Your Questions

Q: Dr. Eppley, Can you do liposuction on the pubic area of a woman? The mons pubis I believe? I have attachments some photos of mine which is oversized tremendously. (as you can see in the attached pictures) How much would a procedure like this cost? How is it performed? What is the recovery?

A: It is very common to do liposuction on the mons area (pubic liposuction) and it can provide a significant reduction. However, your mons problem is going to require more than just liposuction due to the excess skin. You need a combined pubic lift to remove and tighten the loose mons skin that will result from it being deflated of fat at the time of the liposuction. Think of it as a reverse mini tummy with an incision in the skin fold at the upper end of the pubic region. This combined liposuction and lift of the mons area is technically know as a monsplasty. This is a one hour outpatient procedure done under general anesthesia. Its total cost is in the range of $4500. There is usually swelling and bruising of the pubic region and mild discomfort and it will take a full six weeks until the true final resut will be seen.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested suprapubic mound reduction surgery. I have grown up with  a prominent suprapubic mound for a long time and did not know there was anything I could do.I have in the process of losing weight buteven growing up in high school when I was thin I always had it.

A: There are two approaches to reducing the size of a suprapubic mound for improving better show of penile length. Liposuction is part of any technique and may be adequate by itself if there is not a skin excess. However many suprapubic mounds do have excess skin, particularly in those patients who have lost weight, and may require a concomitant pubic lift (like a reverse mini-tummy tuck) with liposuction. I obviously do not know which one would be better for you based on your description alone. Ultimately I would need to see pictures or perform an actual examination to know whether suprapubic mound liposuction would be adequate.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I would like to get a buried penis repair done. How exactly is it done?

A: When you use the term ‘buried penis’ that unfortunately does not tell me what type of tissue problem there is and what needs to be done to make it better. Is it a short penis only, an isolated large suprapubic mound, is there an abdominal overhang or some combination of two or all of them? There are different plastic surgery techniques that are done for the buried penis problem with varying degrees of success. These could include pubic liposuction, a pubic lift, penile release and lengthening or some combination of all of them. Having a picture of the pubic area, ideally from the front and side views, would help me understand the buried penis problem and give you some recommendations on whether plastic surgery would provide a positive improvement. (increased penile show)

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have a buried penis problem and was wondering if liposuction of the pubic mound would help. I have always been obese, my last 12 yrs I have been morbidly obese. I remember my penis has always been small I have had sex many times but is very uncomfortable. Normally I have to choose an small lady, but I can remember seeing it better when I was not as obese as I am now. I can feel the erections coming from way inside under the fat and if I push the fat back the penis will pop out .. I can only push so much that I am able to grab it with a full fist not including the head. But if I was to push more I can see that I have an average penis and of course if I don’t push that fat back it goes all the way in and can’t be seen.

A:  The buried penis problem is usually multifactorial in what causes it. Certainly a large suprapubic fat pad is one easily identifiable cause and in the obese male can be the major factor. The shape of the suprapubic mound must be looked at carefully to see whether loose skin hanging down may also be a cause in addition to the fat content of the mound. These helps makes the determination as to whether liposuction alone or liposuction combined with a pubic lift may be needed. The other factor in the buried penis is that the penis itself may be part of the problem as well. It may be naturally small or may be tethered down by fibrosis. It may need to be released as well.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a 52 year-old male and am concerned after some weight loss that my lower abdomen is still fatty, and my pubis area is sagging. This is not exactly the look I want, what can I do? I have attached some pictures for your assessment from the front and the side.

A: Thank you for sending your pictures. What I see is mainly a pubic sag issue, not so much go an abdomen overhang. While there is some fat in the pubic area, an equal contributor to the problem is loose skin. Your options for improvement are either liposuction alone or liposuction combined with a pubic lift. A pubic lift, in essence, is really an inverted or reverse mini-abdominoplasty.  It lifts the skin from above along the waistline.

There is also some abdominal fat, but no real excess skin that I can see. Thus liposuction of the abdominal area could be performed at the same time.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, It has been a year since my tummy tuck was done. I had a full spare tire removed and now I can finally fit into reasonable clothes again. I’m very happy with the results. However, I’ve noticed my pubic mound area seems to be bigger now and bulges out. Where the zipper is on my pants is really tight over this mound. My pants fit fine everywhere else on my waist and hips. But my pubic area now looks weird and puffy.

A: It is very common after very large tummy tucks or absominal panniculectomies to have loose skin and extra fat in the pubic area. The reality is that this pubic fullness was always there, it just never became apparent until the spare tire was removed. This this is not a new physical development just a new observable one to you. It is magnified because it sits below a more narrow waistline area abovhe it where the scar lies. This cane be very effectively flattened by pubic liposuction which may require a little bit of a pubic lift is there is any loose skin there.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I believe I need a pubic lift. I have lost 100 lbs and am still over weight by a lot. But I had an abscess removed from one side of the upper pubic area and I’m also uneven on both sides. If you type in pubic lift blog on yahoo and under images there is pictures I believe of one you did that is quite large like mine little different I presume. My question is cost and what would be the steps and healing?

