Table of Contents

Preface
Introduction
Chapter 1: The History of Penile Fascination
Chapter 2: Anatomy of the Penis
Chapter 3: Medical Conditions That Can Affect Penis Size
Chapter 4: A Healthy Sex Life!
Chapter 5: A Woman’s Perspective
Chapter 6: The Desire for Penile Augmentation
Chapter 7: Attempted Methods of Penile Enlargement
Chapter 8: Proven Results: The Elist Silicone Implant
Chapter 9: Testimonials
Chapter 10: Questions and Answers About Augmentation with the Elist Silicone
Implant
Bibliography
Preface
This book is a resource for men who wish to increase the size of their penis or
testicles safely. Co-author James Elist—a world-renowned and board-certified
urologist specializing in adult male sexual dysfunction, infertility and male
enhancement—provides a scientific explanation of the products and services
available to increase penis and testicle size. His exciting technique helps men
achieve their realistic sexual potential permanently and relatively safely.
Introduction
The subject of penis enlargement has a long history; however, throughout history
there has been one consistent belief: bigger is better. During primitive times, men
had a strong urge to achieve a larger penis size in certain cultures across the globe.
Prehistoric stone phalluses, and even statues and hieroglyphs, show that penis size
helped men reach higher levels of power.
Historical evidence from about 2000 years ago supports claims that African men
from certain tribes would hang weights from their genitals as a method of penis
enhancement. This method is still popular among many African tribes, despite its
damaging effects. Young Arab men would practice jelqing, or massaging the penis,
each day to encourage growth.
Chinese men were known to use a variety of herbs for penile enhancement. Some
were asked to eat the testicles and penises of some animals in order to grow a
longer, thicker penis and to enhance libido. In Brazil, men from the Topinama tribe
would allow poisonous snakes to bite the penis for enlargement purposes—after
which they would suffer excruciating pain for nearly six months. In Borneo, men
inserted metal rods in the penis to maintain a permanent erection. Gradually, this
practice achieved widespread popularity, and men began piercing their privates to
impress women.
The history of penile enhancement shows that men have always desired larger
penises. And with recent technological advances providing plenty of options for
penis enhancement, it is no wonder that men continue to obsess over penis size.
In the year 2000, a medical breakthrough occurred in the science of penile
enhancement. Dr. James Elist’s patented, US Food and Drug Administration-
approved, innovative subcutaneous soft silicone penile implant provided the first
tangible method of penis enlargement, with measurable gains that are immediately
noticeable. This technique has revolutionized the field and provided a concrete
answer in place of myths, superstition and archaic means of enhancement.
The Elist subcutaneous soft silicone penile implant has finally answered the
question, “is there a scientifically proven method to enhance the penis?” With
more than 1,000 procedures successfully completed by Dr. Elist, finally, the
answer is yes!
Chapter 1: The History of Penile Fascination
The penis has long been the most fascinating, exploited and admired organ of the
male body. Most men place a great deal of emphasis on the penis for perfection in
appearance and performance. Since the beginning of Western civilization, the
penis has been more than a body part: it is a gauge of a man’s place in the world,
symbolizing his virility and power within relationships and life.
The worlds of advertising, fashion, automobiles and food promote decadence and
excessive living by suggesting, “bigger is better.” This larger-than-life mentality
has driven many men to search for physical perfection, acceptance and well-being.
Plastic surgeons have made billions of dollars helping average “Joes” and
“Josephines” feel more comfortable with themselves, nipping and tucking
imperfections to help increase a patient’s level of self-esteem. The penis is no
exception. In Western society, sex influences what we see daily, from ads that
lightly enhance features to explicit portrayals or displays of sexual acts.
Genital size has been a major source of anxiety for men throughout history.
Various social and psychological ramifications include social maladjustment, fear
of intimacy and lack of self-confidence. Many men feel a need to enlarge their
penis to improve their self-esteem or to satisfy and impress their partners.
Phallic identity is the tendency of men to seek their identity through their penis,
with an emphasis on the belief that bigger is better. Phallocentrism is the idea that
the penis is central to a man’s identity and symbolic of his power. These notions
are deeply embedded myths that persist among men in modern society.
Most men seek physical perfection for mating purposes, hoping to attract the
opposite sex while feeling healthy and secure. A man’s confidence in his penis can
be a key component in maintaining a healthy sexual relationship. Without that
confidence, he can develop other severe social disorders, including depression and
an overall feeling of discontent.
Some men develop these negative feelings and suffer from poor genital body
image after they are diagnosed with various medical conditions, such as cancer,
diabetes, or erectile dysfunction. The news that a man’s penis no longer works the
same way it once did is not only devastating but can also take a toll on his psyche.
Frustration and sadness can make him feel unattractive and broken.
Men who have no functional problems with their penis may also be affected by a
perception that their penis or testicles are too small. These feelings typically begin
during childhood, with young boys comparing the size of their penis to that of their
father. For many men, this feeling of inadequacy grows stronger over time and
negatively affects their lives and the lives of their friends and family.
In some cases, this preoccupation can develop into body dysmorphia. Defined as a
perceived body defect that does not actually exist, body dysmorphia can severely
disrupt and impair quality of life. In cases of body dysmorphia, as with other
mental illnesses, it is best to see a therapist or psychiatrist.
This leads to the age-old question, “does size really matter?” Many men
throughout the world struggle with the question of how big their penis should or
should not be. Men who feel their penis is adequate or large feel powerful,
masculine, healthy and strong. Men who perceive their penis as too small often feel
impotent, effeminate, and undesirable. This type of man has a self-esteem that
suffers and, consequently, so do his relationships at work and at home. A thorough
physical and psychological assessment that normalizes the worry and explores
treatment options in detail is essential in order to enable confidence levels to return
to a healthy state.
Priapos was the rustic god of bounty for the vegetable garden in ancient Greek
mythology. Priapos was depicted as a dwarfish man with an enormous penis
symbolizing garden fertility. In paintings of Priapos, his massive penis is always
the central focus. This belief that larger penises are more fertile and desirable
continues today and leaves men around the world questioning themselves and their
ability to satisfy and impress a mate.

Figure 1-1. Wall mural of Mercury/Priapus, Italy (left); Priapus in Ephesus

Museum, Turkey (right).
Evolutionary biologists have developed a theory that this psychological pattern of
thought plays a part in our choice of a mate. Men seek mates who appear healthy
and fertile and use many physical cues to make this decision: shiny hair, skin, and
nails; healthy body weight; wide birthing hips; and, yes, breast size (the reason
why so many women augment their breasts). Female nudity plays a large role in
sexuality. Many female body parts indicate a woman’s fertility and visually
increase arousal for a man. The more attractive attributes a woman possesses, the
more her physical desirability increases; in turn, allowing her to be selective when
choosing a mate.
Men look to many parts of a woman to indicate her fertility, but women have one
dominant image associated with a man’s sexuality and fertility: his erect penis, or
phallus.
Men feel the same pressures to have a larger penis that women do to have bigger
breasts and for the same aesthetic reasons. However, medical science has proven
that a smaller penis does not indicate infertility, just as smaller breasts do not
produce less or inadequate milk. This mindset is purely psychological: a larger
penis equals a more masculine man.
Breast augmentation surgery is a permanent, widely accepted and recognized
breast enlargement procedure. An implant, usually silicone, is placed behind the
woman’s breasts, increasing their overall size. Women can choose to add anywhere
from 200 to 500 cc of material to increase total breast cup size. For a woman who
struggles with low self-esteem because of feelings of inadequate breast size, this
procedure can significantly change her attitude and life.
Breast enlargement has become the most popular elective cosmetic procedure in
the United States today. More than 290,000 US women underwent breast
augmentation in 2013, according to the American Society of Plastic Surgeons.
Albeit expensive, people around the world have accepted this procedure and even
glamorized its innovators on shows like “Dr. 90210” and “Extreme Makeover.”
For men, surgical penile enlargement is not as common or accepted as female
breast augmentation procedures; however, it is a viable option. Just as women used
breast augmentation to improve self-confidence, so can men with the surgical
penile implant. There are many reasons to seek out penile augmentation: genetic
disorders leading to a smaller-than-average penis, hormonal changes that can cause
atrophy, or just wanting to have a bigger penis.
Many gimmicks on the market today claim to enlarge the penis. We’ve all seen the
advertisements: a vacuum cylinder that helps expand your penis to maximum
potential, a pill derived from natural sex hormone research designed to actually
enlarge the penis permanently and help induce and maintain multiple, long-term
erections. Remember, if it sounds too good to be true, it usually is!
Most do not work, and because many of these products originate from countries
outside the United States, they do not necessarily comply with US Food and Drug
Administration (FDA) requirements. Side effects that have not been researched,
documented or known may lead to irreversible and permanent damage. Such
products rarely offer much scientific proof, yet many men spend significant
amounts of money hoping for easy and permanent penile enlargement.
These men fall prey to two common misconceptions: that they have a smaller than
average penis and that nonsurgical penile enlargement is safe and effective.
Chapter 2: Anatomy of the Penis
It is important to be well-versed on the anatomy of the penis and testicles when
making decisions about penile and testicular enlargement. To avoid complications,
you must understand the anatomy of the male genitals before trying any method of
enlargement or augmentation. Understanding your anatomy will help you make the
best possible decision when determining the safest and most successful
enlargement method for yourself.
The penis is a cylinder that contains within it three other cylinders. If you picture a
cross-section of the penis, these three cylinders would look like a pie cut into
thirds, with each cylinder being one-third. Each cylinder is covered by layers of
skin and fascia for protection. As you can see in Figure 2-1, the top layer of skin is
what you see when you look at your penis. Beneath the top layer of skin is a thin
layer of fascia called the dartos fascia. Beneath that is Buck’s fascia, and finally,
beneath Buck’s fascia is the spongy-like erectile tissue called the corpus
cavernosum—this is what engorges and fills with blood during an erection, making
the penis longer and thicker.

