It is in consultation with Dr Richard Diacakis, a plastic surgeon in Paris, that the interest of performing this operation will be discussed and decided upon.
In the vast majority of cases, a man always has the feeling that his penis is too small at rest and/or erect. Very often this is not the case, but patients are no less complex.
The main reasons for consultation are the “locker room syndrome”, the aesthetic aspect, premature ejaculation, thickening of the glans or simply a larger penis for more sensation during sexual intercourse. 
Hyaluronic acid penoplasty or medical penoplasty is done in the office because this technique is not surgical, there are no incisions or sutures.
If there is an outbreak of genital herpes on the patient’s sex, the session is postponed. 

A wash with Betadine scrub (red) is preferable at home before coming. Otherwise a cleaning will be done at the office with an antiseptic.  Anaesthesia is obtained with an anaesthetic cream and/or a very light and painless local anaesthetic performed at the office. 
The injection of hyaluronic acid, according to a personalised grid technique, is then carried out in 30 minutes. 
Using a micro-cannula, the hyaluronic acid is introduced between the skin and the corpus cavernosum in a well-defined space that is in contact with the corpus cavernosum. It is very important to inject into this space in order to have a very natural result. The product is injected around the entire circumference of the penis. 
In order to obtain a satisfactory thickening of the penis, 8 to 15 ml of hyaluronic acid is required from the first session.
For the thickening of the glans it is possible, on request, to thicken the crown and/or the entire glans associated or not with the thickening of the penis. Usually 2 to 4 ml are necessary. The anaesthesia is the same as for the penis. Hyaluronic acid is different from that used for the penis. 

When the patient leaves the practice the thickening is only 30%, it will be 100% after 48 hours.

A more significant thickening (130%) is to be expected due to a reactive oedema caused by the injection, which will disappear within 15 days and which could suggest that the product has been resorbed.
This is why after the hyaluronic acid penoplasty it is preferable to envisage a control visit between 1 and 2 months. It may allow us to refine the result in case of small irregularities in volume to add or remove product.  
Hyaluronic acid can be easily removed on request.
Sexual intercourse should only be resumed after one week of the operation.
Preventive antibiotic therapy combined with a non-systematic anti-inflammatory may be prescribed.
The patient can resume sports activities and work on the same day without discomfort or pain.
Sometimes transient side effects can be observed in the first few days after the session, which are, as with any injection, pain/burns/stinging, oedema and/or haematoma related to the injection. 

Contraindications are those of hyaluronic acid : Allergy to the product, autoimmune disease, history of granuloma, blood coagulation disorder, genital herpes outbreak.

The immediate result is 30% on leaving the practice. The result is total at 72 hours and even greater for about two weeks due to the oedema induced by the injection.
The choice of hyaluronic acids studied by Dr. Richard Diacakis, a plastic surgeon in Paris, allows a significant volumizing effect with a firm consistency. If one respects an injection in contact with the corpus cavernosum, the result is very natural and homogeneous whether one is circumcised or not.

Enlargement : The penis gains 2 to 3 centimetres in circumference both at rest and in erection. It is then heavier and visually appears double at rest. The gain depends on the anatomy of each person and the quantity injected. But the enlargement is systematically evident and convincing. During an erection, the penis is larger and the distribution of the product is homogeneous. It is possible to obtain a larger enlargement, from 4 to 6 centimetres, or even more, depending on the person, if you combine the sessions.

The length : An obvious and immediate lengthening is observed at rest by making the penis heavier and because it retracts much less due to the presence of the product. The penis then remains longer permanently at rest without suffering, as before, from variations in length, especially in the cold. On the other hand, the penis is not longer in erection. 

Duration : The choice of suitable hyaluronic acids allows you to keep about 70% of the volume for a year and a half. It is therefore recommended that the patient redo an injection in order to keep the same volume.   

When this procedure is repeated, the hyaluronic acid tends to be less resorbed, and the injection times become longer and longer. 

Result on the glans : Since physiologically the glans varies a lot in volume and is not as elastic as the skin of the penis, it is more difficult to put an exact figure on the gain. Generally speaking, the gain is 1cm thickening both at rest and in erection and obviously depends on the quantity of injections given. The sensitivity is not modified. The duration is more than a year. 

The thickening effect is felt during the erection.

Results on premature ejaculation : Very interesting results have been obtained on premature ejaculation. In fact the control of ejaculation is delayed for two reasons: 

• The thickening of the penis allows, by the presence of the product during sexual intercourse, to be less solicited by the uncontrollable excitement that is premature ejaculation by decreasing the hypersensitivity that characterizes premature ejaculation.
• Moreover, the greater thickness of the silk restores confidence in the silk, which is of considerable help in this context, which is known for its very often psychological reasons.