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Pubic Contouring after Massive Weight Loss in Men and Women: Correction of Hidden Penis, Mons Ptosis, and Labia Majora Enlargement

Alter, Gary J. M.D.

Plastic & Reconstructive Surgery: October 2012 - Volume 130 - Issue 4 - p 936–947
doi: 10.1097/PRS.0b013e318262f57d
Cosmetic: Special Topics

Background: Weight gain and subsequent weight loss usually result in unsightly large fat deposition in the pubic areas along with ptosis of the fat pad and skin. Men also complain of burying of the penis and the woman complains of labia majora enlargement, both causing secondary sexual dysfunction, hygiene issues, discomfort, and aesthetic concerns. Even with weight loss, most of these deformities persist.

Methods: The hidden (buried) penis is characterized by a lack of firm attachments between the Buck fascia surrounding the tunica albuginea of the corpora and the dartos fascia and skin. Successful treatment requires the penile skin and dartos fascia to be stabilized to the penile corporal bodies to make the penis one integrated unit. The method of surgery is usually to excise and lift excess pubic skin, eliminate the pubic fat without creating a significant pubic concavity, and stabilize the penile skin to the corporal bodies with tacking sutures dorsally and ventrally. If inadequate penile skin is present, scrotal flaps or skin grafts are used to cover the penis. Treatment of the mons pubis requires similar pubic lifting, fat excision, and pubic tacking. Labia majora reduction requires skin and usually fat excision.

Results: Results are excellent with the use of these techniques.

Conclusions: Pubic contouring after massive weight loss in men and women is very successful and safe if performed meticulously. Treatment improves self-esteem along with the associated physical and aesthetic deformities.

Los Angeles, Calif.

From the Division of Plastic Surgery, University of California, Los Angeles.

Received for publication January 3, 2012; revised April 23, 2012.

Presented at the Vllth International Symposium on Plastic Surgery, in São Paolo, Brazil, March 24 through 26, 2006; First International Course About Aesthetic Genital Surgery Male and Female, February 17, 2007; “Panel: Genital Rejuvenation and Reconstruction: Fringe Procedure or New Frontier,” American Society for Plastic Surgeons Annual Meeting, in Baltimore, Maryland, October 31, 2007; Special Seminar, “ Cosmetic Rehabilitation of the Post-Bariatric Patient,” American Society for Aesthetic Plastic Surgery Annual Meeting, in San Diego, California, May 2, 2008; Sexual Medicine Society of North America Annual Meeting at the American Urological Association Meeting, in Chicago, Illinois, April 26, 2009; Web Symposium “Surgical Problems in Pediatric Gynecology,” Case Western University, in Cleveland, Ohio, September 10, 2009; Society of Genitourinary Reconstructive Surgeons, General Membership Annual Scientific Session in association with the American Urological Association, in San Francisco, California, May 30, 2010; American Society of Plastic Surgeons/American Society for Aesthetic Plastic Surgery Breast Surgery and Body Contouring Symposium, in Santa Fe, New Mexico, August 27, 2011; Cutting Edge 2011: Advanced Body Sculpting Head to Foot, 31st Aesthetic Surgery Symposium, the American Society of Plastic Surgeons and the International Society of Aesthetic Plastic Surgery, in New York, New York, December 1 through 3, 2011.

Disclosure: The author has financial interest to declare in relation to the content of this article. No outside funding was received.

Gary J. Alter, M.D., 416 North Bedford Drive, Suite 400, Beverly Hills, Calif. 90210, altermd@altermd.com

©2012American Society of Plastic Surgeons