenulum.

The cut will be re-stitched lengthwise to elongate the frenulum and alleviate the pain. We will use dissolvable stitches to close up the incision, which usually disappear within two to three weeks. Each patient may experience different things after their surgery. The important thing to remember is that the side effects below are either temporary or uncommon:.

No referral from a physician is needed. Common knowledge used to hold that men over the age of 50 needed to get an annual digital prostate exam. Catching cancer early is important, but do men really need to get the uncomfortable procedure every year? Tom M Do you know what causes bent penis?

It's called Peyronie's disease and refers to penises with curvature or deformity that can cause pain, make it difficult to get or keep an erection, or have any sexual function at all. A healthy level of testosterone can lead to higher energy levels as well as an increase in strength and virility. But what are your options if you have low testosterone? On this Health Minute , Dr. James Hotaling, A vasectomy is considered the least invasive and lowest risk procedure someone can have. However, when it comes to "getting snipped," there are a lot of myths floating around.

Urologist Dr. Alex Pastuszak debunks some of Why Do People Get Circumcised? What Does Circumcised Mean? Paraphimosis— This is when the foreskin of an uncircumcised penis cannot pull back over the head of the penis. Balanitis— This is inflammation of the glans penis the head of the penis.

Posthitis— This is inflammation of the prepuce, otherwise known as the foreskin. Balanoposthitis— This occurs when both the head and foreskin of the penis are inflamed. Cancerous or pre-cancerous lesions on the foreskin. Warty lesions of the foreskin— like viral warts. What Are the Benefits of Circumcision? Find a Men's Health Doctor. By Name By Location.

Update Search. Circumcision Procedure There are a few different circumcision techniques. Dorsal Slit Procedure Your doctor may use the dorsal slit technique if you are suffering from phimosis or paraphimosis. These may include: Swelling of the penis, which only lasts a few days.

Increased sensitivity of the penis head, which can last for up to two weeks. Permanent altered or reduced sensation in the head of your penis. Less common risks include: Infection of the incision, which may require antibiotics or surgical drainage. Bleeding from the wound, which occasionally requires another procedure. Swelling of excess skin, which requires further surgery and skin removal. Anesthetic or cardiovascular problems, which could require intensive care.

What Is a Frenuloplasty? Frenuloplasty Procedure The procedure can be done under a local anesthetic or general anesthetic, whichever you prefer. Side Effects Each patient may experience different things after their surgery. Reduced sensation in the head of your penis. No improvement in symptoms, which may result in the need for a full circumcision. Infection at the incision site, which could require antibiotics or further treatment. Scar tenderness at the incision.

Anesthetic or cardiovascular problems that may require intensive care. Wear loose-fitting clothing for a few days. Avoid any sexual activity for at least four weeks. Do not swim for one to two weeks.

Avoid strenuous exercise for the first month after surgery. Take simple pain medicine as needed for discomfort. Keep the wound clean and dry after urinating.

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Circumcision frenulum cosmetic

Circumcision frenulum cosmetic

Circumcision frenulum cosmetic