Penis Lengthening Through Modified Ligamentolysis

The Anatomical Basis – Why It Is Possible to Lengthen the Penis

To understand why penis lengthening is possible at all, it helps to take a look at the anatomy of the penis.

The penis does not consist only of the visible external portion. A significant part lies inside the body – anchored by so-called suspensory ligaments (the ligamentum suspensorium penis and the ligamentum fundiforme penis) that attach the penis to the pubic bone. This internal portion is not visible from the outside, but it contributes to the overall length.

Through a targeted surgical adjustment of these ligament structures, the internal portion of the penis can be partially relocated outward. The result is a lengthening of the visible penile shaft – both in the flaccid and in the erect state. This is because we do not simply divide the ligaments, but create a new attachment to give the penis stability in its new position.

Important to understand: No length is created. Existing length is made visible.

The Surgical Method in Detail

Penis lengthening, as performed by the surgeons at UGRS Darmstadt, thus combines the adjustment of the ligament structures with a new attachment – a technique that uses exclusively the body's own tissue in place. Foreign materials, implants, or fillers are not used.

This approach is consistent with the current recommendations of the European Association of Urology (EAU), whose guidelines explicitly point out the risks of various foreign materials in penis-enlarging procedures.

Penis lengthening at UGRS is performed according to a scientifically grounded technique based on proven principles of male intimate surgery. The procedure is carried out equally by Prof. Alessandro Littara and Dr. med. univ. Roberto Melone, both of whom have extensive skill and many years of experience in this highly specialized methodology. At the centre of the procedure is always the same urological-reconstructive, medically therapeutic goal: to achieve a functional and at the same time harmonious lengthening, agreed upon with the patient, without impairing the natural structures and functional elements of the penis.

The male organ consists of a visible external portion and an internal portion that lies within the body. According to the widely cited description by our Lead Physician Jörg Hagen, this ratio is approximately 50:50 – an assessment that has been frequently picked up internationally, both in the press and on medical specialist websites. It is precisely this internal portion that our surgeons' technique addresses.

The so-called ligamentolysis is performed through a small, arc-shaped incision in the pubic hair area, deliberately designed to follow the natural course of a skin fold. The posterior ligaments, along which the nerves and vessels supplying the penis run, remain completely untouched. This approach – a core principle to which both Prof. Littara and Dr. med. univ. Melone are committed – is today regarded internationally as the consensus among experts in male intimate surgery, as it significantly reduces the risk to the patient.

The technique used, which has been published scientifically, makes use of an anatomical characteristic of the internal portion of the penis: it originally follows a slightly curved course. When this course is straightened, a geometric surplus is created, which produces the actual lengthening. This shifts the ratio of external to internal portion in favour of the visible area. As a result, penis length can on average be increased by 3.8 to 8.1 centimetres in this way, both in the flaccid and in the erect state. In individual cases, depending on the patient's specific anatomical conditions, results of over 8 centimetres are also possible.

Foreign materials such as silicone or implants are not used in this method. Prof. Littara and Dr. med. univ. Melone thus consistently follow the guidelines of the European Association of Urology (EAU), to which they are fully committed. Instead of foreign material, the body's own tissue is rotated in from the side and fixed using specially developed suturing techniques. The root of the penis, where the nerves, blood vessels, and urethra enter the penis, is spared in the process and remains unchanged. Because no incision is made into the penis itself, the risks associated with such an incision do not apply.

How pronounced the individual result turns out to be depends on several factors: the original angle of inclination, the length of the symphysis, but above all the structure and composition of the ligament tissue. This "quality" cannot be determined in advance through examination (neither technically nor by palpation), which is why the individual result cannot be predicted. These individual differences in connective tissue correspond to a principle known from other areas of medicine – comparable, for example, to the varying composition of intervertebral discs from patient to patient. This is precisely why the evidence-based approach of our two surgeons at UGRS Darmstadt is so important.

Procedure, Anaesthesia, and Aftercare

The procedure is performed on an outpatient basis and usually takes about 45 minutes. It uses a combination of local anaesthesia and state-of-the-art twilight sleep anaesthesia – with EEG monitoring, for an even more pleasant, relaxed experience. This is, of course, always administered by an experienced anaesthesiologist. General anaesthesia has not been necessary for this procedure at our practice for over 20 years. General anaesthesia would bring only disadvantages and no benefits for this procedure. The sutures used dissolve on their own, so no separate appointment for suture removal is needed. The patient can travel home, accompanied, on the same day. For predominantly office-based occupations, no time off is required; for physically demanding professions, we recommend a break of three to seven days.

