June 20, 2026 | Uncategorized
A patient sat down across from me recently, closed the door behind him, and said he had been thinking about a procedure for almost a year before he made the appointment. He had done the research online. He had even talked to our chatbot first, because it felt more private. By the time he got to my desk he already knew most of the terms. He just wanted someone to tell him the truth.
That is the version of this conversation I have several times a week now. So many men are curious but embarrassed to ask about these treatments. What I tell them is that these are actually very common procedures that most men already know about and have even researched for themselves. We just do not talk about them. So let me write the honest version here, in plain language, the same way I would say it across the desk.
What Men Are Asking For
Men are asking for several different kinds of procedures, and the most common request is size enhancement, which is usually done with fillers. The fillers that give the most volume in the penis are Voluma and VoluX. These fillers increase girth and can increase length up to about half an inch, but that is not really the main objective or how it physically works.
Men who want to enhance sensation, or who have erectile dysfunction, are getting the P-Shot, which is essentially PRP, platelet-rich plasma derived from your own blood. It is injected into the cavernous bodies of the penis and the crown to increase sensation, libido, and erection strength.
More recently we have seen an increased demand for Bocox, which is botulinum toxin injected into the cavernous bodies. This creates vasodilation, which creates a larger erection. It usually increases length by half an inch to one inch, creates a stronger erection, and is used both in men with erectile dysfunction and in men who simply want a stronger result.
Some men are looking for a descended testicle look, where the testicles hang more pronounced, with smoother scrotal skin, and to avoid the scrotal shrinkage we sometimes see with changes in temperature. These men are candidates for Scrotox, which is Botox injected into the dartos muscle and the scrotal skin. It relaxes both to create that descended look and smoother skin.
One Thing You Have to Understand About Scrotox
This is the part I make sure every patient hears clearly. The muscles we relax with Scrotox are the muscles your body uses for temperature control of the testicles and the spermatic cord. Relaxing them can cause sterility. A man who still wants to have a family is not a candidate for Scrotox, because the procedure can make a male sterile. That is not a footnote. That is the conversation we have before anyone schedules anything.
It is also important to understand that all of these treatments are off-label. The products themselves are FDA-approved, but we are using them in an off-label nature, with the patient’s full consent and understanding of the risks and complications.
The Misconceptions Men Walk In With
One of the biggest misconceptions men have is that the procedure will considerably lengthen the penis. As I tell every patient, these procedures really do not create a lot of length. If anything, it is half an inch maximum, or one inch. They do seem to create a lengthening effect at rest, when the penis is not erect, and they mostly create an increase in girth.
The other misconception is that the results are permanent. Fillers can last one to two years. Botox usually lasts three to six months.
And then there is the biggest misconception of them all, that bigger is always better. That is not necessarily the case. Sometimes the quality of the erection is more important than the size.
Who Is the Typical Patient
Honestly, the typical patient is anything you can imagine. There really are no stereotypes for who is seeking these procedures. There is a wide range of ages and a wide range of backgrounds. You would think most men consider themselves small and that is why they come in, but a lot of men are already well-endowed and are just looking for enhancement. The age between thirty and fifty is the most common, but we see all types of patients, and many travel to us from other states and around the country for this.
The Risks Nobody Should Skip Over
There are real risks and complications, which is exactly why it matters so much who does this. It is extremely important to go to a board-certified physician, to use a facility that uses FDA-approved botulinum toxin and fillers, and to have these procedures performed in sterile environments. This is not a procedure where you want to bargain or shop for the least expensive provider if that means cutting back on safety and quality products.
With the penile fillers specifically, there can be areas of contour deformity, which can be touched up later, and sometimes palpable nodules, which can be dissolved if necessary. The product has to be injected in the right plane. Too superficial, and the nodules and irregularities show more. Fillers can also create edema in uncircumcised men, which can interfere with intercourse and even normal voiding. The most dangerous complication is infection in this area, which is avoidable with proper sterile technique and postoperative care.
What Recovery Looks Like
Recovery for any of these is rather straightforward. I usually ask patients to refrain from sexual activity for forty-eight to seventy-two hours. There can be mild discomfort, usually managed with over-the-counter ibuprofen or Tylenol. For the botulinum toxin treatments, it takes about two weeks to start working. The PRP injections take two to four weeks, and sometimes need to be repeated.
Part of a Bigger Shift
I think this is part of a broader male aesthetics trend. We are seeing men more frequently in our clinics for cosmetic procedures, hair restoration, hormone replacement, weight loss therapies, peptides, and wellness IV drips. Men are getting more comfortable with these treatments, and a lot of it comes down to finding the right provider they trust and feel comfortable with. Clinics that perform these on a regular basis understand the needs of men and cater to them in a respectful, private way, where a patient feels understood and not judged.
Why Choose Dr. Agullo
Double board-certified, American Board of Plastic Surgery and American Board of Surgery. American College of Surgeons Fellow. Mayo Clinic plastic surgery fellowship. Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center Paul L. Foster School of Medicine. Affiliate Professor at UTEP. Castle Connolly Top Doctor for thirteen consecutive years. These procedures are performed in a sterile, accredited setting with FDA-approved products and a frank, private conversation up front about what each one can and cannot do.
Ready to Talk?
If you have been curious but holding off, the first step is just a conversation. You can read about the procedures privately on our site, message us, or come in and ask whatever you want to ask. Nothing is off the table and nothing is judged.
For the surgeon-to-surgeon take on where male aesthetics is heading, see the companion essay on drworldwide.com. For the MedSpa and wellness side of men’s care, see the version on swplasticsurgery.com.
Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. #StayBeautiful.
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