Penile Girth Enhancement with Hyaluronic Acid

What is hyaluronic acid, and why is it used for girth enhancement?

Hyaluronic acid is a gel-like filler, identical to a substance found naturally in the body's connective tissue, which is injected under the skin of the penis to increase girth. It has been widely used for decades in other areas of medicine, and over the past decade it has also been studied in controlled trials for penile girth enhancement: an increase in girth, not length¹⁰¹¹.

Unlike permanent materials, hyaluronic acid is temporary and the body absorbs it over time, which also explains why follow-up treatments are usually needed. A key advantage over some other materials is that it can be broken down with an enzyme, a point explained further down this page.

What did the controlled studies show?

Several randomized controlled trials have tested hyaluronic acid injection for girth enhancement, mainly against another filler, polylactic acid (PLA), and showed a measurable increase in girth with a relatively low rate of side effects. The table summarizes the main findings:

An important limitation: most of these studies had a relatively high dropout rate. In Yang 2019, for example, 43% of participants did not complete follow-up¹. In addition, most controlled trials in the field came from one research group in Korea, which limits how far the results can be generalized to other populations³. A meta-analysis of 4 studies (283 participants) found a larger girth increase with hyaluronic acid than with PLA, with no significant difference in complications¹².

How long does the result last, and what happens afterwards?

In the study with the longest follow-up, the result was partly maintained for up to about 18 months, but it tends to fade gradually over time. According to the International Consultation on Sexual Medicine (ICSM 2024), hyaluronic acid “is considered relatively safe, but additional procedures are likely to be needed” to maintain the effect over time¹⁰. The Sexual Medicine Society of North America (SMSNA) describes a similar pattern: an average increase of about 2 to 2.5 cm, which fell to about 1.5 cm after 18 months⁶.

In practical terms, this is a treatment that usually calls for thinking about ongoing maintenance, not a one-time procedure with a permanent result. How long the result actually lasts, and when a follow-up treatment is considered, is explained on the page how long penile girth enhancement lasts (Hebrew).

Where exactly is the filler injected?

The injection goes into the layer just under the skin, above the deeper tissue that contains the main blood vessels and nerves. It is not placed “somewhere” at random, but in a defined anatomical plane. The following illustration shows the principle schematically only, without explicit anatomical detail:

This plane is chosen to spread the filler evenly around the circumference and to keep a distance from the deeper structures. That is why injecting in this area requires specific anatomical knowledge, not just general experience with fillers⁸.

What does the procedure look like, in general?

The procedure is done in the clinic, under local anesthesia, usually in a staged approach: starting with a moderate amount and adding according to the result. Hyaluronic acid injection is usually performed in the clinic under local anesthesia, followed by massage to spread the filler evenly⁸. The exact details (type of anesthesia, length of the procedure, number of sessions and recommended follow-up) vary between protocols and are decided according to the individual case. What you feel during and after the injection: does penile girth enhancement hurt (Hebrew).

An accepted, responsible approach is staged treatment: start with a moderate amount, let the result settle, and decide later whether to add more in a separate session. This lets you see the actual result without committing in advance to a large amount, and lets you set the pace to your own preference. The full timeline of the first days of recovery is on the page what happens day by day.

What side effects and complications are possible?

The most common are swelling, lumps, migration of the filler and infection, at rates ranging from about 5% to 14% in individual studies and about 9% on average in a recent meta-analysis of 23 studies and more than 2,600 participants⁶⁴³. Other documented effects include phimosis (narrowing of the foreskin) and the “Tyndall effect”, a bluish tint of the skin over the filler⁸.

More serious complications, such as blood vessel occlusion or a severe hypersensitivity reaction, are rarer but have been documented in the literature¹³. Treatment of such complications usually includes early massage, heat, and sometimes partial dissolving of the filler with the enzyme, antibiotics, drainage of an abscess, or excision of persistent lumps⁸. Worth knowing: the meta-analysis that showed the lowest complication rate for hyaluronic acid was based mainly on indirect comparisons between methods, so it is not a single trial that compared all methods head to head³.

Can the result be reversed?

