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Managing residual volumes in penile girth enhancement with hyaluronic acid fillers: a case series and literature review

International Journal of Impotence Research (2025)Cite this article

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Abstract

Hyaluronic acid (HA) fillers are widely used in aesthetic medicine due to their biocompatibility and reversibility with hyaluronidase. However, their use in penile augmentation (PA) remains limited, and knowledge of hyaluronidase application in this context is sparse. This case series presents four patients with residual HA from previous penile girth enhancement (PGE), successfully managed using hyaluronidase. These cases illustrate its utility in correcting asymmetries, managing adverse effects, and preparing the site for reinjection. Although underutilized in urologic practice, hyaluronidase represents an effective adjunct in the refinement and maintenance of HA-based PGE.

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Fig. 1: Reinjection of HA after removal of 3.5 year-old focal HA remnant by Puncture & Squeezing.
Fig. 2: Reinjection of HA after removal of 4 year old HA remnant by Hyaluronidase Injection.
Fig. 3: Reinjection of HA after removal of 4 year-old HA large remnant by Hyaluronidase Injection to previous unsatisfactory Puncture & Squeezing.
Fig. 4: Partial correction of HA overinjection-induced Penile Deformity by Hyaluronidase Injection.

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References

  1. Narins RS, Brandt F, Leyden J, Lorenc ZP, Rubin M, Smith S. A randomized, double‐blind, multicenter comparison of the efficacy and tolerability of Restylane versus Zyplast for the correction of nasolabial folds. Dermatol Surg. 2003;29:588–95.

    PubMed  Google Scholar 

  2. Kontis TC. Contemporary review of injectable facial fillers. JAMA Facial Plast Surg. 2013;15:58–64.

    Article  PubMed  Google Scholar 

  3. Rohrich RJ, Bartlett EL, Dayan E. Practical approach and safety of hyaluronic acid fillers. Plast Reconstr Surg Glob Open. 2019;7:e2172.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Littara A, Palmieri B, Rottigni V, Iannitti T. A clinical study to assess the effectiveness of a hyaluronic acid-based procedure for treatment of premature ejaculation. Int J Impot Res. 2013;25:117–20.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Kim JJ, Kwak TI, Jeon BK, Cheon J, Moon DG. Human glans penis augmentation using injectable hyaluronic acid gel. Int J Impot Res. 2003;15:439–43.

    Article  CAS  PubMed  Google Scholar 

  6. Kwak TI, Oh M, Kim JJ, Moon DG. The effects of penile girth enhancement using injectable hyaluronic acid gel, a filler. J Sex Med. 2011;8:3407–13.

    Article  PubMed  Google Scholar 

  7. Manfredi C, Romero Otero J, Djinovic R. Penile girth enhancement procedures for aesthetic purposes. Int J Impot Res. 2022;34:337–42.

    Article  PubMed  Google Scholar 

  8. Pang KH, Randhawa K, Tang S, Fallara G, Katelaris A, Castiglione F, et al. Complications and outcomes following injection of foreign material into the male external genitalia for augmentation: a single-centre experience and systematic review. Int J Impot Res. 2024;36:498–508.

    Article  CAS  PubMed  Google Scholar 

  9. Ahn ST, Il Kwak T, Park KS, Kim JJ, Moon DG. Complications of glans penis augmentation. Int J Impot Res. 2019;31:245–55.

    Article  PubMed  Google Scholar 

  10. Buhren BA, Schrumpf H, Hoff N-P, Bölke E, Hilton S, Gerber PA. Hyaluronidase: from clinical applications to molecular and cellular mechanisms. Eur J Med Res. 2016;21:1–7.

    Article  Google Scholar 

  11. King M, Convery C, Davies E. This month’s guideline: the use of hyaluronidase in aesthetic practice (v2. 4). J Clin Aesthet Dermatol. 2018;11:E61.

    PubMed  PubMed Central  Google Scholar 

  12. DeLorenzi C. Complications of injectable fillers, part I. Aesthet Surg J. 2013;33:561–75.

    Article  PubMed  Google Scholar 

  13. Ahn ST, Shim JS, Bae WJ, Kim SW, Kim JJ, Moon DG. Efficacy and safety of penile girth enhancement using hyaluronic acid filler and the clinical impact on ejaculation: a multi-center, patient/evaluator-blinded, randomized active-controlled trial. World J Mens Health. 2021;40:299–307.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kim H, Kwon S, Whang K, Lee J, Park Y, Lee S. The duration of hyaluronidase and optimal timing of hyaluronic acid (HA) filler reinjection after hyaluronidase injection. J Cosmet Laser Ther. 2018;20:52–7.

    Article  CAS  PubMed  Google Scholar 

  15. Broder KW, Cohen SR. An overview of permanent and semipermanent fillers. Plast Reconstr Surg. 2006;118:7S–14S.

    Article  CAS  PubMed  Google Scholar 

  16. Rzany B, Becker‐Wegerich P, Bachmann F, Erdmann R, Wollina U. Hyaluronidase in the correction of hyaluronic acid‐based fillers: a review and a recommendation for use. J Cosmet Dermatol. 2009;8:317–23.

    Article  PubMed  Google Scholar 

  17. Kroumpouzos G, Treacy P. Hyaluronidase for dermal filler complications: review of applications and dosage recommendations. JMIR Dermatol. 2024;7:e50403.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Murray G, Convery C, Walker L, Davies E. Guideline for the management of hyaluronic acid filler-induced vascular occlusion. J Clin Aesthet Dermatol. 2021;14:E61.

    PubMed  PubMed Central  Google Scholar 

  19. Cohen B, Bashey S, Wysong A. The use of hyaluronidase in cosmetic dermatology: a review of the literature. J Clin Investig Dermatol. 2015;3:7.

    Google Scholar 

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Authors and Affiliations

  1. Department of Urology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea

    Du Geon Moon, Sun Beom Cho & Sun Tae Ahn

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  1. Du Geon Moon
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  2. Sun Beom Cho
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  3. Sun Tae Ahn
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Contributions

Conception and design: DG Moon. Acquisition and interpretation of data: DG Moon and ST Ahn. Draft and revise the content of the article: DG Moon and SB Cho. Review and editing, final approval of the completed article: DG Moon, ST Ahn, and SB Cho.

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Correspondence to Du Geon Moon.

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Competing interests

The authors declare no competing interests.

Ethics statement

The original study protocol of this case series was reviewed and approved by institutional review board (No. 2023GRO0449 at Korea University Guro Hospital). Consequently, all methods were performed in accordance with the Institutional Clinical Trial Guidelines and Regulations. All subjects were informed and instructed about the objectives and procedures of the current clinical trial. They were asked to sign the informed consent after a detailed explanation of possible adverse events (AEs) related to the filler and filler injection procedure. They were also asked to sign the informed consent after a detailed explanation of publication of the results in which the photo or image of their penis can be used.

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Moon, D.G., Cho, S.B. & Ahn, S.T. Managing residual volumes in penile girth enhancement with hyaluronic acid fillers: a case series and literature review. Int J Impot Res (2025). https://doi.org/10.1038/s41443-025-01182-8

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