Figure 2-1. Cross-section of the penis.

Two of these cylinders are parallel structures, and the third, located on the bottom
of the penis, contains the urethra (the opening through which urine and semen
travel). The top two cylinders are corpora cavernosa (erectile tissue); most of the
time, these two chambers are flaccid, but when stimulated, the erectile tissue
becomes engorged with blood and the penis swells (appearing bigger, thicker and
longer).
Nerve impulses send blood to the penis through the arteries and simultaneously tell
the adjacent veins to close to prevent blood from flowing out, thus sustaining an
erection. These nerve messages come from two nerve centers in the body: one is
the brain, which responds to erotic thoughts and mental images; the other is located
in the lower spinal cord and responds to touching and stroking. These two centers
work together, but each depends on the male hormone testosterone and on
chemical neurotransmitters.
Usually the penis remains erect until ejaculation occurs. Following climax, the
same nerve impulses that initiated the ejaculation may result in the constriction of
the arterioles feeding blood into the penis, causing a decrease in blood flow,
collapse of the sinusoids and rapid drainage of blood from the penis (resulting in
the penis returning to its normal size).
Although the opportunity to enlarge your penis may be your dream, function
cannot be compromised for size. After an enlargement procedure, you may finally
have a penis size that makes you feel more comfortable and confident; however, if
your penis does not function properly, it was all for nothing. It is important to
understand what absolutely cannot be manipulated in the penis during cosmetic
enlargement. There are three critical areas of the penis that must not be
manipulated or damaged in any way to prevent loss of penile function (urination,
ejaculation and sustaining an erection).
Critical Area 1: Manipulation below Buck’s fascia (erectile tissues)
In the penis, Buck’s fascia is a thin layer of connective tissue that acts as a barrier
between the top layers of skin and fascia and the important structures that make up
the penis. If a surgeon were to dissect or inject below Buck’s fascia, the surgeon
would be interfering with the nerves, veins and delicate erectile tissue that make up
the penis. Manipulation of this area usually results in complications like
inflammation, loss of sensitivity of the penis, damage of vital tissues required to
produce and maintain an erection and possible permanent deformity of the penis.
Critical Area 2: Manipulation of the tissue surrounding the urethra
The corpus spongiosum (the third erectile cylinder), located at the bottom the
penis, contains the urethra, which is responsible for releasing urine and semen
from the penis. If trauma occurs to this delicate cylinder, it will interfere with a
man’s ability to release semen and urine properly. Puncturing or causing trauma to
the urethra can cause development of a fistula—an alternative abnormal
passageway of the urethra. This can lead to urine or semen exiting through two
different locations during urination and ejaculation, respectively.
Critical Area 3: Cutting the suspensory ligaments for penile lengthening
The suspensory ligaments (three separate ligaments with separate tasks; Figure 2-
2) maintain the base of the penis in front of the pubic bones and behave as a major
point of support for the mobile portion of the penis during erection. These
ligaments can be cut without negative effects to most patients, who typically will
achieve an increase of 0.5 to one inch in flaccid penile length. This increase in the
length is only visual, caused by lowering the base downward from the pubic bones,
giving the appearance of a longer penis. This technique does not increase the
length of the erect penis and has been shown, in some instances, to lead to erect
penile retraction, that is, loss of length while erect. Cutting the ligament decreases
the angle of elevation of the erect penis; for example, the penis will stand out
horizontally rather than oblique, or upward, as before. In addition, cutting can
cause scar tissue formation and retraction of the penis.