A: When

one has lost 100lbs, I would have no doubt that a pubic lift is needed. But I am suspicious that you may need much more than that. Usually such weight loss causes a lot of abdominal tissue overhang which is most commonly called a pannus or apron. This is a hip to hip removal of the abdominal overhang that would include a pubic lift. It is possible that an isolated pubic lift may suffice, or be partially helpful, but I would have to see pictures of your abdominal area to make a visual evaluation. There is a big difference in the cost and recovery of a pubic lift vs. abdominal panniculectomy so knowing what you look like is essential to answer your questions with any accuracy.

Dr. Barry Eppley

Indianapolis,Indiana

Q: Dr. Eppley, can the pubic lift affect the nerve supply to the penis or interfere with erection in any way?

A: This is actually a common sexual function question whether it is liposuction or a lift in the pubic region. Men are concerned that it will affect erection while women are concerned that it may interfere with having an orgasm. While the pubic region is near the sexual organs of either gender, neither a pubic lift or pubic liposuction will interfere with their function. The nerves to the penis lie deep and way below the tissue planes for either procedure. While the female clitoris is just below the pubic fat pad, liposuction does not traumatize it even though there is the possibility of some temporary labial or clitoral swelling and bruising as gravity pulls down any blood released during the procedures. Conversely in a handful of cases, I have had reports that a pubic lift in women has enhanced orgasmic sensations which may be due to changing the exposure of the pubic area. For men, pubic reduction may improve penile exposure and length.

Dr. Barry Eppley

Indianapolis,Indiana

Q: Dr. Eppley, I found your website while looking for other penises like my husbands. He is an overweight man of 37 and his penis is slightly hidden. referring to this article– http://exploreplasticsurgery.com/category/buried-penis/ I found you can do surgery to help his “show size”. He basically looks like the pictures within this article. He would not let me take pictures of his body. I hope you can still give me a price idea. Thanks!

A: Thank you for your inquiry. Without seeing some pictures of the problem, I can not even tell if it is improveable. As a plastic surgeon, what I can do for buried penises is to decrease the size of the surrounding suprapubic mound through liposuction or lift away overhanging skin that is contributing to penile concealment. Often times both have to be done to get the best result. But many concealed or hidden penises also have penile contraction due to tissue fibrosis which requires the use of an experienced Urologist to diagnose and treat. In this cases, a combination Urologic-Plastic Surgery approach is needed.

But as a general guideline, I will have my assistant contact you to give you a cost for the combined procedure of a suprapubic lift with mound liposuction, which was what was discussed in that article.

Dr. Barry Eppley

Indianapolis, Indiana

Q:  Dr. Eppley, The picture used on the December 28, 2008 article written by Dr. Eppley looks like my body.  I have lost some weight but am still a large women.  I am very curious about this procedure.  Do I have to be at normal weight to have a pubic lift done?  Does insurance ever cover this type of procedure.  My Gyn says that she thinks I may have some sort of a “prolapse” and suggested I go see a plastic surgeon.  I am so embarassed by how I look I haven’t done so.  Your website gives me hope that I am not the only person who has this problem.  I look forward to hearing from you.  Thank you.

A: A large overhanging suprapubic mound is a common problem for men and women that either have a large abdominal pannus or who have lost a lot of weight. The difference between the two is in the amount of fat that either contains. Either way, this overhanging mound can interfere with urinary outflow, sexual function as well as pose hygiene issues. Its removal can be done through a procedure known as a suprapubic reduction/lift (mons reduction) which consists of liposuction debulking of its fat volume if needed and reduction and lifting of the excess skin that it contains. Based on the above or overlying abdominal anatomy, it may be necessary in some cases to remove any overhanging abdominal pannus or extra skin first before proceeding with a pubic lift procedure. (e.g., abdominal panniculectomy or extended tummy tuck) This is usually not a procedure that medical insurance will cover.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Just had a question about the pubic lift…Can I still have children after the surgery is done or is it something that needs to be done after having children? Thank you so much for your time.

A: The pubic lift is a modified form of a tummy tuck or abdominoplasty. It is very much like the reverse of a mini-tummy tuck or an upside down mini-tummy tuck. During the procedure, the suprapubic area is first thinned out or reduced by liposuction since there is usually a lot of fat within it. (which is one reason it is so puffy) Then skin is removed and the pubic area is lifted up to a predetermined line. The combination of the two creates the pubic lift.

Pubic lifts are often done concurrently at the time of an abdominal panniculectomy or a large tummy tuck as large pubic mounds are usually present in patients that need these procediures. More often, however, a pubic lift is done as a secondary procedure after a large tummy tuck or panniculectomy as they are hard to optimally treat at the same time. The pubic lift is then done using the scar line from the first stage tummy tuck or panniculectomy.

There is no problem having children after any pubic procedure, albeit pubic liposuction or a formal pubic lift. Pregnancy, however, will not help the result and from an aesthetic standpoint one could argue that it is best to wait until one has a more  stable abdominal area before investing in that  effort.

Dr. Barry Eppley

Indianapolis Indiana