The typical patient with partial hidden or buried penis. The patient has a large pubic fat pad. The penis buries into the pubic fat and scrotal sack. The skin is not well attached to the underlying penile structures.
An incision is made above the pubic fat pad. If extra skin is present, some is excised . Fat is removed by a combination of liposuction and excision. The pubic skin is sutured to the underlying muscle to prevent it from sliding down and to prevent the penis from going inside the fat. This stabilizes penile skin to the penile shaft.
An incision is made at the junction of the penis and scrotal skin. Sutures are placed from just under the skin to stabilize the skin to the penile shaft. This prevents the penile shaft from burying into the scrotal sack.
The patient at the end of the procedure. The pubic skin is anchored to the pubic muscles with pubic fat removed. The underside of the penis is anchored to skin at the junction of the penis and scrotum. The penoscrotal incision is closed with a zig-zag. Sometimes extra penoscrotal skin is removed.
The men all had the operation illustrated above.
53 year old male who had a hidden penis and then developed chronic inflammation of the penile skin and head of the penis. The penile skin ulcerated and scarred causing chronic pain, inability to pull his penis out of his pubic fat, and inability to have sexual intercourse. He had to sit to urinate and could not void with a stream. The patient underwent removal of suprapubic fat with tacking, excision of all penile shaft skin, and placement of a thick split thickness skin graft. His pain is now gone, and he can now void while standing and have sexual intercourse.
45 year old male with a severe buried penis with inability to pull out his penis. He had massive weight loss after gastric bypass surgery. The penile skin was damaged from chronic inflammation and dampness. He had previous unsuccessful attempts to correct the buried penis by other physicians. I performed a suprapubic excision of excess skin and fat, tacking of the pubic tissues to the underlying fascia, excision of all his damaged penile skin, and grafting of thigh skin onto the penis. The photos are 3 months postoperation. The residual penile swelling will decrease over the next 1-2 years.