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ncreasing penile length requires releasing the suspensory ligament and the wearing of penile weights after the surgery. Releasing the ligament partially frees the penis from its pubic bone attachments, dropping it to a lower position, which may increase penile length or give the illusion of length gain. I usually perform the operation through a several-inch transverse (sideways) incision in the pubic hair. Many surgeons advance skin onto the shaft of the penis with VY advancement flaps. A V-shaped triangle of pubic skin is moved (advanced) to the base to the penis and closed in a Y-shape. However, a large VY flap based at the junction of the penis and pubic skin is not recommended, because it often produces a deforming hair-bearing hump at the base of the penis. It also is associated with a high incidence of wound breakdown. The low transverse incision does not cause such deformities.

Ligament release alone may occasionally increase flaccid (soft) length a half an inch, but often no gain is achieved. Releasing the ligament frees more of the penis to be stretched. Weights are suspended from the penis several times daily for a period of months. Flaccid (soft) length is often increased, and erect length gain is also possible. Length increases of several inches are rare; these claims are usually based on misleading measurements taken from the apex of a V flap. However, some compulsive weight-users report anecdotal flaccid as well as erect gains of several inches. In fact, a one-inch gain is considered a success even with the use of weights. Each man's penis varies, so no guarantee can be made as to the eventual length gain will be achieved. Decreased length resulting from penis reattachment after ligament release is uncommon. Weights can stretch the penis without surgery, but a greater incremental gain will result if the suspensory ligament is released. Data concerning the average gain possible have not been accurately documented or verified in peer review journals.

Release of the suspensory ligament is a relatively minor operation performed as an outpatient in a surgical center. The patient has only minor discomfort. The skin is closed meticulously. Sutures are placed just below the skin, which improves the appearance of the final scar. The patient should refrain from sexual activity and active sports for about one month.