Figure 2-2. A section of the male genitalia and the suspensory ligament.
Patients who want augmentation of the width and girth of their penis with a solid
silicone implant need their suspensory ligaments intact for fixation of the proximal
end of the implant. If the ligaments are cut, the implant will slip under the pubic
bones, shortening the visual penile length.
Chapter 3: Medical Conditions That Can Affect Penis Size
Before talking about medical conditions that can affect the size of a penis, we must
understand what size is “normal.”
What is the average penis size?
The normal range of erect penis length for most men is between five and 6.5
inches, and erect circumference is, on average, four to five inches (Gebhard and
Johnson, 1979, 120).
Doctors at the Kinsey Institute at Indiana University in the 1940s pioneered studies
on human sexuality and sexology to determine what constituted an “average size.”
Men were asked, “how long is your penis, measuring on the top side from your
belly out to the tip?” They were each given a pre-stamped card to take home and
instructed to mark the length on the card when flaccid and when erect.
Approximately 2,500 men participated. In addition, during interviews with more
than 4,000 men, the interviewer asked the subject to estimate his penis size. The
interviewer would hold out a ruler (the numerals were not visible to the man being
interviewed) and move his finger along it. In most cases, there was a slight
underestimation of penis size compared with actual measurements.
What is the relationship between the size of a flaccid (soft) penis and an erect
(hard) penis?
There is a much wider size range among flaccid penises, with the average ranging
from one to four inches. In general, smaller flaccid penises lengthen at erection by
a greater percentage than do larger flaccid penises, with most men reaching an
average size of five to seven inches at erection. This means that the flaccid size of
a penis is not a good predictor of erect size. The vast majority of men measure
within the average range for genital size and have a penis size that is more than
adequate for sexual functioning.
What is a micropenis?
The term micropenis is used by researchers to refer to penises less than 2.8 inches
(seven centimeters) in length when stretched. This condition is thought to affect
only 0.6 percent, or six in 1,000 men, and believed to be caused by inadequate
testosterone at a late stage of fetal development.
Can you make a penis bigger in length or girth?
No non-surgical technique can make the penis bigger. Penis pumps may help
create a stronger erection, but they will not create a larger penis. Because the penis
is composed largely of spongy erectile tissue and not muscle, it cannot be
strengthened or “built up.” Surgery may cause scar tissue to grow that can cause a
painful or even a shortened erection.
Some medical conditions can affect penis size. These include buried penis
syndrome (hidden or concealed penis), micropenis (inconspicuous penis), small
penis syndrome, or microphallus.
Buried Penis Syndrome (hidden or concealed penis)
Buried penis syndrome describes a penis that is normal in size but lacks an
appropriate sheath of skin. It is a true congenital disorder in which the “buried”
penis is located beneath the integument of the abdomen, thigh or scrotum. The
penis may also be buried within its own skin. This condition is more common in
children, usually presenting in neonates or obese prepubertal boys; however, it can
also be seen in adults and has been observed in both circumcised and
uncircumcised men. This condition is rare, but instances of concealed penis are
expected to rise as the epidemic of obesity becomes more prevalent in society.
Primary buried penis syndrome is present from a young age and is caused by
penile tissue dysgenesis, which results in trapping of the penis. Secondary buried
penis syndrome is present from puberty or adolescence and is caused by obesity,
radical circumcision, or lymphedema.
Most cases of buried penis do not require any sort of treatment because the
condition usually improves spontaneously over time. Cases of hidden penis
syndrome that do not improve are treated surgically. The appropriate treatment of
concealed penis syndrome is determined during a pre-surgical consultation with a
urologist. After a physical examination and medical history review, your physician
will discuss all possible treatment options, expected results, as well as associated
risks and complication.
Micropenis (inconspicuous penis), Small Penis Syndrome, or Microphallus
A micropenis is a penis that is normal in anatomical configuration but smaller than
the average adult penis size (average penis size: about seven centimeters [three
inches] flaccid and 12.5 centimeters [five inches] erect).
The term microphallus is used to describe a penis that is both small in size and
abnormal in the positioning of its urethral opening (a condition known as
hypospadias).
Micropenis syndrome can be caused by hormone deficiencies, structural
anomalies, or genetic syndromes. In most cases, micropenis results from abnormal
hypothalamic or pituitary functioning or a testicular disorder. These problems lead
to hypogonadotropic hypogonadism, a condition characterized by diminished
function of the gonads that can cause decreased production of sex hormones.
Other causes of micropenis syndrome include conditions associated with
hypogonadotropic hypogonadism, conditions associated with decreased
testosterone production and hypergonadotropic hypogonadism, deficiency of five-
alpha reductase and partial androgen insensitivity syndrome.
Micropenis can be treated several ways. If micropenis is present during infancy
and is diagnosed as being caused by a hormone deficiency, hormonal replacement
therapy—or Testosterone therapy—is administered to facilitate genital growth.
Testosterone therapy is generally highly effective in treating micropenis.
Appropriate hormonal replacement can be provided for infants with other
hormonal deficiencies (growth hormone deficiency, hypothyroidism, adrenal
insufficiency).
If a patient is unresponsive to hormonal therapy, penile enlargement surgery
remains a treatment of last resort for adults and adolescents. Penile enhancement
surgery uses a subcutaneous soft silicone implant to effectively enhance the length
and girth of the penis in men older than age 22. Although not recommended, if
penile length is a patient’s only concern, a procedure in which the suspensory
ligament is released, followed by an extensive stretching regimen, can also be used
to increase penis length. It should be noted that once the penile stretching stops, the
penis returns to its normal size or possibly shorter.
If life has dealt you challenges and obstacles that make you feel that your penis or
testicle size is abnormal or undesirable, know that years of scientific research have
been dedicated to help treat these feelings of sexual inadequacy. With current
scientific advancements, many treatments are available to help you regain your
sexual confidence.
Chapter 4: A Healthy Sex Life
A healthy sex life comes with many benefits that may help you lead a happier,
more confident life.
Benefit: Stress relief
Having sexual intercourse involves a lot of anatomical systems within the body.
The Brain, nervous system and vascular system are all working—and that’s just in
the penis. The cardiovascular system is also working, lowering blood pressure and
assisting in stress reduction. This can be a major benefit for men who may not get
exercise in their daily routine.
The American College of Sports Medicine recommends 30 minutes of moderately
intense exercise per day, five times a week, or 20 minutes of vigorously intense
activity per day: “moderate-intensity physical activity means working hard enough
to raise your heart rate and break a sweat, yet still being able to carry on a
conversation. It should be noted that to lose weight or maintain weight loss, 60 to
90 minutes of physical activity may be necessary. The 30-minute recommendation
is for the average healthy adult to maintain health and reduce the risk for chronic
disease.”
If a man is enjoying a regular and healthy sex life, he is unknowingly keeping
himself more fit with cardiovascular exercise. For men, having sex twice or more
each week has been shown to reduce the risk of a fatal heart attack by 50 percent
compared with those who had sex less than once a month.
Benefit: Release of oxytocin
Orgasms increase levels of oxytocin, sometimes called the “love hormone,” which
helps us bond, build trust and sleep more soundly. Higher levels of oxytocin have
also been linked to greater feelings of generosity and urges to bond.
The release of oxytocin aids in sleep, deep sleep and relaxation. Deep sleep is
when the body repairs and restores itself from daily wear and tear. If you are not
receiving enough sleep, then your body is not receiving the time it needs to refuel.
Patients who report more sleep per night report lower average body weight and
lower blood pressure.
Benefit: Heart and body health
A British study that followed participants over 20 years showed that having sex
two or three times per week was associated with 50 percent less heart attacks in
men. The study also showed no association between sex and stroke. A benefit of
sex is burning calories. Just half an hour of sex burns 85 calories. You say, “that’s
it?” Well, it certainly adds up: 42 sessions of sex for 30 minutes will burn more
than 3,000 calories, which means one pound of weight loss.
Chapter 5: A Woman’s Perspective
We know that penis size has been linked to masculinity since the beginning of
time, but why does it matter? Do women really even care? Is it just something that
is important to men? The answer might surprise you.
Women all over the world admit that penis size should not matter when choosing a
mate. Some women in long-term relationships say they actually prefer a smaller
penis for various reasons and have perfectly happy and satisfied sex lives.
Sometimes a woman may prefer a smaller penis because she experienced sexual
trauma as a child and maintains a negativity association with larger penises. Some
women actually experience physical pain during intercourse with a penis that is
either too long or too thick.
When asked to evaluate a sexual partner based solely on a sexual encounter, the
response changes. An overwhelming number of women state that they prefer a
larger and thicker penis, when given the option, because it feels better. Why would
a longer, thicker penis feel more satisfying for a woman?
Scientists Masters and Johnson developed a theory that the vagina is a not a space
but a potential space, meaning the vagina accommodates and stretches as
necessary to fit the penis inside her, much as it adjusts to accommodate childbirth.
When looking at the anatomy of a male penis and a female vagina, it is easy to see
why women may identify a thicker penis as more satisfying.
“Penis width may be important due to a penis thick at the base providing greater
clitoral stimulation as the male thrusts into the female during sexual intercourse,”
noted Russell Eisenman, psychology professor at the University of Texas-Pan
American. “That is, a wide penis would seem to offer a greater degree of contact
with the outer part of the vagina, including the clitoral area.”
A thinner penis does not provide a woman with the same feeling of “fullness” by
stretching the vaginal walls, which is psychologically and perhaps physiologically