In many cases hyaluronic acid can be broken down with an enzyme called hyaluronidase, which is also used to correct asymmetry, treat side effects, and sometimes to prepare for a repeat injection⁷⁸. This enzymatic reversibility is considered one of the main safety advantages of hyaluronic acid over other materials, and a recent meta-analysis cites it as such³.

To be precise: there is no reported success rate for dissolving filler in the penis specifically, so complete dissolving cannot be promised in every case. In addition, PLA does not respond to the same enzyme: hyaluronidase acts only on approved hyaluronic acid, not on other fillers⁸. A fuller explanation of how the enzyme actually works and when it is used is on the page reversibility: how the filler-dissolving enzyme works (Hebrew).

Does it affect erection, sensation or ejaculation?

The controlled studies did not report harm to erections, and some even reported a change in time to ejaculation: an estimated lengthening, which may also reflect a change in sensation. In Ahn 2022, a longer estimated time to ejaculation was measured after the injection, a finding that should be stated with caution and not as a blanket “benefit”⁵. At the same time, the ISSM reports isolated cases in the literature of erection and sensation problems after hyaluronic acid injection¹³. In other words, it cannot be said that there is “no risk at all” in this area, even though most controlled studies did not observe harm.

On the other hand, satisfaction with the appearance of the penis and with sex life was reported to increase in several studies, and men with size anxiety also showed lower scores of negative beliefs about size (BAPS)⁴. It is important to stress: such a finding does not cancel the strong EAU recommendation against treating men with penile dysmorphic disorder (PDD). Size anxiety and PDD are two different conditions¹¹.

Hyaluronic acid or PLA?

The results are similar, with a slight advantage in girth gain for hyaluronic acid, and with one important practical difference: only hyaluronic acid can be dissolved with an enzyme. The two materials have been compared head to head in several controlled trials, and their results are broadly similar, with a slight advantage in girth gain for hyaluronic acid¹⁴²¹². An important practical difference: hyaluronic acid can be partly dissolved with an enzyme, while PLA does not respond to that treatment⁸. On the other hand, granulomas have been documented with PLA: inflammatory lumps that appeared two months or more after injection, some of which required surgical excision¹⁴. A full comparison with the other methods is on the page fat injection and PLA for the penis (Hebrew).

Who is the treatment not suitable for?

The treatment is not suitable for men with suspected body dysmorphic disorder, until an appropriate evaluation has been done, or for men whose mental health is not stable. Both the EAU and the SMSNA address these groups explicitly: the EAU makes a strong recommendation against using fillers, including hyaluronic acid, in men with dysmorphic disorder¹¹, and the SMSNA states that suspected PDD should be checked before any procedure, and that a procedure is not suitable for a man whose mental state is not stable⁶. The difference between ordinary concern and dysmorphic disorder, along with data on average penis size, is explained on a separate page. Age-related considerations are on the page penile girth enhancement by age (Hebrew).

Why is there no “specific approval” for this use?

No filler currently has regulatory approval specifically for penile girth enhancement, from any regulatory body we checked. Hyaluronic acid fillers are originally approved and marketed for other uses, and there is no dedicated approval for this indication⁹. This is important to know before deciding. It is not necessarily a reason to avoid treatment, but it is part of what should be weighed and asked about at the consultation.

In Israel, hyaluronic acid fillers are classified as medical devices, and their regulation has been reviewed in the past by the State Comptroller, Israel's public audit authority¹⁵. Anyone who injects a filler must be a physician, not a cosmetician or a non-physician practitioner¹⁵. A discreet consultation is the simplest way to get personal, accurate answers to all of these questions.

What does a consultation with Dr. Dana Buchbut look like?

The consultation is a discreet conversation, with no pressure and no commitment to treatment. Hyaluronic acid is the method the clinic works with, so the consultation starts with measurement and understanding your goal, goes over what has been shown and what has not, and explains the risks and the option of dissolving the filler with the enzyme, which the clinic performs based on a medical decision. After that, you decide together whether and how to proceed, in a staged approach. You can get in touch by phone or by discreet message, including on WhatsApp in English. The reversibility page (Hebrew) covers the enzyme in detail, and the page on choosing a doctor (Hebrew) covers the questions worth asking before you book.

The information on this page is general and for education only. It does not replace an examination, diagnosis or personal medical advice. A decision about treatment is made only after an examination.