What's driving men to get penis fillers, despite the risks?

By

Inside Health presenter, BBC Radio 4

Jason didn't want a "Coke can" – that's the nickname for a penis that has been enlarged with so much filler it resembles a stubby drink can.

"Some people go really overboard," Jason tells me when we meet in Manchester.

His procedure increased the girth of his penis by 16% - an amount he, and his partner, are really happy with. He says it has given him a "self-confidence boost".

"Everything still functions" as normal, Jason explains - just with "that extra little bit of width".

It is not clear how many men like Jason are having penis fillers. And you can't walk down the street and get a sense of it in the way you can visibly see the popularity of lip fillers. There is little regulation and there are no official records as anybody can start offering the procedure.

Penis fillers even became the topic of a bizarre conspiracy theory at the last Winter Olympics. Male ski jumpers were rumoured to be using fillers to increase the surface area of their suits so they could jump further.

However, some men have ended up in A&E with a penis turning black and skin "sloughing off" after a botched procedure. And the British Association of Urological Surgeons has issued warnings to men having these procedures.

So why are men doing it and what are the risks?

Inside Health

Inside Health

Jason talked to us frankly, but anonymously, about his decision to have fillers.

He was happy with the length of his penis but wanted a "bit more symmetry" and more girth to "get that nice, balanced look".

"If you feel like it's a bit lacking," Jason says, "then, why not?"

He spent a year weighing up options and ruled out having a surgical procedure. He chose a type of filler - hyaluronic acid - that is temporary so he knew that even if he hated the look it would "eventually just dissolve".

Jason says he wasn't motivated by swaggering alpha masculinity - "I don't subscribe to 'how big your dick is, is how big of a man you are'". Rather, he says expectations of male beauty have shifted.

"It's not just women that need to keep up, men need to keep up as well.

"It's literally just society changing. I think the way the media portrays everything has a massive impact on everyday life now," he says. "It's like you can't actually go anywhere without seeing some picture-perfect somebody."

Trawl the websites of clinics offering penis enlargement - which ask questions like "are you embarrassed by the size of your penis?" - and you can see how some tap into this.

There are a variety of penis-enhancement options. There are surgical and non-surgical techniques and different materials that can be injected into the penis.

Most common by far is injecting the gel-like substance hyaluronic acid - the same key ingredient used in lip fillers.

Hyaluronic acid is a naturally occurring sugar molecule in the body and is known as a "moisture magnet" as it grabs hold of water.

Dr Javed Hussain has been offering penis fillers for more than a year at his clinic in Prestwich, Greater Manchester.

Hussain trained as a doctor before moving into cosmetic procedures, but penis fillers do not legally require any medical training to perform.

He says demand is increasing. He's treated men of all ages - some in their mid-20s, while his oldest client is aged 72.

The process starts with consultations on the patient's health, reasons for wanting to have the procedure, expectations about the results, and a discussion about the risks.

On the day of the event itself, a penis is injected with hyaluronic acid three times - on the top and on either side. The hyaluronic acid filler is delivered through a cannula that enters at the base and travels along the length of the shaft.

The filler is then massaged to give an even look, which the patient continues as home.

At a cost of up to £3,500, Hussain says men can expect between 10% and 20% more girth for the next six to nine months.

But there are risks. These range from relatively minor ones such as soreness, bruising and uneven filler, to serious ones including infection. These risks apply to all procedures using filler. However, there is also a risk of damaging the vital structures and blood vessels in the penis that are needed for an erection.

When asked why he feels comfortable offering procedures that are concerning surgeons, Hussain says he "totally understands" why some are worried.

"It comes from the right place, that nervousness," he says, "but at the same time, more and more evidence is growing and we're getting the results" and that "there is a benefit" to men.

Hussain says he has an "immediate action plan" including drugs to quickly dissolve the filler in the event that things go wrong, and reports that "thankfully, we've never needed to" - although the BBC cannot independently corroborate that.

But he recalls one patient who came to him for advice after treatment elsewhere, which had "really gone wrong".

He says the incorrect type of filler had been used and the "shaft of the penis was starting to become black" as the procedure had damaged the blood vessels in the penis and the skin was dying. The man was sent straight to A&E.

Prof Vaibhav Modgil, an andrologist and consultant urological surgeon for the NHS in Manchester, has seen these men coming into hospital after botched procedures.

"When it does happen, it can be devastating for the patient," he says.

He recalls seeing men with "skin necrosis, where an area of the skin dies off it turns very black and then it sort of sloughs off.

"So, men will go in thinking, 'Oh, it's gonna be brilliant', but they might come out actually being even more dissatisfied than when they went in."

Alex, who did not want his real name to be used, travelled to Germany for a different type of penis enhancement procedure.

He had surgery to cut the ligament that attaches the penis to the pubic bone to make it appear longer. He also had his own fat cells harvested and injected into his penis to enlarge it.

When he woke up after the procedure, he was in so much pain he couldn't stand.

"I sustained a lot of bruising and all my upper legs turned yellow," Alex says. "I couldn't walk properly for about a month."

Alex was treated in Modgil's clinic where eventually he was given the all-clear. "Many people do not get that luxury," he says. "I got off lucky."

Alex says he knows he was "never small in the first place", but society and porn had convinced him that a bigger penis was "masculine and the best".

Despite a lack of official data on the number of penile enhancement procedures, Modgil says online search trends, advertising and social media all "points to the fact that the numbers are on the up".

This has led the British Association of Urological Surgeons to issue new recommendations against these procedures.

"The guidance that we've recently produced essentially says we cannot recommend that any of these procedures should take place because the evidence is so poor," says Modgil.

It looked at 36 studies, involving 3,750 men, but said it was still not clear what the "safety profile" of these procedures were.

This is partly down to a lack of data on how fillers affect the penis long-term. But there is also concern that - just like lip fillers - you do not need any qualifications to perform the procedure.

Modgil says an outright ban is "probably too severe", but if these procedures are going to continue then the industry "massively needs regulation".

He called for a national registry to record when penis filler procedures have been performed and for long-term data to be collected so men can make an informed decision based on the risks and the benefits.

Back in Manchester, Jason is happy with the results of his procedure and thinks he'll do it again when his current fillers wear off.

Inside Health was produced by Gerry Holt.