satisfying. Many women also need to have their clitoris stimulated while being
penetrated to achieve an orgasm. A small penis is not as capable of stimulating the
clitoris during penetration due to lack of length and girth, again, leaving the
woman unsatisfied.
The University of Texas conducted a study to determine women’s actual opinions
with regard to the importance of girth and length during sexual intercourse. In
2001, 50 healthy, sexually active, undergraduate women between the ages of 18
and 25 were interviewed in a study to understand the female perception of penis
width versus length in female sexual satisfaction. An overwhelming number (45 of
50) reported width of the penis as more important than length (p < .001).
The clitoris of a woman contains as many nerve endings (approximately 6,000) as
the penis of a man, but the vaginal walls have relatively few sensitive nerve
endings. Generally, only the lower third of the vagina has enough nerve endings to
feel any stimulation from a penis.
What every man needs to know
Vaginal arousal occurs within the first two the three inches of the vagina, not in the
upper part. Consequently, width matters much more to the average woman than the
length of a penis.
When conducting research for this book, the author informally interviewed women
for their true opinions on penis size and how it affects them during intercourse. To
support the theory, homosexual men who regularly engaged in anal sexual
intercourse were also surveyed. Knowing their answers would be a hundred
percent confidential (scientific research experiments are conducted under the
regulations of the Health Insurance Portability and Accountability Act and patient
confidentiality), these men and women were shockingly blunt. Following are
actual testimonials made in response to the survey:
I would never base a relationship on a set number [or] make a
standard for myself that I only date men who are this number or more
inches thick or long when erect, but I do know what feels good and
what doesn’t quite do the trick. I can enjoy sex with a smaller penis,
but it takes the length and especially the girth of a good sized penis to
really make me orgasm during intercourse. I can feel how hard and
deep the penis feels inside me and how much pressure its thickness
puts against my vaginal walls. That’s the most important thing: the
thickness. —Cincinnati, OH
From a female perspective, I definitely think the size of a man’s penis
matters.. No matter how good you think your performance is, it’s
never just “the motion in the ocean” that counts. Some women are just
as visually stimulated as men, and we like something to look at. Guys
like big boobs for a reason, and women are no different when it comes
to their man’s penis. The sight of a large, erect, thick penis helps get
me ready for sex because I can anticipate the pleasure about to come.
Never am I more turned on than when a man has a nice healthy bulge
in his pants. —Los Angeles, CA
 Size definitely matters, but, more so, confidence matters. If a guy is
smaller than he would like to be, it usually shows in his performance.
I want a guy who is confident and strong and not afraid to be who he
is. Whatever a man has to do to get that confidence is fine by me.
–Indianapolis, IN
For most men, the pressure for their penis to be thick, long, and strong—plus the
added stresses of work, relationships and family—is emotional overload. The
anxiety that develops from perceived penile inadequacy can begin to consume a
man’s thoughts and, over time, negatively interfere with his entire life.
Chapter 6: The Desire for Penile Augmentation
Your size may be more normal than you think. Many patients do not understand
that their penis size is actually not as small as they may think. The media tends to
imply numbers such as eight or nine inches in length as normal when erect, but
scientific evidence proves otherwise.
As mentioned earlier, according to Gebhard and Johnson, the average erect penis
of American men is five to seven inches long, and the average circumference is
four to six inches. More recent data (unpublished) indicates that an average erect
penis length is five to six inches, and an average flaccid penis length is one to four
inches. A study of 300 men (unpublished) conducted by Kinsey Institute
Researcher Dr. Erick Janssen from 1989 to 1993 returned a mean circumference of
12.2 centimeters (approximately 4.8 inches) for an erect penis.
These studies prove that what many American men think is a small penis is
actually quite average. The statistics are informative but do not address the body
image and psychological issues that are the true cause of unhappiness for many
men.
For some men, reading this book and learning the statistical facts may be enough.
They may understand that the image of their penis being too small is only in their
minds and that science shows their size is quite average. This may be enough to
raise their confidence to an emotionally healthy level.
Some men may still feel inadequate after learning the facts and may still be
considering a safe augmentation procedure. The following augmentation
questionnaire is administered by Dr. Elist to all of his patients being evaluated for
penile or testicular augmentation. This survey is professionally designed to
determine how much and how often feelings of sexual inadequacy affect men’s
daily lives. If you answer “always” or “often” to more than five of these questions,
you may be a candidate for augmentation.
Augmentation questionnaire
Answer each statement as Always, Often, Sometimes, or Never:
1. I think about my physical appearance more than others.
2. I am affected deeply by what other people think of me.
3. I feel sad or unhappy.
 4. I am worried that I look old.
5. I feel I have nothing to look forward to.
6. I don’t enjoy things the way I used to.
7. I am more critical of my appearance than others.
8. I feel like I have failed more than the average person.
9. I believe that I am ugly.
10. I feel that there are permanent changes or discrepancies in my
appearance that make me look unattractive.
11. I have low self-esteem.
12. I avoid urinals in the restroom.
13. I avoid locker rooms at the gym.
14. I have fear associated with sexual experiences.
15. I avoid sexual experiences.
16. I obsess over my penis or testicle size.
17. I am embarrassed of what women or men probably think about
my genitals.
18. I will never find a woman who can love my penis.
If you answered “always” or “often” to many of these questions, you are not alone.
The benefits of penile or testicular enhancement using a silicone implant have the
potential to change a man’s life.
Chapter 7: Attempted Methods of Penile Enlargement
Throughout history, men have taken extreme measures to increase the size of their
penis. What methods have been used? What works and what does not? From
methods of the ancient Egyptians to the latest technologies used by today’s
biochemists and doctors, each method will be examined individually.
Weights
Perhaps the earliest attempt at penis enlargement was made by the ancient
Egyptians, who are believed to have hung weights from the shaft of the penis for
days. The concept of hanging weights from a body part is one of the world’s oldest
methods of stretching tissue and skin, and that is all that hanging weights from the
penis really does. One study showed that 1-1.25 inches was the average flaccid
gain for 18 men studied over 4.5 months. The men wore various weights for up to
12 hours per day, seven days a week, for the entire 4.5 months.
Weight hanging for potential increases in penile length is a time-consuming, often
painful experience with many associated risks.
Nerve damage. The most significant risk associated with hanging weights is the
damage it may cause to the nerves and structure of the penis. Although the
anatomical structure of the penis can allow a certain amount of stretching and has a
certain amount of elasticity, excessive weights can surpass those levels, effectively
causing irreversible damage. Once nerves are pulled, damaged or severed, a loss of
sensation can occur and, in turn, can lead to loss of erection.
Narrowing. If the weight is too heavy, hanging could actually result in the
narrowing of the penis, which is the opposite of what most men want. Unlike most
other parts of the body, the penis is dynamic in that it can rapidly change size,
shape and consistency. By applying external forces to gain one desired effect (e.g.
length), other aspects may be sacrificed (e.g. girth).
Circulatory problems. Hanging weights can result in ruptured microvessels within
the penis. Once ruptured, blood circulation to the penis itself is compromised.
Similar to a heart attack, in which the organ lacks vital nutrients supplied by blood,
if the penis does not obtain enough blood, parts of the penis can become necrotic
and die.
Weight hanging from the penis shaft is time consuming, painful and dangerous.
This high-risk practice is not recommended for anyone who has access to modern
scientific, technological and medical techniques.
Jelqing
Jelqing is thought to have originated in the Middle East by Arab men who claimed
the ritual increased the size of their penis, in some instances to more than 20 inches
long.
These numbers are most likely untrue, but the practice of jelqing began with a
series of penis pulling, stretching, milking, and massaging techniques believed to
enlarge the penis if practiced early in life (many Arabic youth were said to have
been jelqed by their grandmothers) and over a long period of time. The practice of
jelqing claims to increase both length and girth of the penis.
The idea is that the milking movement increase blood flow to the spongy tissue of
the penis, expanding it and allowing it to hold a greater volume of blood when both
erect and flaccid. To achieve and maintain results, jelqing experts recommend a
minimum of 500 jelq strokes per day, preferably in the shower or during a warm
bath.
Jelqing poses several risks and disadvantages.
Damage. Men jelqing too roughly causes bruising and structural damage to the
penis.
Body awareness. Jelqing cannot be performed if a man has a full erection; rather it
must be performed while semi-erect. For some younger, more aggressive men, this
practice can be dangerous because they do not know their body’s physical
limitations well enough.
Orgasm control. A man should not ejaculate during a jelqing session. Many men
have trouble controlling their orgasms, especially when they are engaging in
jelqing motions associated with sex and masturbation.
Time. Jelqing requires a minimum of three to five minutes to warm up and cool
down with a hot, wet cloth wrap, plus 500 or more strokes every day. The process
is very time consuming.
Jelqing requires a strong will, a great deal of time and meticulous attention to detail
in study and practice. Even then, the threshold between being beneficial and
causing permanent damage is quite thin. The results are usually minimal and
difficult to sustain. In general, the practice of jelqing is not recommended
according to sound medical principles.
Penis Pump or Vacuum
Many men have a misconception that a penis pump will increase their penile size
permanently if used routinely. That is incorrect.
The intent of a penis pump is to help men who experience erectile dysfunction and
need short-term help achieving an erection for sexual intercourse. The pump is a
temporary solution to an erectile dysfunction problem.

