Two seemingly unrelated stories sparked two major storms — one local, the other international — with a shared theme: penile enlargement injections.
In the first, doctors involved in a chain of failures were sentenced after a 65-year-old billionaire died following an injection intended to enlarge his penis. In the second, an investigation revealed that ski jumpers at the Winter Olympics had injected hyaluronic acid into their genitals in an attempt to jump farther, prompting the World Anti-Doping Agency to open an inquiry.
So what exactly happened in the billionaire’s death?
“They injected him with a substance called papaverine, which induces an erection when injected,” explained Dr. Abraham Levy, a senior plastic surgeon at Meir Medical Center. “These substances can cause blood pressure problems, which in turn can lead to a heart attack.” A court in France ruled that the doctors failed at several critical junctures. The patient complained of chest pain, and an ambulance was called. He later asked to continue the procedure, which was resumed. Only when his condition visibly deteriorated did staff call another ambulance — but it was too late.
The case cast a spotlight on a procedure that is becoming increasingly common in Israel and worldwide: penile enlargement injections. “It’s very common today. It’s less talked about, but thousands of men undergo this procedure around the world,” said Dr. Levy, who has performed hundreds of such injections at his private clinic over the past decade. “It’s important to clarify that this is not a medical procedure but a cosmetic one,” he emphasized.
In the past, problematic substances such as silicone and paraffin were used, causing severe deformities, he said. Today, two main materials are used: hyaluronic acid or the patient’s own fat. “Hyaluronic acid is injected along the shaft of the penis. It’s a substance that naturally exists in our bodies, produced scientifically and injected along the penis. It lasts roughly a year. The second option is autologous fat injection — fat is taken from another area of the body and injected there.”
A preference for autologous fat
Dr. Levy said he now uses only patients’ own fat. “I used hyaluronic acid in the past. I stopped because there were more complications,” he said. “I switched to autologous fat. Hyaluronic acid tends to migrate, and its effectiveness lasts at most a year. Autologous fat has a much longer shelf life.”
Dr. Abraham LevyPhoto: Steve FriedmanThe procedure itself is relatively simple. The patient receives a topical anesthetic cream and an anesthetic injection at the base of the penis. Once the area is numbed, the doctor performs the injection using a cannula — a thin tube with a blunt, flexible tip that reduces the risk of damaging blood vessels.
“With fat injections, I extract about 40 cubic centimeters of fat from the inner thighs or above the penis,” Avraham said. “The fat floats in the test tube, and then I inject it into the penis.” Hyaluronic acid injections take only a few minutes, while fat injections take longer.
The procedure may be straightforward, but recovery can be challenging. “For about two weeks, sexual intercourse is prohibited,” Avraham said. “After two weeks, you can resume sexual activity. There is swelling and some pain, and with fat injections, pain mainly in the area from which the fat was harvested.” Patients leave with an elastic bandage on the penis for five days. For a short time, the penis appears swollen, and many are alarmed by the appearance until it subsides.
“It’s important to know that the injected fat is absorbed by the body — only about 30 percent remains in the penis,” Dr. Levy said. “After three months, anyone dissatisfied with the result can repeat the procedure. In additional injections, larger quantities are used, and the effect is greater the second time.”
The high cost — about 10,000 shekels ($2,700) for a first injection and more thereafter — does not appear to deter men seeking enlargement. “The classic age range is 20 to 45,” Dr. Levy said. “The main reason is that, in their view, the penis is not large enough. Studies show that 98 percent of men would be happy to enlarge their penis slightly, just as many women want to enlarge their breasts and undergo surgery for that purpose. Some of the men are divorced and reentering the dating scene, others are looking for improvement. A surprising segment comes from the Arab sector,” a term used in Israel to refer to the Arab community.
In most cases, he said, the complaint is psychological. “The physiological issue is extremely rare — what’s called a micropenis — something you hardly ever see,” Avraham said. The scientific average length is 13.5 centimeters (5.3 inches) when erect. “The feeling is mostly personal. Often, it’s psychological and not truly physiological. Men see their penis when urinating, dressing or showering — when it’s flaccid. That’s when the difference is noticeable. The erection does not change.”
'Not convinced of the need for it'
Despite growing demand, relatively few doctors perform the procedure. Some specialists object because of its elusive nature — the hoped-for improvement in sexual performance and emotional well-being does not always materialize.
“In Israel and around the world, two issues are being debated,” said Dr. Ohad Shoshany, a senior physician and urology specialist who heads the sexual function and male fertility unit at Rabin Medical Center’s Beilinson Hospital. “One is whether the injections should be performed by urologists, who are familiar with the anatomy, or by plastic surgeons. The second is whether it is ethical to inject substances into the penis when what the patient really needs is psychological treatment for body image issues.”
Dr. Ohad ShoshanyPhoto: Raviv SteinAccording to Dr. Shoshany, “Some men don’t realize the injection is intended for the flaccid state, not for erection. Imagine the disappointment of a man who arrives with low self-esteem and expects improvement in his erection.” Even approved materials such as hyaluronic acid carry side effects, he said, primarily reduced sensation or penile deformities. “Recently the issue has been widely discussed at urological conferences, and it is still not settled,” Dr. Shoshany said. “I and almost all my colleagues in Israel refrain from performing these injections. We are not convinced of the need for it beyond appearance in public locker rooms. For the main issue — penile length — no solution has yet been found.”
Dr. Levy said he is aware of the dilemma. “I always tell patients that the feeling is mainly psychological and not physiological. But if a person understands the possible complications, understands the implications and is mentally and physically healthy — only then do I perform the injection.”
And what about the risks of penile enlargement procedures?
“I always tell every patient who asks whether something can be dangerous — even driving to the clinic or the operating room carries risk,” Dr. Levy said. “It’s a matter of experience, and of course you must always err on the side of caution in any medical procedure. You must not use medications that are not approved by the Health Ministry, and you must not dismiss any complaint from a patient. Whenever we dismiss these things or assume they will resolve on their own, we are surprised.”