Girth enhancement is accomplished in the following way. First the surgeon aspirates fat from fat-rich body parts, for example the pubic mound, abdomen and "love handles". He then injects this fat underneath the skin of the penile shaft. In this process the surgeon aims at  creating as smooth, symmetrical and cylindrical a shaft as his skill of hand-work permits.

By this process it is essential that the injected fat cells fasten at the right place, and that they do not die. Mechanical impact may make the fat slide away from the place where it was injected before it has fastened. Cell death causes the fat to be reabsorbed again and the enlarging effect disappear.

The objectives of enhancing the thickness may be reached at various degrees, sometimes the result is excelent, at other times rather poor. With a poor result, the girth enlargement is not totally permanent, and the process may produce lumps, bumps and clumps.

Surgical enhancement of the circumference, neither do produce any real growth of the original penile skin and penile tissue, the penil skin is only pumped up by the fat injected. Therefore the injected fat produces a greater internal pressure of the penis, and will make the penis stiffer and more entrenched. This may feel allright, and not have any great negative consequences on the penile function, but may also cause  major  problems. Furthermore, this fat encapsulation does not have any enervation. Therefore it may cause an insulation of the sensorial mechanisms of the penis from the stimulation by sex, thus making the penis numb and make a loss of feeling.

Some other possible drawback is that the transplanted fat cells feel soft, somewhat like female breast tissue.

Some surgeons claim that they can increase the penis circumference by 50 % in the best cases, but by such results, the sensory isolation problem and the stiffness or pressure problem will tend to be greater. In order to avoid problems, most surgery customers must be content by much less.

Elongation of the penis

Penis lengthening procedures are very different from the procedures used to increase the girth of the penis. The spongy tissue in the penis that fills with blood, the corpora cavernosa and the corpus spongiosum surrounding the urethra, normally extends from the visible penis backwords under the scrotum and all the way to the prostate area near the anus. In some cases, half of the erectile bodies may be hidden under the scrotum and in the male perineum. Penis lengthening is effected by releasing a part of this concealed tissue which effects an apparent lengthening of the penis.

The lengthening of the penis is achieved in the following way: The surgeon makes a small angle-shaped incision on the pubic mound at the penile base (within the cover provided by the pubic hair). Then the suspensory ligaments that ancher the hidden part of the penis to the pubic bone is divided. This releases a portion of the penis that normally lies hidden under the upper part of the scrotum and this portion, about an inch and a half, rises from the scrotum into visibility, and moves somewhat foreward. By this procedure, the newly visible part of the penis also have to be covered by skin from the abdomen.

This surgery may be combined with the use of a penis strecher some hours a day for some months in order to gain permanent results.

Such a surgery do not in reality lengthen the penis, but causes some hidden part of the penis to come forward. Cutting ligaments will of course also have some effect on the stability and angle of the erected penis, the erected penis may wobble when being in action. After the surgery, the penis will also naturally seem to have change place somewhat downward.  These things may or may not  be felt as a problem. The resulting net effect may be good or bad.

Quality of outcome from penile augmentation surgery

Penis augmentation surgery does not as explained above really elongate the penis or add real penile tissue to make it thicker. It will however make the visible penis longer and thicker, and this may give a better functionality. The surgery may however cause scarring of the penile skin, making the penis less elastic and giving an irregular cosmetic result.

Some men are contented by the outcome of the surgery, while the frustration of others about the surgical result have made them sue their doctors. Because of the uncertainties with this surgery, the American Urological Association (AUA), the American Society for Aesthetic Plastic Surgery (ASAPS) and the American Society of Plastic Surgeons (ASPS) have policy statements against cosmetic penils enhancement surgeries.