Figure 7-1. Commercial penis pump.

The concept is that an apparatus surrounds the penis and, by sucking air away from
around the penis shaft, draws blood into the penis on a temporary basis to form and
support an erection. The man is usually able to sustain an erection long enough for
sexual intercourse, and then the blood returns to its original location following
climax.
No penis pump device will promote permanent, long-term penile or testicular
enlargement, despite the many false claims and gimmicks on the market.
Herbs and Enlargement Pills

Figure 7-2. Enlargement pills promise you the moon.

Many available herbal pills claim to supplement your dietary needs with natural
herbs and botanicals. Some extreme herbal enthusiasts claim they have a
supplement that can even make a penis grow thicker and larger naturally. That
claim is entirely false.
The ingredients in most natural male enhancement supplements almost always
include gingko biloba, damiana, yohimbe, maca, Siberian ginseng, ashwaganda
and horny goat weed. These herbs are natural supplements intended to increase
blood flow to the genitals and promote a stronger sexual desire. These
supplements, like the penis pump, are effective in only occasionally helping
achieve a temporary erection—they do not make the penis larger.
Supplements promote easier, stronger erections but cannot physically increase the
size of the penis or testicles. Revisiting the anatomy of the penis: within the penis
are the cylindrical tissues known as the corpus cavernosum. These tissues are
responsible for erectile size and firmness. To increase the size of a penis from a
molecular level, the size of these tissues would have to increase. Currently, no
medication nor supplement can increase the size of the corpus cavernosum. The
size of the corpus cavernosum is genetic and is partially determined by DNA.
Herbal supplements and pharmaceuticals, such as Viagra (sildenafil citrate), are
recommended as a remedy to increase libido and erection strength, but are not
recommended methods of thickening and enlarging the penis or testicles.
It is important to distinguish between engorgement and enlargement. Almost all
“enhancement” supplements are marketed as products that will enlarge the penis,
but this is false. Penile enlargement refers to increasing your current measurements
in both flaccid and erect states to a larger measured size. For example, if a man’s
current flaccid and erect measurements are three and five inches, a product must
increase these measurements in both states to truly be considered an enlargement
product.
Many holistic natural and pharmacological products marketed as enlargement
supplements merely cause an increased frequency of erections without any effect
on size. Such products only allow for more blood flow to the penis, which should
be correctly termed as engorgement. Without proper scientifically-approved
surgical augmentation, one cannot increase the size of the penis.
Penis-Stretching Devices
Penis-stretching devices have been on the market for years. Many styles and
variations of penis-stretching devices can be found online, each with its own
complex assembly system and various risks associated with use. Penis-stretching
devices endeavor to stretch the ligaments and skin of the penis in much of the same
way as weight-hanging techniques do.

Figure 7-3. The Penistretcher and Dahan Penis Enlarger.

Most penis-stretching devices must be assembled and applied by the purchaser. In
addition, most devices are sold exclusively online and are extremely difficult to
service, repair or replace.
Penis-stretching devices are meant to be assembled around the penis, and users are
instructed to wear the device periodically for a number of hours per day, for
months at a time. Penis-stretching devices tend to be bulky and, when worn
frequently, significantly interfere with a man’s work and social schedules.
These devices attempt to promote penile enhancement by stretching the suspensory
ligament (see Fig. 2-2), allowing the penis to hang further down. This gives the
visual effect of a longer penis in the flaccid state.
An independent study, published in the International Journal of Impotence
Research, was conducted to determine the efficiency of one such penis-stretching
device. Nine healthy men suffering from a “small” penis were enrolled (age range:
26 to 43 years), and the initial stretched penis length was 12.0 centimeters (range:
8.1 to 15.4 centimeters). The Penistretcher device was prescribed for at least six
hours a day, to be worn daily for at least four months. In all subjects, the
elongation of the penis was proportional to the device time of use.
After four months, the average stretched flaccid penis augmentation was +1.8
centimeters (range: +0.05 centimeters to +3.1 centimeters). The daily average use
was 6.5 hours (range: three to nine hours). No significant side effects occurred.
The authors concluded that their data showed the efficacy of this penis-stretching
physiotherapy in treatment of small penis.
Most penis-lengthening devices are intricate, susceptible to user error and can
cause major complications and side effects. Although potentially effective relative
to flaccid length if used over a long period of time, most men do not have the type
of lifestyle that would allow them to discreetly or comfortably wear such devices
consistently and long enough to be effective.
It should also be noted that penis-lengthening devices simply stretch the skin and
tissues in the flaccid penis; they do not add erect length or girth to the penis.
Stretching techniques, with respect to erect penis length, are in vain because of the
strong fascia surrounding the corpora cavernosa (e.g. the tunica albuginea), which
will never stretch. Furthermore, because of the inelasticity of the strong fascia,
stretching devices can cause excessive strain and traction that can lead to
microruptures in the fascia. Due to its nature, fascial healing can be a lengthy
process and can lead to further complications and deformities.
Cutting the Suspensory Ligament
Cutting the suspensory ligament is the most widely used technique for visually
lengthening the flaccid penis. It is usually done in combination with a (double) Z-
plasty or a VY-plasty—a procedure which removes suprapubic fat tissue, in turn,
increasing flaccid penis length.
The fundiform ligaments are a continuation of Scarpa’s fascia. The suspensory
ligament lies posterior to the fundiform ligaments and splits in two around the base
of the penis after being cut. Through the procedure, one can use fat tissue or a
small silicone testis prosthesis to fill the cavity created between the pubic bone and
the corpora. In this way, the penis is kept as far away as possible, but it also
ensures that there can be no retraction or scarring between the corpora and the
pubic bone. Furthermore, it is recommended that the corpora be attached to the
lower rim of the pubic bone using two stitches.
The next step is to remove fatty tissue from the pubic area. Excision of fat tissue by
scalpel is preferred over liposuction; the former method utilizes the septa until
smoothing out. A visual illusion of length gain of ±2 centimeters in the flaccid
state is considered an average result of the procedure.
Men with body dysmorphic disorder often have unrealistic expectations regarding
the outcome of this procedure. Rather than inherently increasing penile length, it
trims back the contrasting pubic wall, giving the illusion of a longer penis. It is
worth mentioning that in certain cases of medical necessity (extreme obesity,
weight loss, or buried penis syndrome), such excisions of fat can be beneficial.
Surgical Injections
Following advancements in the use of fat transfer and collagen fillers for plastic
surgery, surgeons began injecting substances under the skin of the penis for
thickening purposes.
The following injected materials are typically used:
Liquid silicone. Liquid silicone is not cohesive, meaning it is free floating and may
dislocate. All injectable fillers used in very loose connective tissue tend to follow
gravity; they end up in the prepuce and form a pear-shaped penis over time.

Figure 7-5. Post Injection of High Viscosity Gel, Penile Deformity.

Collagen (bovine or porcine). Collagen tends to dissolve and absorb in the body
within three to nine months. It is an organic material, meaning the body is able to
break it down over time. The patient ultimately ends up back at square one, with
more complications, and has lost the opportunity to move forward with other
scientific procedures.
Fat (autologous). Fat is liposuctioned from one area of the body, then harvested
and reinjected below the skin of the penis. The real “take” rate is usually about five
to 20 percent, which means that at least 80 percent of the injected fat will absorb
quickly or will form oily cysts or nodules that may remain for months or until
surgical removal.
Paraffin and polyacrylamide gels. Used mainly in Asian countries, this material
has consistently caused severe foreign body granulomas and skin slough. When the
skin perforates and opens, the material leaks continuously and can continue for
months without healing. These patients also lose the opportunity to proceed with
surgical scientific procedures. Furthermore, this material has never been FDA-
approved for any procedure in the United States.
High-viscosity gels from cross-linked hyaluronic acid (HA) are injected between
the skin and corpora, typically remaining for 12 to 18 months until absorbed by the
body. After injection, the HA gel needs two to four weeks for stabilization. The
greatest risks include: decrease in tactile sense, abnormal undulation, unevenness,
nodule formation and dislocation during intercourse. When the skin perforates and
opens, the material leaks and can continue to leak for months without healing.
Similarly, these patients lose the opportunity to proceed with surgical, scientific
procedures.

Figure 7-6. Subcutaneous injection of fat, severe penile deformity.