Achievable Results – What Is Realistic?

Based on our clinical experience with several thousand procedures and our treatment concept, the following changes can be achieved in practice:

• Lengthening: approx. 3.8 to 8.1 cm permanent
• With our treatment concept, the result shows in both the flaccid and the erect state

When making your decision, however, please always consider whether a result at the lower end of this range would still achieve your desired outcome.

Individual Factors Influencing the Result

The figures given are intended as guide values and are explicitly not a guarantee of a particular result. How much lengthening can actually be achieved in an individual case depends on a range of factors that come into play during treatment.

A central role is played first of all by the individual anatomy in combination with the tissue elasticity of the ligament structures. The internal portion can be mobilised and straightened to varying degrees. The patient's general starting situation and body weight also factor into the achievable result, as both can influence the anatomical conditions and the visibility of the result. Last but not least, where necessary, consistent aftercare helps to secure the result achieved in the long term.

In addition to these individual factors, the surgeon's experience is equally central to the reliability of the result. In this context, Prof. Alessandro Littara is the only physician named by name in the current guidelines of the European Association of Urology (EAU) on the subject of surgical penis enlargement. This mention is more than a formal footnote – it underscores the scientific standing his work enjoys internationally in this field, and reflects the many years of clinical and scientific engagement underlying his methodology.

What Realistic Expectation Management Means

After the procedure, many patients report not only greater functional size, but also a changed sense of their own body, greater self-confidence, and an improved way of dealing with intimacy. Some find that the external change does not automatically resolve inner insecurities – that takes time.

That is precisely why an honest consultation always includes the question: what do you expect – and can this be achieved surgically?

Who Is Penis Lengthening Suitable For?

The decision to undergo penis lengthening is always a very personal one, and it should be carefully considered. From our experience, such a procedure can make sense when several conditions are met together. This first includes a persistent sense of discomfort – that is, a real, objectifiable level of distress. Not a passing doubt, but a feeling that persists over a longer period and noticeably affects quality of life. It is equally important that the individual starting situation makes this procedure appear medically and anatomically sensible. Not every starting situation can be resolved through this operation, and it is precisely this assessment that we make together with you as part of the detailed initial consultation.

Realistic expectations of a surgical procedure are also of central importance. Penis lengthening follows the anatomical possibilities of the individual body. When a patient's expectations align with what is medically achievable, this is an essential foundation for a satisfactory result and for your satisfaction after the procedure. Finally, general health must also permit an outpatient procedure, so that the operation can be performed safely and with low risk.

When We Advise Against Penis Lengthening

Just as important as the question of when a procedure makes sense is, for us, the question of when we deliberately advise against it. Not every situation can be treated surgically with this procedure, and for us this openness is inseparable from responsible consultation.

We advise against penis lengthening when expectations, which can sometimes arise from intense and long-standing distress, exceed the medically achievable results. A procedure that cannot from the outset fulfil what a patient hopes for rarely leads to genuine satisfaction – even if it is technically performed flawlessly. We likewise advise against it when the psychological distress is complex and an operation is not the right or the only answer to that distress. In such cases, it is our task to address this openly. The same applies when a patient's state of health does not permit a procedure, for example due to pre-existing conditions or unsuccessful prior surgeries.

In patients whose individual starting situation offers no medical reason for an operation, we deliberately advise against a procedure.

This openness is a fixed part of how we understand treatment. We do not see our task as fulfilling every wish for a surgical procedure, but rather as honestly working out together with you whether penis lengthening is the right therapeutic path for your personal situation. An initial, no-obligation conversation helps to carefully assess your starting situation, your expectations, and the medical possibilities.

Combination with Girth Enhancement

In most cases, penis lengthening is combined with girth enhancement. The reason is not only the more pronounced change, but above all the natural realities in how an organ is shaped.

An isolated lengthening without an adjustment of girth often cannot fully solve the problem and can lead to an unbalanced result that did not exist beforehand. The combination makes it possible to control the overall picture more precisely and to achieve a natural, therapeutically coherent appearance.

You can find out more about the girth enhancement method on the corresponding page.

What Does Penis Lengthening Cost?

As a guide:

• penis lengthening alone: approx. €9,500
• combination of lengthening + girth enhancement (recommended): approx. €12,300

The price includes the medical consultation, the surgical procedure, anaesthesia, use of the operating facilities, and medical aftercare. Please feel free to contact us regarding payment options and further details.

Frequently Asked Questions About Penis Lengthening