PENILE PARAFFINOMA
One of the type of conditions which still at this day and age; presents to the dermatologist and plastic surgeon is penile paraffinoma or sclerosing lipogranuloma of the penis
Many men undergo injections of illicit substances such as mineral oil or paraffin motivated by a desire to increase penile shaft length and girth in an attempt to satisfy their sexual partners or to boost self-esteem.
https://coconuts.co/bangkok/news/might-cut-off-doctor-warns-thai-men-penile-injection/
Some even insert foreign objects leaving a bizzare appearance that will require surgery for correction.
Photo depicts sequela of penile paraffinoma with ulceration on lateral surface of penile shaft
The origins of this practice can be traced back to Austrian surgeon Robert Gersuny who injected paraffin (mineral oil) to correct the testicular deformation left by castration (removal of testicles) for tuberculous epididymitis. The immediate volumization effect was deemed a miraculous success.
The technique continued to be popular for the next 2 decades in the early 20th Century with paraffin being touted as the ideal "filler' for breast augmentation, facial wrinkles and etc.
Unfortunately, late complications were common leaving a sequela of nodules, granulomas, deformation, infections (abcesses), necrosis, ulcerations & migration of the material with lymphangitis.
Even modern fillers that we have today and which are widely promoted as being safe, quick with no downtime may have some long-term sequela if not used judiciously. Many complications are seen on a daily basis. And I have written on filler fatigue previously.
https://drkhooleesengplasticsurgery.blogspot.com/2020/08/filler-fatigue-what-your-doctor-does.html
Today, the injection of paraffinoma for penile girth and length enhancement remains popular especially in Asia (especially Thailand & Malaysia) & Eastern Europe and are often done by unregistered practitioners underground.
Histology will show pseudocystic spaces and giant cell foreign body reaction as the human body is unable to enzymatically degrade the mineral oil.
Histology (microscopic) image showing Giant Cell Granulomas and large cystic spaces.
Treatment with antibiotics, corticosteroids and immunomodulators are not effective in treating penile paraffinoma and the only treatment is surgical therapy.
Various surgical techniques have been described for the treatment of penile paraffinoma.
I attach a link of video of my surgery for penile paraffinoma excision and reconstruction with a scrotal flap.
https://www.youtube.com/watch?v=xbRwaGlpUf4
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I have come across patients who present with non-specific ulceration and nodules over the penis/penile shaft, and it is only after prolonged probing & questioning do they admit the illicit injections done. At first glance, the clinician may mistaken the lesions for a sexually transmitted disease (STD). Wider public education on the dangers of penile injections of paraffin/mineral oil and other substances are essential to curb the practice.
For penile enlargement, consult an experienced surgeon who has the entire toolkit for the trade which can include detachment of the suspensory ligament of the penis (to increase length) , fat grafting with Platelet Rich Plasma or Platelet Rich Fibrin, and augmentation using alloderm biocompatible material to enhance penile girth.
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References
Gómez-Armayones, S., Penín, R.M. and Marcoval, J. (2014). Penile Paraffinoma. Actas Dermo-Sifiliográficas (English Edition), [online] 105(10), pp.957–959. Available at: https://www.actasdermo.org/en-penile-paraffinoma-articulo-S1578219014002868 [Accessed 30 Jan. 2021].
Glicenstein, J. (2007). [The first “fillers”, vaseline and paraffin. From miracle to disaster]. Annales De Chirurgie Plastique Et Esthetique, [online] 52(2), pp.157–161. Available at: https://pubmed.ncbi.nlm.nih.gov/16860452/#:~:text=In%201899%2C%20Robert%20Gersuny%2C%20an [Accessed 30 Jan. 2021].
Downey, A.P., Osman, N.I., Mangera, A., Inman, R.D., Reid, S.V. and Chapple, C.R. (2019). Penile Paraffinoma. European Urology Focus, [online] 5(5), pp.894–898. Available at: https://pubmed.ncbi.nlm.nih.gov/30007541/ [Accessed 30 Jan. 2021].
Salauddin, S.A. and Ghazali, H. (2019). Surgical Techniques for Correction of Penile Paraffinoma. The Malaysian Journal of Medical Sciences : MJMS, [online] 26(6), pp.137–142. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6939734/ [Accessed 30 Jan. 2021].