A surgeon injects semi-viscous fluid into the space beneath the skin of the penile
shaft, increasing the thickness (but not length) of the penis. The penile shaft
normally has little or no fat, and this method typically results in unevenness and an
unnatural appearance and feel. In the hands of an unskilled surgeon, the injection
of fat (not to mention all of the aforementioned injections) can be injected
accidentally into the corpus cavernosum, which can lead to an embolism and death.
Risks of Fat Injections
• Unnatural look and feel due to dislocation of the fluids
• High risk for infection, inflammation and granulomas
• Low risk of damaging the nerves of the penis (loss of sensation)
• Injected material often migrates and changes shape
• If fat is used, there is a 50 to 90 percent “death rate,” meaning the fat does not
survive the transfer process and dissolves or forms oily cysts and nodules
• The procedure is largely irreversible and is difficult to correct
The injection of liquid silicone or any other dermal filler substance to the penis or
testicles is neither a recommended surgical procedure nor an FDA-approved
method for penile or testicular enlargement. These methods and procedures often
produce unnatural and irreversible results.
Tissue Grafting

Figure 7-7. A sheet of wet AlloDerm (left) and dermal grafting (right).
Acellular human dermis is a thin sheet of human cadaver tissue used by surgeons
around the world to correct, support and build stronger body tissue. LifeCell, the
manufacturer of AlloDerm, describes its product as:
AlloDerm® Regenerative Tissue Matrix provides a strong, intact
repair material for challenging hernia repair and breast reconstruction
 post-mastectomy procedures. Unlike other acellular human dermis
products, AlloDerm® Tissue Matrix is produced through a unique
non-damaging process that allows the body to mount its own tissue
regeneration process.
Donated human skin tissue supplied by US AATB [American
Association of Tissue Banks]-compliant tissue banks is aseptically
processed using LifeCell’s proprietary technique to remove the
epidermis and cells that can lead to tissue rejection and graft failure.
The result is an intact acellular matrix of natural biological
components that promotes rapid re-vascularization, white cell
migration and cell re-population.
In layman’s terms, AlloDerm is like “faux skin” inserted under the patient’s own
skin. It attaches to the existing skin and tissue cells, making them stronger, thicker
and more durable. AlloDerm is made of cadaver skin and tissue, killing all viable
cells and leaving only the collagen. The collagen is then cut into thin sheets and
delivered to surgeons. The manufacturer of AlloDerm recommends use for full-
thickness skin grafting, wound healing and abdominal wall repair.
Many urologists and plastic surgeons took note of the efficiency of AlloDerm in
breast reconstruction and began to test the placement of AlloDerm sheets under the
subcutaneous skin of the penis for widening and thickening purposes.
The manufacturer does not recommend AlloDerm for use in phalloplasty penile
enlargement. The FDA regulates its use and has specifically not approved
AlloDerm as a “void filler” or for “cosmetic augmentation.” Cosmetic
augmentation phalloplasty does not fall within the approved procedures for which
LifeCell can recommend and promote AlloDerm.
Despite LifeCell’s admonition not to use its product for penile thickening,
urologists and plastic surgeons around the world continue the practice. While a
minority of men have experienced limited positive results from the procedure, at
least three major risks are associated with this surgery.
No approval for use. First and foremost, this product is not FDA-approved for use
in penile enlargement surgery. AlloDerm is FDA-approved for breast and
abdominal surgery and for wound healing, but it has not been approved for
insertion in the penis for the purpose of penile enhancement.
Expense. AlloDerm is very expensive, and the penile enlargement procedure
requires the use of a significant amount of the product to obtain optimal results.
Disfigurement. The most disturbing risk associated with use of AlloDerm for
penile augmentation is the disfigurement it may cause. AlloDerm has been known
to contract inside the penis (like an accordion), disfiguring and shortening the
penis—possibly permanently. Hardening is another common occurrence that
results in a nodular feeling and appearance, as well as in hardening the skin.

Figure 7-8 Penile deformity status post insertion of AlloDerm.

Complications with removal. Complications with removal are often major. When
AlloDerm is placed in the human body and left there for a period of time, it
attaches to the existing skin and tissues. Removing AlloDerm is not like removing
breast implants, in which everything comes out in one encapsulated shell. Because
AlloDerm has been physically integrated into the body, the surgeon must literally
scrape off each layer of the product from the penile structure. The process of
surgically removing AlloDerm is complicated and messy, often leaving the
removal area misshapen and with diminished blood supply and sensation due to
heavy surgical intervention and manipulation of the surrounding tissue.
Although AlloDerm may seem desirable because of the added thickness it may
provide the penis, the limited benefits of the procedure in selected patients simply
do not justify the risks.
Several other implanted biological or artificial materials have been used in
attempts to thicken the penis: the patient’s own “autologous” dermis (dermal
grafts), collagen “felts,” Dacron, polyethylene mesh, materials used in hernia
repair. These materials all face the same problem: contracting like an accordion
around the base of the shaft, penile skin perforation if too stiff and not pliable
enough, difficulty removing the tissue, permanent damage and loss of the only
chance to proceed with a surgical procedure.
Chapter 8: Proven Results: The Elist Silicone Implant
Dr. James Elist, a board-certified urologist, has developed a silicone implant far
ahead of its time in terms of medical effectiveness and patient comfort and
satisfaction.
The Elist silicone implant is the only such implant cleared for penile
enhancement.
Chapter seven compared and evaluated some of the many methods of penile and
testicular enlargement being marketed to men today. After thoughtful evaluation, it
is appropriate to consider that phalloplasty and testicular augmentation surgery
using a silicone implant may be the most reliable, most effective and the longest
lasting option for penile and testicular enhancement available to men today.
Most penile and testicular enlargement surgeries are cosmetic in nature and are
performed on an elective basis. The vast majority of men who decide to undergo
augmentation phalloplasty do not have a debilitating medical condition—they
would just like their penis or testicles to appear larger. Phalloplasty augmentation
is very similar to breast augmentation in this respect.
Like most cases of breast augmentation, phalloplasty augmentation is not covered
by health insurance unless the patient has a specific condition that would make the
surgery medically necessary.
Silicone penile implants for male sexual enhancement are typically used for:
• Treatment of major cosmetic deficiencies such as congenital
malformations or in postcancer reconstruction
• Cosmetic girth enlargement
Silicone testicular implants for male sexual enhancement are typically used for:
• Testicular atrophy
• Testicular loss due to trauma, cancer, or other causes
• Congenital lack of one or both testicles
The Elist silicone implant is made of durable, medical-grade soft silicone, the same
material used to make modern day breast implants. But unlike breast implants, it
does not have any saline core gel and is naturally and especially soft. The Elist
silicone implant will not lose its shape or texture and typically will not cause any
major negative reactions in the body after surgical insertion. Most other penile
implants, particularly the semirigid type, develop fibrosis, which causes the penis
to gradually shrink and lose its rigidity and length over time.
Researchers have learned that silicone is inert, meaning it typically causes no
unfavorable clinical or biological reactions. Silicone is extremely safe for
implantation—the first breast implant was inserted in 1964 and after more than 30
years of intensive research, no definitive data demonstrates that silicone implants
cause any kind of human disease.
Silicone is not just used for cosmetic purposes; it is also used for medically
necessary treatments, such as facial and body-part implants, finger joints, heart
pacemakers, penile implants for impotent patients and prosthetic arm and leg
limbs. If silicone were not safe, the product would not have been adopted and used
as the most implanted material by surgeons all over the world.

Figure 8-1. The new Elist penile implant.

The Elist Procedure: Penile Augmentation
Dr. Elist begins by making a small horizontal incision of about two to three inches
in the hairy mons pubis above the penile base. From there, a large pocket is created
between the penis skin and underlying corpora cavernosa. The implant is inserted
into the space between dartos fascia and Buck’s fascia, which surrounds the
corpora cavernosa and contains the deep penile arteries and veins.
The implant is cylindrical in shape. To help imagine it, think of the implant almost
wrapping around the top three-quarters of the penis, from seven o’clock at the
lower left side, over the twelve o’clock position, to five o’clock at the lower right
side. Note that the bottom portion of the penile shaft containing the urethra remains
untouched and uncovered. The implant remains above Buck’s fascia, which is
critical in maintaining a structurally normal and functioning penis.
At the end of the operation, a surgical drain is placed internally along the implant
to collect the wound fluid and prevent seroma (a pocket of clear, non-infected
fluid) accumulation. To prevent infection, the pocket is irrigated with disinfectants,
and a broad-spectrum antibiotic is left in place for two hours. The patient is then
picked up at the surgery center and driven home or taken to stay overnight at a
nearby hotel if he does not live in the greater Los Angeles area.
In general, the drain can be removed by either the surgeon or the patient after two
days, when the drained daily fluid accumulation is less than 30 mL daily. Pain
medication is rarely needed but will be provided for the first three days as
necessary. The surgical bandage can be removed the day after surgery. The
subcuticular sutures are absorbable and disappear by themselves after about three
weeks.
The Elist silicone implant for penile augmentation has many advantages that
distinguish it from other treatments:
Gains in both length and girth. Unlike other implants, the Elist silicone implant
can achieve enlargement in both the radial and lateral dimensions of the penis in
the flaccid state.
Quality design. As a result of its design and location, the implant does not interfere
with the structural integrity or normal functions of the penis. The penis is a very
intricate organ and multiple body systems work together to allow it to function
properly. With the Elist silicone implant, all systems, tissues, nerves and skin
remain intact and function normally, as if the implant were not present.
Reversibility. Unlike other penile-enlargement methods, the Elist silicone implant
can simply be removed, if requested, without permanent damage to the structure of
the penis or its function. Other methods, like tissue grafting, leave the penis
misshapen after correctional surgery.
Short operative duration. Unlike many other augmentation procedures, the Elist
silicone implant requires about 60 minutes for implantation. Many types of
anesthesia can be used, making this procedure an option for those who dislike
undergoing general anesthesia (completely asleep). The operation can be
performed under general anesthesia or “twilight” anesthesia, similar to that used at
the dentist’s office.
Minimal scarring. The implant procedure does not leave any perceptible scars and
does not compromise the aesthetic look or the function of the penis.
Permanent results. Results with the Elist implant are permanent. Once you have
the operation, you will have the results forever (or as long as you would like
them)—no fiddling with painful weights or confusing vacuums or remembering to
take a pill every day. The implant does not expire or require replacement and will
not deteriorate, disintegrate, or rupture and float to other parts of the penis or body.
The operation takes just under an hour and is performed on an outpatient surgical
basis, meaning the patient gets to go home after the procedure. This procedure does
not require an overnight stay in a hospital.
The Elist Procedure: Testicular Augmentation

