What the treatment actually is
Dr. Emer performs girth enhancement to the male genitalia using injectable fillers, most commonly hyaluronic acid, but also longer-term options such as PMMA (polymethylmethacrylate, an FDA-approved filler for folds and scars, used off-label for penile enlargement) and fat transfer. The acrylic polymer in PMMA builds collagen over time and thickens the area, and can be placed on the shaft and head of the penis to increase size and girth.
Fat can be harvested separately or during a liposuction procedure, though Dr. Emer notes that after nearly 15 years of performing these treatments, he personally prefers the look of fillers over fat. When fat is used, it is often combined with fillers initially or in subsequent sessions to build upon the result.
The treatment Dr. Emer calls Downunder is not only about size. It combines filler with the P-Shot (PRP, stem cells and exosomes), Botox to stimulate circulation and prevent complications, and shock wave therapy to traumatize the tissue in a controlled way, decrease inflammation, and build blood vessels. The result is stronger erections, better orgasms, more sensitivity, and a bigger appearance, all while reducing the risk of filler-related complications such as injection into an artery or vein.
How many sessions it takes
Expectations should be set around multiple sessions. It takes a few visits to achieve a more even, bigger result, which requires more filler, more money, and more healing time. If you start smaller and do not need as much filler, it may only be one or two sessions. If you start longer, are a grower, or want a significantly larger size, it may be more sessions over time.
Dr. Emer has patients who have had over 100 syringes across four to six treatments over a few years, and others who have had only 8 to 16 syringes after one or two sessions because they were smaller to start. Each filler syringe is about a teaspoon, a very small amount. To gain half an inch in girth around the penis, a number of syringes are required. Typically, each session can add about a quarter to half an inch in size, depending on how much filler is used and which filler is chosen.
Sessions are typically spaced one to two months apart.
What makes the process easier or harder
If you are circumcised, you are going to have a much easier time getting a more symmetric and straightforward result compared to being uncircumcised. The penis expands and stretches when erect, some people are growers, and everyone starts at a different size, so the process is more complex than filling other areas of the body.
There will be bruising and swelling for up to two weeks, which is why there is no sex or masturbation during that time. There may also be some limitation on submerging in water, as Dr. Emer does not want patients to put themselves at risk for infection. During healing, normal showering, bathing and exercise are fine, but no hot tubs, saunas, steam rooms, sex, masturbation, or submerging in oceans, ponds or lakes.
Pain, toxin, and what to expect long term
There is not a lot of pain. Nerve blocks are used to numb the area, along with topical numbing cream. One of the other things Dr. Emer does, more common now than before, is using toxins such as Botox, Dysport, Xeomin or Jeuveau to the penile area. This is done to make the scrotum hang a little more (called Scrotox, where both the sac and the cremaster muscle are treated to release the testicles), and to release the suspensory ligament at the base of the penis to help it hang. Toxin is also injected into the penis itself to give it more circulation and more girth when erect.
You may feel some fine irregularities, a lump, bump, or some hardness to the penis, and that is all normal and expected. You will have to be okay with that if you are going to do this treatment for a long-term improvement.