Figure 8-2. The Elist soft testes enlargement implant compared to other oval
implants.
Testicular enhancement is designed to help the scrotum appear more proportionate
in relation to the size to the penis. The procedure is ideal for testicular
reconstruction following trauma, as well as for men with small, non-functioning
testes looking for a cosmetic solution.
Dr. Elist has developed and patented an implant that can be inserted around the
testes into the scrotum on an outpatient basis. The Elist testicular augmentation
implant will relieve the concerns of many men self-conscious of a large, loose,
unaesthetic, bothersome and extended scrotal sac.
Testicular implants are also an appropriate choice for children with undescended
testicles or torsion of the testicles. Torsion is the extreme rotation or twisting of
one or both testicles within the scrotum that can eventually result in damage and
ultimately require the removal of the testicle. Adult men can also experience
torsion, trauma, injuries, or testicular cancer, all of which may require the removal
of a one or both testicles. Testicles can be replaced by commercially available
silicone implants in a rather simple manner.
Figure 8-3. Mentor soft/solid testicular prostheses.
The surgery is similar to that of penile augmentation using a silicone implant. A
small incision is made in the skin of the scrotum, the testicle is freed from
surrounding tissue, and the implant is placed around the testicle. The location of
the implant will not interfere with any function of the testes.
The Elist testicular implant is crescent-shaped—the concave portion fits perfectly
against the testicle (implants come in pairs, each implant fitted against each
testicle). This procedure has the potential to enlarge the testicle to a size that is at
least double its original size. The implant is securely fixed in the tunica vaginalis (a
thin protective membrane surrounding the testicle).
The Elist testicular implant comes in three sizes—large, extra-large and XXL—to
provide the patient with the option of customizing his degree of enlargement.
With respect to male feelings of penile and testicular inadequacy, testicular and
penile augmentation surgeries are potentially outstanding ways to improve sexual
self-image and personal interactions. Increases in self-confidence positively affect
personal interactions with sexual partners as well as with coworkers, friends and
family.
It is obvious how a man’s life can change and improve after undergoing these
procedures. A man’s seemingly endless stress and anxiety can be addressed,
allowing him to experience the benefits of a healthy sex life and a positive personal
life.
Chapter 9: Testimonials
Patient 1
Some background: I’m a 21-year-old Latino; I’m 5’9,” 145 pounds and
attractive, but the size of my penis and testicles has always made me feel
incomplete. I finally feel I’m on my way to feeling whole and confident
about myself. I’m optimistic about my life, my physical appearance…
and ultimately about improving my life emotionally.
I had testicular implants (XL), a circumcision due to my semi-
circumcision as a baby and webbing recession due to a flap of excess
skin that I’ve never liked. I’ve wanted this surgery for years.
I am very impressed and thankful that my surgery went so well; the
incisions are perfect and my healing is coming along great. I am excited
to have a new outlook on a life filled with personal self-esteem,
satisfaction and fulfillment.
Patient 2
I can’t thank you enough for helping me, and everyone else who wants a
larger penis, by inventing a method that is actually safe, effective and
permanent. My confidence has increased exponentially since my PE
[penile enlargement] procedure in March. I can’t help but notice women
staring at the new bulge in my pants every day.
There was a point in time (after nearly seven years of researching PE
surgery) when I had given up and was willing to settle with what I had.
None of the methods available at the time were permanent, and they all
carried significant risk of complications.
But then I found you. You invented a method that is permanent, safe and
effective—for nearly half the price of what other doctors are charging for
what I believe to be dubious methods.
Patient 3
I only write this to give any individuals out there some reassurance that
this is very real and life changing. I have always been self-conscious
about the size of my penis. I did not lack in erect length. I was about
seven inches in length, but my girth was only about 4.5 inches. The
locker room situations were always embarrassing because I was tiny in
 my mind. I am married, and while we are in love, I never truly enjoyed
sex—I was so concerned about not pleasing her. This insecurity finally
pushed me to search the internet for a solution. I tried the pills and
jelqing and clamping. What a waste of time and energy, and for only
temporary gains! I then came across a forum that led me to Dr. Elist.
Most guys talk and talk about penis enlargement, but only a few seem to
write about their experiences.
I learned a great deal from the forum. I learned that I did not want FFT
[free fat transfer] or dermal grafts. I learned about scaffolds but did not
want to put my penis in the hands of a doctor in Belgrade [Serbia] for a
centimeter gain. I read stories and saw pictures of horrible surgical results
from other doctors on the Internet with professional websites that lure
you in.
I then started to read the Elist threads. The Elist implant provided me
with the least invasive surgery with the most possible girth increase. It
took one week to read every thread and make a decision to put my penis
in the hands of Dr. Elist.
Five weeks after the surgery, I asked Dr. Elist if I could make love to my
wife. He agreed.
All I can say is wow. Time and money well spent! It was amazing and
never felt so good. I had a little swelling and some soreness but was back
to normal the next day.
Whoever says size doesn’t matter is full of it! I am 6.4 inches at the base
and 5.8 inches midshaft. This is the perfect size for me and my wife, but
Dr. Elist says I should expect some more gains in the next few months
due to the capsule forming around the implant.
Patient 4
At a very young age, I had an accident that caused major trauma to my
testicles and they never grew like they should have. For 25 years, I had to
live with this, always feeling less than adequate. I had looked into doing
surgeries but never found a physician with whom I was willing to risk
undergoing surgery.
After finding out about your practice and doing my research, it became
clear to me you were the one physician for the job. For one, you are a real
urologist and a physician—not just a plastic surgeon.
Long story short, I found out about your patents and decided to undergo
both testicular and penile enlargement surgeries. It has been five months
since my penile enlargement and let me tell you this from the bottom of
my heart: thank you, thank you and forever thank you.
I am a new man. Not only am I longer, but I am also much thicker. Every
morning when I wake up and every night before I go to sleep, I thank you
for this wonderful gift and for your exceptional service and knowledge.
You, sir, Dr. James J. Elist, have brought total happiness to my life. I was
already a happy person before, but now I am so confident and feel like a
better individual as a whole.
Chapter 10: Elist Silicone Implant Q&A
PENILE IMPLANT
What is the average penis size?
Three studies of penis size in which measurements were taken in a laboratory
setting report the following ranges:
• Average penis length (flaccid/not erect): 3.4–3.7 inches (8.6–9.3
centimeters)
• Average penis length (erect): 5.1–5.7 inches (12.9–14.5 centimeters)
• Average penis girth (circumference when erect): 3.5–3.9 inches (8.8–10
centimeters)
A penis that falls substantially below these values is referred to as a micropenis
or inconspicuous penis. Although this condition generally does not prevent a
man from being sexually active, it may have psychological effects.
Does penis size matter?
According to early studies (Gebhard and Johnson, 1979) based on original
Kinsey data, yes, penis size does matter. After surveying 300 women and 300
gay men aged >18 years from different ethnicities, we found that 82 percent of
women and 95.8 percent of gay men surveyed preferred a penis that was big
enough to satisfy them.
What can cause a micropenis?
Penile retraction can occur following a spinal cord injury called webbed trapped
micropenis.
However, new plastic surgery procedures for the penis can give the flaccid
penis additional length and a more normal appearance, and several plastic
surgery procedures will correct a penile deformity.
The latest addition to the treatment options is the insertion of a soft silicone
implant under the penile skin that can be contoured by the surgeon to create a
custom implant according to personal needs.
What are the risks associated with the surgery?
Like any surgery, there are possible risks and complications. The main risk is non-
harmful bacteria infecting the implant. These non-harmful bacteria produce and
cover themselves with biofilm, a type of mucous. This risk is unavoidable since a
patient’s skin, even after sterilization, can never be a hundred percent free of the
bacteria living in the epidermis and in sebaceous glands.
What is a biofilm?
Many pathogenic and nonpathogenic bacterial strains produce a mucous gel after
settling on a smooth surface, like that in catheters, smooth silicone implants, or
artificial joints.
This biofilm protects the bacteria from the effects of disinfectants and antibiotics.
Recent studies have shown that alcohol and peroxide can penetrate this mucous
when applied early on. Consequently, the wound pocket will be irrigated with
these disinfectants at the end of the operation, and antibiotics will be instilled
during the first few postoperative days.
Should I get circumcised before penile augmentation?
No, the penile arteries are not end arteries, meaning the arteries of the skin are
Yes. All patients must be circumcised prior to the insertion of a subcutaneous
connected to the arteries of the corpora cavernosa via the prepuce. To keep optimal
penile silicone implant.
blood supply to the skin—which is lifted up during the operation—an intact
prepuce is rather helpful.
How long does the operation take?
Approximately one hour.
Is the procedure done under general anesthesia?
It can be done under local anesthesia with a sedative or under general anesthesia.
Do I have to stay in the hospital after the surgery?
No. Following the surgery, we ask that you stay in the hospital for two hours, after
which, you can be picked up and driven home. If you are from out-of-town, it is
recommended you stay overnight in a nearby hotel.
Does this surgery have a high patient satisfaction rate?
Yes.
Does the surgery affect sexuality or erectile function?
Increased self-esteem may influence sexual intercourse rather positively.
How much can surgery increase the length of my penis?
If a solid silicone implant is inserted between the suspensory ligament and glans,
then your flaccid penis will maintain its stretched length. The implant prevents the
penis from shrinking and retracting in the cold.
The length of the implant has to be adjusted during operation depending on your
preoperative flaccid length. Overweight patients may have an accumulation of fat
in the pubic region that may cover part of the penis and adversely affect the length
gain that is seen.
How much can surgery increase the width of my penis?
The Elist penile implant has a width of eight millimeters on each side, allowing
your penis to widen approximately 16 to 20 millimeters (three-quarters of an inch),
including capsule formation around the whole implant.
How long after surgery can I start having sex?
Approximately four to six weeks after the operation.
Are the results of flaccid penile lengthening permanent?
Yes.
Are the results of penile widening permanent?
Yes.
Is help available without surgery?
There are several unproven, nonsurgical techniques for penile lengthening. The
medical community does not recommend these techniques, and because no studies
have been done, it is impossible to tell how effective these techniques are or what
the risks might be. There is no nonsurgical technique that produces permanent
penile lengthening or widening.
What are the risks of other surgical penile lengthening methods?
Unfortunately, no reliable data is available regarding the complication rates.
However, a few reports indicate that releasing the suspensory ligament can
decrease the angle of elevation of the erect penis. Paradoxical penile shortening
can also occur as a result of spontaneous reattachment of the ligament to the pubis
bone. Skin advancement can cause unnatural hair growth proximal to the penile
stump. Using a large flap can impair blood supply, leading to poor wound healing,
possible dehiscence, and, in some cases, hypertrophic scarring.
What are the risks of penile augmentation?
The risk, as with any type of surgery, is infection. However, Dr. Elist is currently
working with a two to three percent infection rate—a rate that is on par with other
cosmetic procedures (breast augmentation). Adherence to our post-operative
protocol is essential in reducing chances of infection.
Will insurance cover these treatments?
If by medical standards you have a small penis—a micropenis—with a length that
measures less than 3.66 centimeters in the erect state and a width that measures
less than 3.5 centimeters in circumference in the erect state—or if you have had
previous penile surgery, Peyronie’s disease, an aggressive circumcision, other
genital trauma, or a neurogenic bladder that caused penile shortening, then
insurance will likely cover your surgery for penile lengthening.
Insurance will not cover the costs of these procedures when done purely for
cosmetic reasons. Furthermore, insurance will not cover penile widening.
Do silicone implants cause any human diseases?
No published data demonstrates that silicone prosthetics cause human disease. The
concern has always been whether silicone gel, used in older implants, may leak and
act as an antigen, that is, a foreign body that activates the immune system causing
an autoimmune disease. An autoimmune disease is a disease process in which the
body’s own immune system acts against itself, causing inflammation and scarring
in otherwise healthy tissue.
It is important to note that all disease-study researched at that time was in
connection to silicone breast implants—not silicone penile or testicular implants.
Today, cohesive silicone gel breast implants are back in use in the United States
and are FDA-approved.
TESTICULAR IMPLANT
Is there any alternative to implantation of testicular implants?
The only alternative to implant placement is simply no treatment. The testicular
implant can create or restore a more normal cosmetic appearance of a testes-
containing scrotum. Not having treatment will require leaving a partially or
completely empty scrotum. Another alternative (except for men with testicular
cancer) is subcapsular orchiectomy—a procedure which removes the testicle tissue
from the capsule, leaving the empty capsule in the scrotum. Although this tissue
removal provides a smaller scrotal structure, it may be preferable to an empty
scrotum.
Do any conditions increase the risk of injury from testicular implants?
Several conditions could increase the risk of injury from testicular implants or
make device implantation difficult or impossible. These contraindications include
infection and untreated cancer.
It is important to note that a testicular implant is strictly for cosmetic appearances
and it in no way functions like a natural testicle.
In contrast, the early onset of a testicular carcinoma can be masked by an implant
for a certain amount of time, and only become clinically apparent if the testis and
implant slowly increase in size.
How many types of testicular implants are currently available?
Three types of implants are currently available; however, only one—the Mentor
saline-filled testicular implant—has received approval from the FDA for
implantation as a testicular prosthesis.
The other two, Silimed’s silicone elastomer device and Mentor’s soft-solid device,
are available for implantation only as part of a research protocol for which Dr. Elist
is a principal investigator.
What are the risks associated with testicular enlargement surgery?
As with any surgical procedure, there are risks such as infection, delayed wound
healing, fluid collection, hematoma formation (a collection of blood inside the
body in and around where the incision is made), bleeding and possible reactions to
anesthesia. However, these complications are uncommon.
Some unanswered questions about silicone implants apply only to silicone gel-
filled breast implants. Certain risks that may be associated with silicone gel will
not occur with the newer devices, including the saline-filled, soft-solid, or silicone
elastomer testicular implant devices.
Do I have to avoid taking any kind of medication before surgery?
You should avoid aspirin and aspirin-like products (e.g. ibuprofen) and stop all
herbal supplements for one week before your surgery.
Is the procedure performed under general anesthesia?
The procedure can be performed under either local, general, or spinal anesthesia,
all of which are extremely safe and effective. These options will be discussed with
you in detail by the anesthesiologist prior to the procedure.
How long does the procedure take?
The procedure usually takes 30 to 60 minutes.
Do I have to stay in the hospital overnight after the surgery?
Testicular implant surgery is usually performed on an outpatient basis (no
overnight stay). For those patients with significant underlying medical problems, a
brief hospital stay might be required.
Will I experience discomfort and pain after the procedure?
Most patients experience some discomfort during the first 24 to 48 hours after the
procedure. Painkillers will be prescribed if needed.
Will I have any difficulty urinating after the procedure?
Your ability to urinate should not be affected.
When can I resume my daily activities after the procedure?
Although every person’s recovery time is different, you should be able to resume
most of your daily activities within one week to 10 days.
Is there a chance of adverse reaction to the implant?
Silicone is one of the best biocompatible artificial substances. The literature shows
no cases of allergies or foreign body reactions against fully polymerized solid
silicone.
How often do patients need repeated surgery to either remove or adjust the
implant?
Approximately one in 30 patients requires “re-surgery” within the first year to
either remove or adjust the implant.
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